Social Care Workforce Research Articles

Health and Care Horizons Leeds: Attracting, navigating and inspiring the future workforce

Abstract Health and social care (H&SC) partners in Leeds connect and collaborate across seven shared workforce priorities, including ‘growing and developing registrants” and “narrowing inequalities”. A range of programmes across the Leeds H&SC system promote collaborative, person-centred recruitment, and developing diverse & accessible talent pipelines. Through these programmes and the aims of the NHS long-term workforce plan we have identified a need to draw together information, insight and opportunities to attract, navigate, inform and inspire young people into H&SC careers. The Leeds partnership co-designed an interactive career exploration tool with young people to meet these aims. This person-centred digital tool is designed to dispel misinformation and equip young people with personalised actions and pathways to work anywhere in the sector based on their skills, values and lifestyle. The framework of our approach to designing the tool and lessons learned is applicable to other settings and localities. An academically embedded evaluation of the co-design phase demonstrated the importance of reaching out to a diverse audience. We worked with over 400 young people across 12 unique and representative networks and made them feel valued. Our partners were persuaded by the potential for the tool to boost recruitment and retention strategies, aligning with the NHS long-term workforce plan and the vision for a Social Care Workforce Strategy. The platform will be launched in September 2024 so process findings will be combined with results around usage, appraisal from the sector and careers services, and impact on employers and educators. Through co-design we have challenged our assumptions at all stages of the project and created a transformational tool to address the needs of the sector and young people in Leeds. We will continue to work closely with our H&SC sector partners to embed the tool in their organisations and expand the tool’s functionality. Key messages • We have created a system-wide operational career exploration tool to attract young people in Leeds to the right Health and Care career for them. • We will highlight the core values that have underpinned the creation of the tool, its functionality and lessons learned post-launch.

What Influences the Use of Research by the Adult Social Care Workforce?

Abstract Despite a recognition that research evidence plays a critical role in informing decisions in adult social care, there has been little investment in developing the sector’s own capacity to engage with it. This article reports on a qualitative study of the adult social care workforce (social workers, occupational therapists, managers and commissioners) in three local authorities in England. Data were collected through twenty-five semi-structured interviews with key stakeholders and analysed iteratively using thematic analysis. The interviews explored participants’ understanding and use of research in adult social care. Four key influences on research use were identified: time; accessibility; skills and confidence; and organisational support. Finding time was the most frequently cited barrier. This was exacerbated by the difficulties participants described in finding research that was trusted and relevant. Protected time was regarded as essential, and both organisations and individuals had a role in ensuring that time was available to engage with research. Participants identified skills gaps, including how to read, critically appraise and apply evidence from research. The findings confirm an appetite within the workforce for developing the skills and confidence to make more use of research but suggest that achieving this requires organisational support and access to resources.

A new model to understand the complexity of inequalities in dementia

Many people living with dementia and unpaid carers experience inequalities in care related to challenges in receiving a correct diagnosis, care and support. Whilst complexities of the evidence are well recognised including barriers in receiving a diagnosis or post-diagnostic care, no coherent model has captured the far-reaching types and levels of inequalities to date. Building on the established Dahlgren & Whitehead Rainbow model of health determinants, this paper introduces the new Dementia Inequalities model. The Dementia Inequalities model, similar to the original general rainbow model, categorises determinants of health and well-being in dementia into three layers: (1) Individual; (2) Social and community networks; and (3) Society and infrastructure. Each layer comprises of general determinants, which have been identified in the original model but also may be different in dementia, such as age (specifically referring to young- versus late-onset dementia) and ethnicity, as well as new dementia-specific determinants, such as rare dementia subtype, having an unpaid carer, and knowledge about dementia in the health and social care workforce. Each layer and its individual determinants are discussed referring to existing research and evidence syntheses in the field, arguing for the need of this new model. A total of 48 people with lived, caring, and professional experiences of dementia have been consulted in the process of the development of this model. The Dementia Inequalities model provides a coherent, evidence-based overview of inequalities in dementia diagnosis and care and can be used in health and social care, as well as in commissioning of care services, to support people living with dementia and their unpaid carers better and try and create more equity in diagnosis and care.

