Nurses more likely to leave NHS hospitals where costs of living have increased quickly

The following is the press release from our colleagues at the Institute for Fiscal Studies for the report published 24 February 2021: ‘Cost of living and the impact on nursing labour outcomes in NHS acute trusts’. The report is authored by Carol PropperIsabel Stockton and George Stoye.

Improving the retention of NHS staff has been a long-term policy challenge, and will be of even greater importance in the aftermath of the Covid-19 pandemic. NHS pay is currently tightly regulated in order to reduce variation in pay for the same roles in different parts of the country and to stop hospitals competing for staff on the basis of pay. However, this regulation has consequences: a new report by researchers at the Institute for Fiscal Studies, as part of the National Institute for Health Research Policy Research Unit on Health and Social Care Workforce, shows that national pay-setting limits the flexibility of hospital trusts to respond to local conditions, exacerbating shortages in hospital nursing labour before the start of the pandemic. These shortages exist despite increases in the overall number of nurses working in the NHS.

Using novel administrative payroll data covering the entirety of the NHS acute hospital sector between 2012 and 2018, researchers find that in parts of England where house prices – a proxy of cost of living – have increased rapidly, the relative earnings of nurses in these areas have decreased compared to nurses living and working in areas with slower growth in living costs. This has translated into increased movement of staff between hospitals, and more exits from the hospital sector entirely among frontline nurses. Continue reading

Next steps for day centres in south London as they reset, rebuild and renew from the COVID-19 pandemic

Kritika Samsi

Dr Kritika Samsi

Jill Manthorpe

Prof Jill Manthorpe

Kritika Samsi is Research Fellow at the NIHR  Policy Research Unit in Health and Social Care Workforce. Jill Manthorpe is Director of the Unit and Professor of Social Work at King’s College London. (1,013 words)

People working in the ARC South London Social Care theme contributed to the first thematic symposium (a webinar meeting) on 17 February 2021, that had the title Inside research: How applied research is tackling health and social care challenges and inequalities in south London – seminar series. The overall theme was Responding to Covid-19 pandemic. We focussed on how we have been Helping adult day centres to ‘unlock’ lockdown. Jill Manthorpe and Rekha Elaswarapu described this with illustrations of the different day centres across South London and some feedback on how our guidance was developed as a unique resource. We then took part in three small groups to discuss the following questions, with Caroline Green, Kritika Samsi and Katharine Orellana also helping with these discussions:

  • How are day centres recovering? What helps?
    – Is it likely that some may never re-open?
    – Do you have any experience or sense of how day centres have coped with the pandemic?

Continue reading

Remembering Darren O’Shea (1977-2021), ‘Expert by Experience’ member of the HSCWRU Homeless Research Programme

Darren O’Shea in London, February 2019

It is with great sadness that we share the news that Darren O’Shea passed away in hospital in London on 17 January 2021. Darren was a long-standing and much valued member of our Homeless Research Programme here at HSCWRU. He worked on the National Institute for Health Research (NIHR) study about improving hospital discharge arrangements for people who are homeless, sharing his lived experiences and giving presentations at many conferences and events. He was also a member of the Department of Health and Social Care’s Rough Sleeping Advisory Group, and advised the Healthy London Partnership based at City Hall. He was influential in campaigning for ‘step-down’ care so that people who are homeless have somewhere to stay when they leave hospital and it is now government policy that these services are developed across England. We are grateful for all Darren did to improve homeless health services and to contribute to our research at HSCWRU.

Stan Burridge, an Involvement specialist and another member of HSCWRU’s Homeless Research Programme, writes:

‘I was fortunate to work with Darren on many occasions over the past few years, and the value he brought to the work is almost beyond measure. We can forget that researching homelessness and social exclusion issues is dependent on capturing the harsh reality of people’s lives. Darren, who was often floating in and out of his own chaos, was a stark reminder that we were working to make a difference to real people with real lives and that our work goes beyond datasets. Darren had an incredibly valuable skill in that he was able to step out of his own difficult world and focus on the plight of others around him, and this brought a richness to the work we did together. His ability to talk openly, often when the rawness of his own journey was very evident, brought vividness to the research from a rich life, sadly now cut short. Darren’s death leaves a void and although we are saddened we are also enriched by the time he gave us. We will ensure his legacy lives on.’

