Care Workforce Wellbeing: Engagement Report 2023
The results of the RBK wellbeing survey showed an appetite for a frontline staff forum / virtual networking site, so that care workers could share experiences and information to improve their wellbeing in the workplace. This also included requests for an escalation pathway for concerns or complaints around equality and diversity issues in the workplace.
When RBK asked who care workers felt would be best placed to host this work, the first choice for respondents was RBK. However, as RBK commissions most of the social care in the borough, it was deemed inappropriate for them to carry out this work. The second choice for both activities was Healthwatch Kingston upon Thames (Healthwatch Kingston) which indicated an awareness of Healthwatch by members of the care workforce.
RBK contracted Healthwatch Kingston to provide a retrospective engagement exercise with care workers about their wellbeing in the workplace during 2021-22 and to report anonymised findings and learning from this engagement to RBK.
Recommendations for commissioners:
1. Healthwatch Kingston recommends RBK (The Council) develop a care worker wellbeing checklist for use during RBK quality assurance visits to care homes to help consistently monitor workforce satisfaction and gather insights.
Response: ‘Care worker satisfaction is monitored by the care providers; the expectation is for care providers to have regular staff meetings and records of the meetings including actions completed and made the records available for the council - these are reviewed by council officers at quality assurance and contract monitoring visits. Council officers talk to the staff members to seek their views of their working conditions as part of the visits - any findings and recommendations are reported in the monitoring visit report. The Council has developed an annual survey sent to the care provider workforce directly, this is sent via the care providers. We have completed a recent survey around the payments and general working conditions. We will run these surveys once a year going forward.’
2. Healthwatch Kingston recommends RBK quality assurance visits assess the quality of staff room environments and the information provided to care workers within, to ensure it is current and includes clear guidance about engagement opportunities.
Response: ‘Council officers talk to the staff members to seek their views of their working environment as part of the visits - any findings and recommendations are reported in the monitoring visit report.’ This is an area the Council will explore jointly with Healthwatch to develop as part of ‘Enter and View’ visits by Healthwatch Kingston to care providers.’
Recommendations for commissioners and care providers:
3. Healthwatch Kingston recommends commissioners, providers, and care workers co-design a wellbeing in the workplace toolkit that builds upon findings from this report.
Response: 'Care worker satisfaction is monitored by the care providers; the expectation is for care providers to have regular staff meetings and records of the meetings including actions completed and made the records available for the council - these are reviewed by council officers at quality assurance and contract monitoring visits. Council officers talk to the staff members to seek their views of their working conditions as part of the visits - any findings and recommendations are reported in the monitoring visit report. The Council has developed an annual survey sent to the care provider workforce directly, this is sent via the care providers. We have completed a recent survey around the payments and general working conditions. We will run these surveys once a year going forward.’
4. Healthwatch Kingston recommends commissioners and providers work collaboratively to run regular ‘you said, we did’ care workforce surveys to help facilitate continuous service improvement.
Response: ‘Care worker satisfaction is monitored by the care providers; the expectation is for care providers to have regular staff meetings and records of the meetings including actions completed and made the records available for the council - these are reviewed by council officers at quality assurance and contract monitoring visits. Council officers talk to the staff members to seek their views of their working conditions as part of the visits - any findings and recommendations are reported in the monitoring visit report. The Council has developed an annual survey sent to the care provider workforce directly, this is sent via the care providers. We have completed a recent survey around the payments and general working conditions. We will run these surveys once a year going forward.’
5. Healthwatch Kingston recommends that provision of care workforce counselling and support is included in future service specifications and that providers report uptake by their staff of this offer in routine contract monitoring and / or during RBK quality assurance visits to care homes.
Response: ‘There are expectations set in contracts for providers to support the care workforce on their wellbeing; the providers are required to have regular staff meetings, supervisions and appraisals to support their staff.’ The Council contracts teams regularly check these meetings are taking place when completing monitoring site visits.’
6. Healthwatch Kingston recommends commissioners and providers work collaboratively to introduce workforce wellbeing training for care provision managers.