Crystal clear: How leaders and coworkers together shape role clarity and well‐being for employees in social care

AbstractWorking in social care is fraught with challenges fueled by changing policies, funding structures, societal expectations, and high relational demands, leaving employees in this sector particularly vulnerable to poor well‐being. In this study, we focus on the importance of a supportive work context—specifically coworker instrumental support and leaders' role clarity—in enabling employee role clarity, and how this can foster better mental health and reduce fatigue from ongoing changes in the sector. We ran a multilevel moderated mediation model on a sample of 270 social care employees matched with 47 leaders across two disability care organizations in Australia. Results showed that coworker instrumental support promotes role clarity, which in turn is associated with lower psychological distress and change fatigue, and higher job satisfaction. The positive relationship between coworker instrumental support and role clarity, and the subsequent relationships with well‐being, were stronger when employees had leaders who themselves had role clarity. Our findings highlight the importance of a supportive work context and role clarity as malleable levers in enabling a sustainable social care workforce and provide new theoretical and practical insights for human resource management in the social care sector.

'It Is Good to See the Person As a Whole Person and… Continue to Improve Our Psychologically Informed Working': A Thematic Analysis of Clinical Psychology Trainee Placements in Homelessness Settings.

The National Framework for Inclusion Health identified the need for collaborative action between the NHS and third sector health to improve access and outcomes for Inclusion Health groups. Clinical psychology trainee placements in homelessness settings could be a valuable pathway to improving access to psychological support for people experiencing homelessness and the provision of clinical services, which is key to developing the workforceand a catalyst for the future recruitment of clinical psychologists in the third sector. A qualitative evaluation was conducted using semistructured interviews to explore the perspectives of clinical psychology trainees, supervisors, staff in homelessness settings and a peer mentor. Twenty-two participants were recruited from two universities and six services across the South East, including 11 clinical psychology trainees, six supervisors, four placement staffand one peer mentor. Placement staff described the value of a psychological approach but identified some challenges to be overcome. Induction was identified as the key to success. Supervisors recognised the breadth and depth added to trainees'knowledge and skills alongside significant challenges. Trainees valued the opportunities to work in homelessness settings and develop their understanding of the role. The peer mentor identified collaborative working as especially important. Clinical psychology trainee placements are a necessary programme to fulfil the NHS vision for Inclusion Health. These placements equip the health and social care workforce to create excellent and sustainable provisions to improve the physical and mental health of people experiencing homelessness whilst also providing much-needed psychological support for staff. Psychologically Informed Environments Through Staff Training: Staff training and support within these placements contribute to the development of psychologically informed environments. This not only leads to better outcomes for both staff and clients but also aligns with the objectives of the National Framework for Inclusion Health, fostering sustainable provision for the health needs of people experiencing homelessness (PEH). Enhanced Therapeutic Adaptability: Trainees gain invaluable experience in adapting therapy to meet the diverse needs of clients, benefiting both trainees and clients alike. This adaptability fosters more effective therapeutic relationships and contributes to the improvement of inclusion health provision in the long term. Tailored Therapy for Timely Intervention: Clinical psychology trainee placements in homelessness settings offer therapy that bypasses long waiting times for interventions, crucial for individuals experiencing homelessness. This flexible approach caters to the unpredictable engagement levels of PEH, ensuring timely support aligning with the Health and Care Act 2022 to improve overall health and address health disparities through primary care networks.

Key children's services challenges to shape next ADCS presidency

The new president of the Association of Directors of Children's Services Andy Smith identifies tackling social care reforms, workforce pressures and demand for SEND support as priorities for his year in office

Evaluating the impact of the supporting the advancement of research skills (STARS) programme on research knowledge, engagement and capacity-building in a health and social care organisation in England