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Darren O’Shea (1977-2021)

Signs of Safety: Findings from the second evaluation by King’s College London

Dr Mary Baginsky

Dr Mary Baginsky is Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce. (1,109 words)

The report on the second round of Children’s Social Care Innovation Programme funding for the 10 MTM (Munroe, Turnell and Murphy) Signs of Safety (SofS) pilots has just been published. The strengths-based approach to child protection and safety is widely used around the world, as well as in two-thirds of local authorities in England (Baginsky et al., 2020). The term ‘Signs of Safety’ refers to a model of practice that consists of:

  • principles that privilege relationships with children and their families
  • disciplines in relation to assessments, behaviours and language
  • tools for assessment and planning, as well as for use with children and families.[1]

It is not known to what extent a ‘pure model’ of SofS is in place in English local authorities. The survey that identified its use also showed the variations – and pick and mix approaches – that  were in place.

Back in 2014 when the 10 MTM pilots were recruited the idea was that they worked to the model above which was developed into a whole system design that MTM considered essential to support, monitor and build high-quality SofS practice based on a supportive organisational culture and the commitment of those in senior leadership positions. The first evaluation found that: Continue reading

Cleaning, catering and housekeeping staff in care homes: shining a light on their contributions during Covid

Kritika Samsi and Caroline Norrie, Research Fellows at the Policy Research Unit in Health and Social Care Workforce, introduce a new study at the Unit. (329 words)

Kritika Samsi

Kritika Samsi

Caroline Norrie

Caroline Norrie

Housekeeping staff in care homes – cleaners, those working in kitchens, laundries, maintenance – are often forgotten but are the backbone of many care homes. What happened to them during the coronavirus pandemic is the subject of a new research study. Researchers at the NIHR Health and Social Care Workforce Research Unit at King’s College London (KCL) have received NIHR Policy Research Programme funding to investigate the experiences and challenges of these care home workers during COVID-19.

Housekeeping and catering staff have been crucial during the coronavirus crisis given their role in infection control, food preparation, and help with social distancing. But they tend to be overlooked. What they have done and the challenges they faced during the crisis are often hidden. Many are women with families, work part-time, and on shifts, and often are from migrant or minority ethnic backgrounds. We know they are not well paid. Some sadly died from the virus. We want to find out whether and to what extent these workers were prepared and supported in their roles during the pandemic. This will help meet a gap in knowledge – how to better support this staff group work to prevent coronavirus, help those with it, and with service recovery. Continue reading

Toolkit for reflection on human rights in the context of social care

Caroline Green is Post-Doctoral Fellow at the Policy Research Unit in Health and Social Care Workforce, King’s College London. (709 words)

During the COVID-19 pandemic, the importance of human rights for people needing care and support in care homes or at home, their carers, families and friends became evident. Care home residents, especially people with dementia, were one of the groups who were and still are most severely affected by the virus, with thousands of deaths from a COVID-19 infection not only in England but many countries around the world. The need to protect people requiring care and support and to balance infection control – thus the basic rights to health and life – with the right to a private and family life and to social participation was but one of many examples of a human rights issue that we as a society had to face during this pandemic. Conversations around these topics are often difficult.

Human rights as enshrined in international and national law, notably the Human Rights Act, are directly relevant to people requiring care and support, service providers and care workers. Not only is every human being entitled to have his or her rights respected, protected and implemented but the English legal and regulatory system for care providers also makes them directly relevant in care settings. However, human rights are more than a legal concept. They are also a moral concept, which can help to build a social care system and determine the way care is provided. Human rights in social care is therefore a broad topic, with many different ways of approaching it in conversations, training and research. Continue reading

Three early papers on self-neglect

At the NIHR Policy Research Unit in Health and Social Care Workforce we are undertaking two studies examining self-neglect, both funded by the NIHR School for Social Care Research. In an article published in The Journal of Adult Protection, for the project examining Adult Safeguarding Responses to Homelessness and Self-neglect, Stephen Martineau goes back to three pioneering research papers on self-neglect to consider what, if anything, they can feed into current debates. (787 words)

Patricia Shaw's contribution in the 1957 paper on ‘social breakdown in the elderly’

Patricia Shaw’s contribution in the 1957 paper on ‘social breakdown in the elderly’

While conducting a review of the self-neglect literature during this year, references to two early papers on the topic have come up repeatedly. The first, published in the British Medical Journal in 1966, by Macmillan and Shaw, is often described as the seminal academic paper in this field and drew on cases in Nottingham. The other is the Diogenes Syndrome article, by Clark, Mankikar and Gray, published in The Lancet in 1975; it derived from a study conducted in a Brighton hospital. Our new Journal of Adult Protection article examines these two articles plus a third, again by Shaw and Macmillan. This one dates from 1957 and, though it did not use the term self-neglect (rather, social breakdown in the elderly), it is the most vivid and interesting of the three.

