Job design

With advances in technology, keeping skills up to date through training is becoming increasingly important for older workers to maintain their employability and productivity. Very few jobs stay the same over time, so someone who has been in a job for a long time can more often than not benefit from training to help them make use of tools like information technology, equipment and other goods and services which change how they carry out their work. Most of the evidence suggests that older workers take fewer days of training than younger ones. For example, according to the UK Labour Force Survey, 23% of people 50 years old and over took part in some job-related training over the past three months compared with 31% of workers under thirty.

Care work has changed considerably over time within the context of ageing populations, increased service demands and advances in medical technology.  Care workers today are responsible for work which 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.

“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)

The current state of work: Task and finish

Many care workers are employed on a precarious basis. In other words, they work irregular work hours, are employed on a non-permanent contract of employment and/or lack a constant work station. This is sometimes called a ‘task and finish’ workload model because care workers are deployed for discrete tasks like visits to clients for a limited amount of time. 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 and argue that Health and Social Care Trusts as well as other contracting authorities should move toward contracts which are outcome focused to foster better approaches to engaging with care workers.

Precarious work impacts on the quality of working life and health and well-being of care workers as well as the care provided to clients. Care workers point to several ways irregular working conditions affects them:

  • Low pay: Many care workers are working at or close to the minimum wage and can fall below it if they are not paid for time spent travelling between clients’ homes. Based on a tribunal decision, employers have a legal obligation to pay for travel time, but workers may often 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.

“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)

  • 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: Having irregular work hours makes it difficult to manage work with other responsibilities like having a caring role inside the home. It also makes it difficult for staff to put themselves forward for training which could enhance the care which 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.

Job redesign care workers would like to see

Care workers with whom we spoke have views on ways to improve the ways that their work is organised. Some of the main aspects of care work which they wanted changed include: precariousness, time constraints, isolation and deskilling of work.  Reforms which they would like to see include:

Case work: Many people become care workers because they see the work as a calling. Their experiences, however, is that work is often routinised, with very limited scope for meeting the needs of their clients. Some care service providers are modelling care workers’ workload on those of social workers. In this way, care workers are given responsibility for delivering care to a caseload of clients and given autonomy as to how they achieve outcomes in delivering care to the group. A case work approach has advantages in providing more stable work for care workers and allows them to foster a more collaborative relationship with clients and their families to delivery better care.

Teamworking: One of the main concerns expressed by care workers is the amount of time in work which they spend alone. This can lead to a feeling of isolation in work which can increase stress in work.  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 on the front-line staff who can be the “eyes and ears” of the care delivery team. Care workers talked about how they can see the changes in health and capabilities of clients which health and social care professionals who see clients less frequently might miss out on.

One approach to care which 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 even community members to deliver holistic care. The focus is on fostering healthier and more active lives for service users. Care workers would be central to 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 HSC professionals, clients, and family members.

In sum, within the care service sector, there is a strong demand for professionalisation of care work.