ObjectivesTo evaluate the impact a novel education programme - to improve research engagement, awareness, understanding and confidence - had on a diverse health and social care workforce. Barriers and facilitators to engagement were explored together with research capacity-building opportunities and ways to embed a research culture. The programme is entitled ‘Supporting The Advancement of Research Skills’ (STARS programme); the paper reports findings from a health and social care setting in England, UK.MethodsA four-level outcome framework guided the approach to evaluation and was further informed by key principles of research capacity development and relevant theory. Quantitative data were collected from learners before and after engagement; these were analysed descriptively. Semi-structured online interviews were conducted with learners and analysed thematically. A purposive sample was achieved to include a diversity in age, gender, health and social care profession, and level of attendance (regular attendees, moderate attendees and non-attenders).ResultsThe evaluation spanned 18 half-day workshops and 11 seminars delivered by expert educators. 165 (2% of total staff at Midlands Partnership University NHS Foundation Trust (MPFT)) staffs booked one or more education sessions; 128 (77%) including Allied Health Professionals (AHPs), psychologists, nursing and midwifery, and social workers attended one or more session. Key themes of engagement with teaching sessions, relevance and impact of training and promoting a research active environment were identified with relevant sub-themes. Positive impacts of training were described in terms of research confidence, intentions, career planning and application of research skills as a direct result of training. Lack of dedicated time for research engagement, work pressures and time commitments required for the programme were key barriers. Facilitators that facilitated engagement are also described.ConclusionsFindings demonstrate the impact that a free, virtual and high-quality research education programme had at individual and organisational levels. The programme is the product of a successful collaboration between health and social care and academic organisations; this provides a useful framework for others to adapt and adopt. Key barriers to attendance and engagement spoke to system-wide challenges that an education programme could not address in the short-term. Potential solutions are discussed in relation to protecting staff time, achieving management buy-in, recognising research champions, and having a clear communication strategy.

Developing the future research agenda for the health and social care workforce in the United Kingdom: Findings from a national forum for policymakers and researchers.

There is a gap between healthcare workforce research and decision-making in policy and practice. This matters more than ever given the urgent staffing crisis. As a national research network, we held the first ever United Kingdom (UK) forum on healthcare workforce evidence in March 2023. This paper summarises outputs of the event including an emerging UK healthcare workforce agenda and actions to build research capacity and bridge the gap between academics and decisionmakers. The forum brought together over 80 clinical and system leaders, policymakers and regulators with workforce researchers. Fifteen sessions convened by leading experts combined knowledge exchange with deliberative dialogue over 2days. Topics ranged from workforce analytics, forecasting, international migration to interprofessional working. In the small groups that were convened, important gaps were identified in both the existing research body and uptake of evidence already available. There had not been enough high quality evaluations of recent workforce initiatives implemented at pace, from virtual wards to e-rostering. The pandemic had accelerated many changes in skillmix and professional roles with little learning from other countries and systems. Existing research was often small-scale or focused on individual, rather than organisational solutions in areas such as staff wellbeing. In terms of existing research, managers were often unaware of accepted high quality evidence in areas like the relationship between registered nurse staffing levels and patient outcomes. More work is needed to engage new disciplines from labour economics and occupational health to academic human resources and to strengthen the emerging diverse community of healthcare workforce researchers.

Addressing the workforce crisis in (rural) social care: A scoping review.

This scoping review identifies strategies potentially addressing the 'workforce crisis' in rural social care. The increasing global demand for social care has been coupled with widely recognised challenges in recruiting and retaining sufficient staff to provide this care. While the social care workforce crisis is a global phenomenon, it is particularly acute in rural areas. The review identified 75 papers which (i) had been published since 2017, (ii) were peer reviewed, (iii) concerned social care, (iv) were relevant to rural settings, (v) referenced workforce shortages, and (vi) made recommendations for ways to address those shortages. Thematic synthesis was used to derive three analytical themes with a combined 17 sub-themes applying to recommended strategies and evidence supporting those strategies. The most common strategies for addressing social care workforce shortages were to improve recruitment and retention ('recruit and retain') processes without materially changing the workforce composition or service models. Further strategies involved 'revitalising' the social care workforce through redeploying existing staff or identifying new sources of labour. A small number of strategies involved 're-thinking' social care service models more fundamentally. Very few papers specifically considered how these strategies might apply to rural contexts, and evidence for the effectiveness of strategies was sparse. The review identifies a significant gap in the literature in relation to workforce innovation and placed-based studies in rural social care systems. It is unlikely that the social care workforce crisis can be addressed through continuing attempts to recruit and retain workers within existing service models.

