Section 6: Job design

Section 6: Job Design

Most of the evidence suggests that older workers take fewer days of training than younger ones.

23% of over 50’s took part in job-related training over the past three months

…compared with 31% of workers under 30

(UK Labour Force Survey)
Care work has changed considerably over time. Populations have aged and there is increased demand on the service, alongside advances in medical technology.
Care workers today are responsible for work that in the past was carried out by other health care professionals. Expanding job roles can enhance the quality of working life. However, when jobs change, people need the skills, training and qualifications to carry out their new responsibilities. This is particularly important for older workers, to maintain their employability and productivity.

“We have seen a significant shift, where personal care is now more very clearly of the service that’s delivered, as opposed to the old service of many years ago, which was the traditional shopping, the lights on, making a cup of tea, whatever. But that’s all changed now, the balance has changed significantly, and it is very much now about personal care, and, in reality, that’s where it should be.” (Belfast Health and Social Care Trust)
Question: Do you feel you have received the training you need to continue to deliver the highest levels of care?

The current state of work: Task and finish

Many of the care workers we spoke to are employed on a precarious basis. They work irregular work hours, are employed on a non-permanent contract and lack a constant work station.

Care service providers say that the ‘task and finish’ workload model is often necessary because of the way that they are compensated by contracting authorities.

They argue that Health and Social Care Trusts as well as other contracting authorities should move toward contracts that are outcome-focused. They say this would foster better approaches to engaging with care workers.

Task and finish
In the ‘task and finish’ workload model, care workers are deployed for discrete tasks like visits to clients for a limited amount of time.

Question: What kind of contract do you think creates the best working environment?

The many impacts of precarious work

Precarious work impacts the quality of working life, the care provided to clients and the health and well-being of care workers themselves.

[VIDEO: Interview with a care worker who has struggled in care work]

The care workers we spoke to mentioned several ways that irregular working conditions affect them:

  • Low pay: Many care workers are working at or close to the minimum wage and can fall below it if they’re not paid for time spent travelling between clients’ homes. Employers have a legal obligation to pay for travel time, but workers may be reluctant to ensure they are paid fully for travel time. This is especially the case if the employer keeps poor records of working time. Staff may also be reluctant to demand full wages if they think they are at risk of losing their job by ‘rocking the boat.’
  • Morale: Care workers talked about feeling undervalued, especially if they are paid less than workers in jobs requiring fewer skills and less responsibility. This leads to poor morale, higher turnover and burnout.
  • Isolation: Some care workers talked about how their work day is structured around travelling between clients’ homes with little to no interaction with colleagues. This then reduces the scope for collegiate support, mentoring, shared learning and exchange of good practice.
  • Poor work-life balance: Irregular work hours make it difficult to manage work with other responsibilities, like having a caring role inside the home. It also makes it difficult for staff to have the training that could enhance the care that they deliver to clients. Care workers talked about having to be on-call from 7am to 6pm. Even if they have the right to decline call-outs, they are reluctant to do so because there is no guarantee they’ll get further work.
  • In-work poverty: Irregular working hours, combined with low pay means many care workers are living below the absolute poverty line. One study by the Living Wage Foundation estimates the number to be 1.2 million.
  • “Money is a big issue. Have you ever heard of the Maslow Hierarchy Needs thing? First thing you need is that you do need a decent wage …after that I think it’s the things that they feel valued, they’re making a difference in something, but the baseline has to be there.” (Northern Ireland care worker)
    Question: Do you agree? What is the greatest need that you have in your professional life? Is it currently being met?

    Job redesign care workers would like to see

    The care workers we spoke with suggested ways to improve how their work is organised. Some of the aspects of care work that they wanted changed include:

    • Precariousness
    • Time constraints
    • Isolation
    • Deskilling of work

    The reforms they suggested were:

    Case work

    Many people become care workers because they see the work as a calling. However they feel that the work is often routinized, with very limited scope for flexibly meeting the actual needs of their clients.

    In response, some care service providers model care workers’ workload on those of social workers. In this way, care workers are given responsibility for delivering care to a caseload of clients. They are then given autonomy in to how they achieve outcomes in delivering care to them.
    A case work approach provides more stable work for care workers and allows them to foster a more collaborative relationship with clients and their families, in order to better deliver care.

    Team working

    Care workers are concerned about the amount of time they spend alone in work. It can lead to a feeling of isolation, which can increase stress. Models of team working can be found across Europe which enable care workers to share responsibilities and support one another. Combined with a case work model, team members can pool time and resources to care for clients, fill gaps and help one another achieve better work-life balance.

    Integrating care workers into health and social care delivery teams

    Care workers are often the health and social care professionals who are in day to day contact with clients. They are front-line staff who can be the “eyes and ears” of the care delivery team. Care workers told us about how they can see the changes in health and capabilities of their clients, which health and social care professionals who see clients less frequently might miss.

    • Within the care service sector, there is a strong demand for the professionalization of care work.
    • One approach to care that is gaining some currency is the so-called Buurtzorg model. Under this system, developed in the Netherlands, health and social care professionals work closely with clients, families and the community to deliver holistic care. The focus is on fostering healthier and more active lives for service users. Care workers are at the centre of more collaborative working between health and social care professionals, clients and families – and could be given outcome targets to map out care plans with other health and social care professionals, clients, and family members.
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