There is a good deal of research interest in self-neglect at present. Following consultation with, and a survey of, practitioners, carers and service users (suggested by our Unit), the James Lind Alliance (2018) Priority Setting Research Partnership on Adult Social Work recommended that the topic should be a research priority. As well as the Unit’s two studies (details below), the NIHR has a call out for a study of self-neglect in the community (closing 28 January 2021). The need for such research is reinforced by Michael Preston-Shoot and colleagues’ new national study of Safeguarding Adults Reviews that were conducted between April 2017 – March 2019. SARs are commissioned where questions are raised about the way agencies involved in safeguarding have worked together in individual cases: among the 231 reviews the authors analysed, self-neglect constituted the most common type of abuse/neglect (featuring in 45% of the reviews). Continue reading

How to improve health and social care unregistered staff’s education and development

Richard Griffin MBE is Visiting Senior Research Fellow, King’s Business School. (434 words)

I write a fair bit about the challenges and barriers support workers can face. Research by King’s College London and others has identified persistent issues such as poor job design, lack of funding for training, pay levels that too often do not reflect the extended nature of the roles and poor progression pathways. I thought though, particularly in the run up to the Royal College of Midwives’ annual Maternity Support Worker Week (23-27 November) and the Royal College of Nursing’s first Nursing Support Worker Day (23 November), I would set out my views of some of the ways these problems can be addressed in the NHS. Continue reading

Understanding the impact of COVID-19 on ethnic inequalities in health and social care – Have your say!

Introducing a King’s College London study examining inequalities experienced by people from racial and ethnic minority groups working in health and social care during COVID-19. (570 words)

Prof Stephani Hatch

Leading the study: Stephani Hatch, Professor of Sociology and Epidemiology in the Department of Psychological Medicine, King’s College London

We have launched a study to help improve working conditions and to tackle the inequalities experienced by people from racial and ethnic minority groups working in health and social care during the COVID-19 pandemic. Based at King’s College London, we are working in partnership with NHS England Workforce Race Equality Standard, NHS Confederation and the Royal College of Nursing. The study findings will be used to develop education and training materials (e.g. Virtual Reality training) available nationally to all staff, specifically to better support and improve the workplace experiences of NHS and social care staff from Black, Asian and minority ethnic groups.

COVID-19 pandemic

The pandemic has shone a light on existing inequalities that have a great impact on Black, Asian and minority ethnic communities. These communities are approximately 14% of the population in England and Wales, yet they have had greater exposure to the virus and are more likely to have poorer outcomes, including severe health complications and death. We have also seen that higher numbers of racial and ethnic minority health and social care workers have died from COVID-19. Despite making up 21% of the NHS workforce, 63% of those who died from COVID-19 were from racial and ethnic minority groups. What is less often known and discussed is that health and social care staff from racial and ethnic minority groups experience greater levels of workplace harassment and discrimination compared to other staff and these experiences have been compounded by the pandemic. This can have long-lasting effects on their health, wellbeing, and their ability to do their job. Continue reading

Black History Month in Social Work and Social Care

Jo Moriarty (Senior Research Fellow) and Prof Jill Manthorpe (Director) of the NIHR Health & Social Care Workforce Research Unit, King’s College London. (1246 words)

In the aftermath of the pulling down of the statue of the merchant and slave trader, Edward Colston, in the June of this year, discussions took place about how best to replace it. We were intrigued to read one suggestion that it should be replaced by a statue of Paul Stephenson. Who was he and what was the boycott we wondered?

Paul Stephenson leading the Bristol bus boycott in 1963 (Photo: ITV)

We soon found out that he was the first black social worker in Bristol (BBC Newsround 2018). The Bristol Bus Company refused to employ black people on bus crews and, inspired by the refusal of Rosa Parks to give up her seat on a bus and the ensuing Montgomery Bus Boycott, Stephenson was one of a group of people who led a bus boycott in Bristol in 1963.

The cause was taken up by the wider black community and white sympathisers in Bristol. Within a few months, the company succumbed to pressure and ended its ban. The following year Stephenson refused to leave a pub until he was served. He is now widely recognised as having played an important part in the passage of the 1965 Race Relations Act and was awarded an OBE in 2009. Continue reading