Response: ‘The Council has recently completed a training needs analysis with the Kingston care provider market and the findings are incorporated into the south west London (SWL) workforce support programme. SWL are developing an online resource for care providers; The Council is supporting the development of this resource base and we will advocate the inclusion of workforce wellbeing training and awareness for managers.’
Recommendations for care providers:
7. Healthwatch Kingston recommends care providers communicate how their staff can access mental health support in their workplace, and ensure relevant care worker wellbeing policies and procedures, such as safeguarding, whistleblowing, code of conduct, and confidentiality are regularly reviewed and accessible.
Response: ‘The induction programme and the regular refresher training delivered by the care providers should cover this aspect. This is an area the Council officers will seek assurance from care providers during site visits that these wellbeing policies and procedures are in place.’
8. Healthwatch Kingston recommends care providers explore ways to address mental health stigma, whether real or perceived, and how to establish safe spaces for open conversations about mental health issues within the care workplace.
Response: ‘Care providers are required to have policies and procedures around bullying, discrimination, code of conduct, equality and diversity and grievance which will provide a supportive arrangement to the care workforce within the work setting. The Council contracts team check there are up to date policies and procedures. The Care Quality Commission is also reviewing the provider compliance.’
9. Healthwatch Kingston recommends that care providers introduce ‘end of life care’ support and training for their care workforce. This should consider the need for mental health support for care workforce experiencing delayed post-Covid bereavement.
Response: ‘The Council is working jointly with the South West London Integrated Care System to promote best practice of End-of-Life Care. RBK Commissioning held a specific forum for End-of-Life Care for providers in January 2023, which included speakers from Princess Alice Hospice, as well as health colleagues. The information and awareness were also cascaded through our ASC Newsletter.
10. Healthwatch Kingston recommends that care providers allow reasonable time for bereavement of care staff if the person they were caring for dies on their work shift.
Response: 'Care providers are required to deliver End-of-Life Care training to their workforce as part of their training programme, this is a requirement if the providers are delivering End-of-Life care services. This aspect of care delivery is on the care home visit template for our quality assurance visits.’
11. Healthwatch Kingston recommends that care providers explore how to provide care workers with continuity of care opportunities to avoid disruption to staff motivation.
Response: ‘The Council expects providers to have a robust training programme and support the care workforce with their development. The Council is working in partnership with south west London councils to deliver a programme to support the care provider workforce; this includes a range of training delivered by the local training providers. This work is ongoing. The aim of the South West London Social Care Academy Hub is to support the social care sector by improving workforce recruitment and retention for local Londoners.’
12. Healthwatch Kingston recommends that care providers review care expectations of their workforce. Also review benefit and expense arrangements along with realistic travel time between clients to ensure they are as supportive as possible and reflect cost-of-living pressures.
Response: ‘The Council’s Care at Home framework requires home care providers to pay travel time. This is included in the contract terms and conditions.’
Recommendations for non-care workforce professionals:
13. Healthwatch Kingston recommends non-care workforce professionals be mindful of the pressures that care workers may be under and approach communication sensitively when contacting care workers for information.
Response: ‘There is much evidence available within the public domain. This is an area the Council or the care providers can not directly impact on.’
Conclusion
The research for this report was undertaken from August 2022 to March 2023, and builds on a wellbeing survey for care workers undertaken by RBK in late 2021. The views of 102 care workers were gathered by HWK through a survey, meetings and events approximately two thirds worked in care homes, and one third in home care.
Although the majority valued their work, gained satisfaction from it and felt that both their physical and mental health were taken seriously by their employer, there were also many stressors, such as being short staffed and feeling bereaved when a patient died. Carers generally felt respected, but over one third had witnessed disrespect and/or discrimination and a fifth did not feel confident in reporting it, or felt that clients who were disrespectful were unwell and not fully aware of their own behaviour.
One third had felt that the workload had become unmanageable in the previous year and it should be noted that 48% had other (unpaid) caring responsibilities as well. They felt stressed by their low pay, exacerbated by the increase in the cost of living, but there was a feeling that ‘nothing will change’, given the well-recognised issues of underfunding in the care system. Being part of a strong team was beneficial, but perhaps more thought needs to be given to how this is created in domiciliary care.