Intersecting sex and gender diversity with sexual rights for people living with dementia in later life: an example of developing a learning framework for policy and practice.

The proliferation of literature on dementia over the last decade has begun to address the experience of LGBTQ+ people's experiences in later life. Changes in cognitive function can jeopardize the safety, wellbeing, and human rights of LGBTQ+ people if the social care workforce are not prepared or versed in responding to their unique needs. The intersection of age, cognitive function, sexual and gender diversity with the expression of intimacy and sexuality requires sensitive and respectful consideration. Yet, this is currently an under-researched and less understood area in social care practice. This paper highlights the main messages from the different bodies of contributory literature and introduces the national framework in England UK on LGBTQ+ aging and its potential for supporting workforce development to consider its flexibility in supporting services to becoming more nuanced and affirmative in these areas of practice.

The Hidden Economic Consequences of Migraine to the UK Government: Burden-of-Disease Analysis Using a Fiscal Framework.

Background: Migraine is a highly prevalent and incapacitating neurological disorder associated with the highest global disability burden in people aged 15 to 49 years. Europe has the fourth-highest prevalence of migraine, after North America, South America, and Central America, and above Asia and Africa. Migraine leads to relatively modest direct healthcare expenditure but has substantial indirect costs due to reduced productivity. Methods: The economic burden of migraine was estimated in comparison with the general population of the United Kingdom (UK) using an analytical fiscal modeling framework applying the government cost perspective. Published measures of migraine's impact on labor participation were applied to rates of economic activity/inactivity of the general population. The model estimates lifetime changes to earnings from employment, direct and indirect taxes paid, and financial support requirements over the life course. Incremental differences between those affected and unaffected by migraine are reported as net fiscal consequences to public accounts. Fiscal costs are reported as the discounted average per capita over a 20-year time horizon and for the entire annual UK cohort with prevalent migraine. Results: People affected by migraine are more likely to be absent from work, unemployed, and disabled, and to retire early. A 44-year-old individual affected by migraine was associated with £19 823 in excess fiscal costs to the UK government, £1379 per year living with the condition, compared with someone not affected by the disease. Annually, migraine was estimated to represent £12.20 billion to the public economy, approximately £130.63 per migraine episode. The model predicted annual productivity losses in the health and social care workforce to be £2.05 billion and total annual productivity losses to be over £5.81 billion. Conclusions: This fiscal analysis monetizes the occupational consequences of migraine to the UK government, both in terms of lost tax revenue and transfer payments. The findings are substantial and useful to characterize disease severity and to inform the body of evidence considered by decision makers appraising the cost-effectiveness of health technologies.

The Hidden Economic Consequences of Migraine to the UK Government: Burden-of-Disease Analysis Using a Fiscal Framework

Background: Migraine is a highly prevalent and incapacitating neurological disorder associated with the highest global disability burden in people aged 15 to 49 years. Europe has the fourth-highest prevalence of migraine, after North America, South America, and Central America, and above Asia and Africa. Migraine leads to relatively modest direct healthcare expenditure but has substantial indirect costs due to reduced productivity. Methods: The economic burden of migraine was estimated in comparison with the general population of the United Kingdom (UK) using an analytical fiscal modeling framework applying the government cost perspective. Published measures of migraine’s impact on labor participation were applied to rates of economic activity/inactivity of the general population. The model estimates lifetime changes to earnings from employment, direct and indirect taxes paid, and financial support requirements over the life course. Incremental differences between those affected and unaffected by migraine are reported as net fiscal consequences to public accounts. Fiscal costs are reported as the discounted average per capita over a 20-year time horizon and for the entire annual UK cohort with prevalent migraine. Results: People affected by migraine are more likely to be absent from work, unemployed, and disabled, and to retire early. A 44-year-old individual affected by migraine was associated with £19 823 in excess fiscal costs to the UK government, £1379 per year living with the condition, compared with someone not affected by the disease. Annually, migraine was estimated to represent £12.20 billion to the public economy, approximately £130.63 per migraine episode. The model predicted annual productivity losses in the health and social care workforce to be £2.05 billion and total annual productivity losses to be over £5.81 billion. Conclusions: This fiscal analysis monetizes the occupational consequences of migraine to the UK government, both in terms of lost tax revenue and transfer payments. The findings are substantial and useful to characterize disease severity and to inform the body of evidence considered by decision makers appraising the cost-effectiveness of health technologies.

