Yet throughout the pandemic, insufficient attention has been paid to the impact on the 1.5 million people working to look after people across residential, nursing and home care in England. We speak to Nadra Ahmed, Executive Chair of National Care Association, and Charlotte Rowe, Care Practice Manager at Markel Care Practitioners, about the ways the pandemic has affected staff in the care sector.
Introducing PPE
While the introduction of personal protective equipment (PPE) presented challenges for many sectors, some of the care sector’s more clinical providers were well equipped. In parts of the sector, the use of PPE was coupled with infection control measures, which, specifically for adult, elderly and nursing home providers, were already underpinned in policy, practice and staff knowledge. However, for many providers and their staff, the introduction of infection prevention and control (IPC) practices, PPE, staff training and competency presented a steep learning curve. Nadra Ahmed says: “The need for masks was new and trying to access them became an enormous challenge. At the outset of the pandemic, stocks were diverted by government to the NHS. Staff movement was also restricted to mitigate risk of spreading the virus, which had an impact on taking in agency staff or moving staff internally where there were multiple sites.”
In addition to this was the lack of service-specific advice or clarity within government guidance. Charlotte Rowe says: “To start with, there was limited guidance for the individual issues which were experienced by different parts of the sector. For example, learning disability-related issues were overlooked for a focus on adult care and nursing homes, making it difficult for providers to know what guidance was relevant to them.” The introduction of PPE also presented challenges for staff in the management of service-user behaviour during a period of change. Charlotte says: “It wasn’t just a change for staff, but also for service users - many with behavioural, learning and communicational needs, meaning they had to adjust to faces being covered and the sound of aprons. The initial lack of guidance didn’t wholly consider the impact on staff to support service users around changes that were ultimately there to protect them.”
Quarantining and self-isolation
As measures such as quarantining and self-isolation were introduced, the care sector took another hit as complying with government guidelines resulted in operational challenges, staff shortages and pressure on the remaining workforce. Nadra explains: “Staff were having to respond to the test result, even if asymptomatic, leading to crippling shortages within the service and putting pressure on those remaining to support the residents. The need for residents to isolate meant care services had to be agile in their operational practice, having to zone off areas and create safe environments for residents who were free of the virus. It was also a challenge to isolate residents in their rooms – especially those with dementia.”
Challenges also arose when the number of staff required to meet the needs of service users were simply not available. This was made worse by the fact that many day, community and activity-based services which provide support to resident services were suspended, increasing staffing requirements across adults' and children’s residential providers. Charlotte adds “staff also faced financial issues along with the additional challenges within practice. With zero-hour contracts, statutory sick pay and staff shortages, there was increasing pressure for those who were not ill […] providers needed enough staff to meet the service users’ needs safely and staff were financially struggling when having to quarantine or self-isolate. All of this meant there was little respite for the workforce.”
Staffing and recruitment
The combination of staff contracting Covid-19, being ‘pinged’ by the NHS app, increased deaths within the sector and new admissions created the perfect storm for staffing concerns for the sector. Nadra says: “The primary challenges were centred around staffing for care homes and homecare services. The consistent need to isolate, coupled with limited access to agency covers and restrictions of movements within services, made it one of the most challenging periods in the history of social care.”
The care sector has struggled with staffing and recruitment for over a decade, and the pandemic has further aggravated the issue, exposing the fragility of recruiting to a resilient workforce which has faced continued challenges. Charlotte details: “The recruitment of new staff to the care sector is inherently difficult due to unattractive hours, poor pay and many not wanting to undertake personal care. With the increased perception of risk presented by Covid-19, this has perpetuated an already difficult landscape into what seems to be the sector's biggest recruitment challenge. As a result, experienced staff are leaving the sector and vacant positions which require experience prove a challenge to fill.” She goes on to explain that recruitment and retention remain difficult: “with a lack of experienced Registered Managers and care staff, vacancies are often filled through agency workers who present their own challenges, including cost. Recruitment remains a significant challenge especially within an aging population.”
Added to the strain of a reduced workforce, is the emotional impact of the pandemic, which has resulted in increasing numbers of professionals looking for work elsewhere. In a Health Foundation-funded pulse survey of nearly 300 social care staff in July 2020, four out of five respondents said that their job had left them feeling ‘tense, uneasy or worried’ more often since the onset of Covid-19. Nadra suggests that the introduction of mandatory vaccinations is likely to aggravate the issue: “The key challenge of a staff shortage has been exacerbated by the pandemic as we see loyal staff face anxieties and fears which are resulting in exhaustion and a steady exit from the sector as they can find roles in retail, hospitality and the NHS.”
Charlotte adds, “the sector is required to not only replace the workforce but also grow given the need for more providers which has been seen through CQC and Ofsted data. To do so there needs to be a systemic change in how the profession is viewed, its value to society, pay, training and the support offered. Wellbeing, recruitment, qualification and retention are all essential factors to meeting the challenges ahead.”
Tackling the crisis
Ignoring the care sector’s staffing issues will negatively affect the services provided, but the sector is fighting back and attempting to take control of the situation. “We are calling for a sustainable career pathway for our workforce, to support parity of esteem with the NHS – there is a need to improve the image of social care”, Nadra says. “We will be looking at a more targeted recruitment campaign for a skilled social care workforce based on an accredited qualification career pathway. We are also calling for a fair fee for care so we can meet all our commitments.”
When it comes to protecting the physical wellbeing of staff, Covid-19 measures (inclusive of PPE, testing and IPC) are well embedded within the care practice. There is also the hope that the isolation exemption will help to ease the staffing shortages. However, this must be met with a need to ensure staff wellbeing, provide carers with long-term prospects and support care-related jobs as a profession which is "recognised for its value to society” says Charlotte. “The care sector is reliant on its dedicated, caring and resilient workforce which has weathered the pandemic supporting families, its service users and the NHS through some of the most challenging times. Recognition outside the sector is overdue and we currently have the opportunity to get it right moving forward. This requires understanding of the sector, consultation and increased funding to support the most vulnerable in society”
