Promoting the Health of Women Working in Home Care: towards an inclusive Women’s Health Strategy

Caroline Emmer De Albuquerque Green, NIHR ARC South London Post-Doctoral Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, introduces a new report on the promotion of the health of women working in home care, which she co-authored with Unit Director Prof Jill Manthorpe.

Women make up the majority of the home care workforce. They provide essential support to people in the community with social care needs. But, the specific health needs of women working in home care have largely gone unrecognised and unmet. The health of home care workers is not just of interest at times of pandemic; it matters in addressing staff turnover, continuity of care for their clients, sickness absences but also the long-term impact on women’s later lives.

In our report, Submission of evidence on the specific health needs of women in the adult social care workforce in London with a focus on home care workers, we summarised what is known about the specific health needs of women working in home care. The report is co-produced with the assistance of the Proud to Care Board of the Association of Directors of Adult Social Services (ADASS) London which includes home care providers, London Boroughs and other stakeholders.

We submitted it as evidence to the Department of Health and Social Care’s consultation on a new Women’s Health strategy. From what is known, we concluded the following points to consider in such a new strategy: Continue reading

Workforce planning in the NHS – it is a kludge

Richard Griffin MBE is Professor of Healthcare Management, King’s Business School. (740 words)

Many years ago, I worked for an NHS Workforce Development Confederation (WDC), that had just been merged with a Strategic Health Authority (SHA). A few months into my role as Director of Education, a colleague asked me a question that has stuck with me ever since. “Who” she said, “owns workforce in the NHS?” A very good question. (1)

Consider the current situation. Is it the Department of Health and Social Care, or Health Education England, or NHS England and Improvement?  Where do Public Health England, Skills for Health or NHS Employers or the Social Partnership Forum fit in? They all have roles. What about regional People Boards? How about Integrated Care System (ICS) People Boards? Or the workforce leads in Primary Care Networks? In Trusts is it HR, or clinical leads like Directors of Nursing or the Learning and Development? It gets even more complex when you consider individual occupations like maternity, where you have Local Maternity Systems, or Allied Health Professions, where you have Councils and Faculties.

From pre-employment to careers information, apprenticeships and beyond, all these bodies are doing good things but not always together. Also, there is no single NHS workforce plan – it is spread across numerous policy documents from the People Plans to the latest Operating Guidance.

Frankly, it is all a bit of a “kludge”. Continue reading

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

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

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

Evaluating the Nursing Associate Role: Initial Findings

Interim Report

Ian Kessler is Professor of International HRM at King’s Business School and Deputy Director of the Policy Research Unit in Health and Social Care Workforce (HSCWRU). Prof Kessler is lead author of the Interim Report and two case studies from the HSCWRU Nursing Associates study, published today. (1,624 words)

Film of webinar (23/11/20) where Prof Kessler discussed these findings.

We are conducting a survey of senior health and social managers on the use and management of the nursing associate role. The survey is open until 18 December 2020.

The introduction of the Nursing Associate (NA) role in England represents a decisive step towards changing the structure of the nursing workforce, with a view to improving the quality of health and social care. Originally proposed by the 2015 Willis report on nurse and care assistant education[1], as ‘a bridging role’ between the care assistant and the registered nurse, the NA has emerged in NHS England as a pay band 4 role, requiring a two-year level 5 qualification, registered with and regulated by the Nursing and Midwifery Council (NMC). The NA programme was launched in early 2017 in two waves 11 pilot and 14 ‘fast follower’ sites, respectively taking-on 1,000 Trainee Nursing Associates (TNA). There were subsequent waves, with 5,000 TNAs recruited in 2018 and 7,500 in 2019. It is a role which attracts interest given its capacity to address a variety of workforce and care management goals. However, as with the introduction of any new role, there are organisational challenges to be faced in ensuring that it becomes established at the workplace level and accepted by the various actors with a stake in it, including nurses, managers, healthcare assistants and service users. Continue reading

Grow your own – an idea whose time has come (again)

Richard Griffin MBE is Visiting Senior Research Fellow, King’s Business School. (869 words)

Back in 2010 I produced a paper for the Department of Health with the snappy title of Widening Participation Into Pre-registration Nursing Degree Programmes. Nursing was becoming an all degree profession and there was a concern at the time that this might narrow the pool of future recruits as vocational routes were closed. The document mapped pathways up to and into pre-registration degrees for existing support staff, including via the then current version of apprenticeships. It also set out the wider benefits of a “Grow Your Own” (GYO) approach to workforce development and recruitment. These included, not only securing future labour supply, but also helping ensure that the NHS workforce better reflected its local population, supporting diversity and reducing turnover.

Fast forward a decade and I’m having a conversation with an NHS Trust who had hoped to recruit from their existing support staff on to a degree apprenticeship. There is no shortage of candidates, but it appears the step up from support role to a pre-registration degree is too large for staff and the Trust is unable to recruit. The 2010 paper, which I repeated for Camilla Cavendish’s review three years later, made the point that GYO needs to be “end-to-end”, starting even before employment begins and delivering investment in the formal education of support staff at every level, creating clear pathways to mobilise what we called back then, the NHS “skills escalator”. GYO seeks to create progression steps creating horizontal and verticals career routes, avoiding the “gap” problem experienced by the Trust I was talking to. Continue reading

Fair Care Work: A Post COVID-19 Agenda for Employment Relations in Health and Social Care

Ian Kessler, Stephen Bach, Richard Griffin and Damian Grimshaw introduce their new paper, Fair care work. A post Covid-19 agenda for integrated employment relations in health and social care, published yesterday by King’s Business School. Lead author, Professor Kessler, is Deputy Director of the NIHR Policy Research Unit in Health and Social Care Workforce. (908 words)

The courage and sacrifice of the health and social care workforce have emblazoned themselves on the national consciousness as the challenge of COVID-19 continues. While classified as ‘key workers’, along with other occupations essential to the community in times of crisis, the distinctive contribution of frontline care workers, reflected in their direct and relentless engagement with the virus, has until recently been reflected in the Thursday night applause reserved for them. This public applause sits uneasily, however, with the treatment of over two million health and social care employees, mostly women, often from black and minority ethnic backgrounds, typically in undervalued, relatively low paid and insecure employment. In a new paper, we seek to kick start a policy debate on the development of fair care work, to stimulate discussion on a refreshed employment relations (ER) agenda which acknowledges and reflects the worth of care workers to our individual and communal well-being. Continue reading