The Views of Practitioners on Care Act Easements during the Covid-19 Pandemic

The easements of the Care Act 2014, permitted by the Coronavirus Act 2020, were in place in very few English local authorities and then only for a short time, but they still rippled across the wider social care workforce. This paper reports findings from interviews with social workers in ten non-easement authorities and with other professionals in easement and non-easement authorities to explore their understandings of easements and their reflections on their use and impact on practice. The interview data are set in the context of a wider study that explored decision-making about the adoption of easements in local authorities. Frontline practitioners (N = 30) confirmed confusion about easements and suspicion that they were a retrograde step in people’s entitlements to care and support. These views were also set in a context of lack of pandemic preparedness in social care and reflections that the care system was already fragile after a sustained period of reductions to local authority budgets and rising need. Both a robust care infrastructure was needed, as well as better crisis or disaster preparedness and planning.

Our approach to developing communities of practice to foster research capacities for the adult social care workforce.

Efforts to build and foster adult social care research in England have historically encountered more challenges to its growth and expansion compared with health research, with a sector facing significant barriers in facilitating research activity due to a lack of resourcing, poor valuation or understanding of the profile of social care research. The landscape for supporting research in adult social care has been rather bleak, but in recent years there has been recognition of the need to foster a research community. The National Institute for Health and Care Research in England have committed to investing in social care research capacity by funding six adult social care partnerships, with one based in Southeast England. Three large online networking events were held in the first year of the project to engage managers and practitioners from the local authority and from the wider adult social care sector. These took place in July and November 2021, with a last event in March 2022. Two COPs were identified, following an ordering and thematising process of feedback from the networking events, of: (a) Supporting people with complex needs throughout the lifespan, and (b) Enhancing, diversifying and sustaining the social care workforce. Whilst it would be premature to identify their long-term impacts, through the facilitation of 20 COP meetings held so far, alongside the engagement platforms and enrichment resources, these have provided a space for regular communication in the sector, knowledge sharing and networking between COP members. The COP framework offers a collaborative approach to initiating research from the grass-roots level in adult social care. This paper focuses on how the COP model offers great promise for knowledge-exchange providing a forum to generate and disseminate knowledge around social care in our two COP domains.

Recruitment to social care roles in remote and rural contexts; strengthening the weakest link in integrated care?

PurposeRecruitment to social care roles can be the weakest link in many integrated systems, with vacancy rates being very high compared to other sectors, especially in remote and rural places. Analysis of Employer Value Propositions (EVPs) in social care can capture and challenge perceptions of care work.Design/methodology/approachThis study of EVP in four organisations in a rural setting in Scotland focussed on young people as a target demographic. This study interprets recruitment challenges in social care in three contexts, the technical-instrumental, the hermeneutic and the emancipatory.FindingsEVP articulation is at present not effective. Refreshed and new messaging has potential to attract, employ and nurture young people to the social care sector in remote and rural places.Research limitations/implicationsRecruiting to social care vacancies is crucial for sustainable social care. Improving the recruitment of young people is a key part of the longer-term solution. More studies on recruitment in a variety of remote and rural contexts, with a range of demographics, are needed.Practical implicationsThe potential impact is attracting more young people to the social care workforce, enhancing capacity for integrated care improving lives for people who receive care and for paid care workers and unpaid carers.Social implicationsRemote and rural areas often feature a generational imbalance, with more older people from in-migration and fewer young people from out-migration. Employment in social care has the capacity to redress that to some extent.Originality/valueThis study is original in outlining the messages and methods that can be adopted to boost recruitment to social care.

Community Health Center Staff Perspectives on Financial Payments for Social Care.

A growing crop of national policies has emerged to encourage health care delivery systems to ask about and try to address patients' social risks, e.g., food, housing, and transportation insecurity, in care delivery contexts. In this study, we explored how community health center (CHC) staff perceive the current and potential influence of fee-for-service payments on clinical teams' engagement in these activities. We interviewed 42 clinicians, frontline staff, and administrative leaders from 12 Oregon CHC clinical sites about their social care initiatives, including about the role of existing or anticipated financial payments intended to promote social risk screening and referrals to social services. Data were analyzed using both inductive and deductive thematic analysis approaches. We grouped findings into three categories: participants' awareness of existing or anticipated financial incentives, uses for incentive dollars, and perceived impact of financial incentives on social care activities in clinical practices. Lack of awareness of existing incentives meant these incentives were not perceived to influence the behaviors of staff responsible for conducting screening and providing referrals. Current or anticipated meaningful uses for incentive dollars included paying for social care staff, providing social services, and supporting additional fundraising efforts. Frontline staff reported that the strongest motivator for clinic social care practices was the ability to provide responsive social services. Clinic leaders/managers noted that for financial incentives to substantively change CHC practices would require payments sizable enough to expand the social care workforce as well. Small fee-for-service payments to CHCs for social risk screening and navigation services are unlikely to markedly influence CHC social care practices. Refining the design of financial incentives-e.g., by increasing clinical teams' awareness of incentives, linking screening to well-funded social services, and changing incentive amounts to support social care staffing needs-may increase the uptake of social care practices in CHCs.

Changing Responses during the COVID-19 Pandemic: A Comparison of Psychological Wellbeing and Work-Related Quality of Life of UK Health and Social Care Workers

Aim: to explore the psychological wellbeing and work-related quality of life amongst United Kingdom (UK) health and social care workers during the COVID-19 pandemic. Subject and methods: Health and social care professionals within nursing, midwifery, allied health professions, social care and social work occupations working in the UK during the pandemic were recruited. Repeated cross-sectional online surveys were conducted during six time periods of the pandemic (May–July 2020, November–February 2021, May–July 2021, November 2021–February 2022, May–July 2022 and November 2022–February 2023). Results: Over 14,000 participants completed the surveys during the data collection periods. The findings revealed that over the pandemic, psychological wellbeing and work-related quality of life scores significantly decreased. Conclusions: The overall psychological wellbeing and work-related quality of life of health and social care workers during the COVID-19 pandemic significantly declined. Further research is warranted on the lasting impact of the pandemic on this workforce. The health and social care workforce needs support to prevent further deterioration and to rebuild its wellbeing and resilience.

Are older people worse off in 2040 regarding health and resources to deal with it? - Future developments in complex health problems and in the availability of resources to manage health problems in the Netherlands.

Developing sustainable health policy requires an understanding of the future demand for health and social care. We explored the characteristics of the 65+ population in the Netherlands in 2020 and 2040, focusing on two factors that determine care needs: (1) the occurrence of complex health problems and (2) the availability of resources to manage health and care (e.g., health literacy, social support). Estimations of the occurrence of complex health problems and the availability of resources for 2020 were based on registry data and patient-reported data. Estimations for 2040 were based on (a) expected demographic developments, and (b) expert opinions using a two-stage Delphi study with 26 experts from policy making, practice and research in the field of health and social care. The proportion of people aged 65+ with complex health problems and limited resources is expected to increase from 10% in 2020 to 12% in 2040 based on demographic developments, and to 22% in 2040 based on expert opinions. There was high consensus (>80%) that the proportion with complex health problems would be greater in 2040, and lower consensus (50%) on an increase of the proportion of those with limited resources. Developments that are expected to drive the future changes refer to changes in multimorbidity and in psychosocial status (e.g., more loneliness). The expected increased proportion of people aged 65+ with complex health problems and limited resources together with the expected health and social care workforce shortages represent large challenges for public health and social care policy.

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Social care funding for England halved: implications for staff and older people

Caroline Abrahams discusses the implications of the reduced budget that has been allocated to develop the adult social care workforce.