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The impact of COVID-19 on people who work as social care Personal Assistants

Report

Woolham, J., Samsi, K., Norrie, C., & Manthorpe, J. (2020). The impact of the coronavirus (Covid-19) on people who work as social care Personal Assistants. London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London.

This study is funded by the National Institute for Health Research Policy Research Programme and led by Dr John Woolham, Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce.

Background

COVID-19 (coronavirus disease) is creating unprecedented challenges for health and social care systems globally. Within England, to prevent NHS Intensive Care Units (ICUs) being overwhelmed, public health services have offered advice to the public about how to minimise risk of infection, with specific advice to people living with a range of health conditions which may put them at particular risk. As well as slowing demand for scarce NHS resources, concerns have been expressed at the lack of personal protective equipment (PPE) for NHS staff and the absence of testing facilities, making cross-contamination more likely. 

Though care services in the community have been less vocal in expressing concerns about the risks they run, or pose, the size of the care industry means staff will need to follow strict hygiene protocols to protect themselves and those they care for or support. Both are vital: if care staff are unable to protect themselves or those they care for, more people will require NHS treatment, and the care industry will be unable to meet the needs of all of those who depend on it.

To date we are unaware of any study that has considered the impact of COVID-19 on care work. This protocol builds on an earlier, large study of social care Personal Assistants (PAs). PAs are a small, but growing segment of the care industry, and are a popular alternative to more orthodox care services for some disabled people. Our previous study aligned with other smaller studies, in finding that because PAs are directly employed (or directly hired, if the PA is self-employed) they offer genuine opportunities for relationship-based care, which can lead to far greater levels of person-centred care/support than are possible in more traditional care roles, and care/support relationships that could be mutually satisfying.

Our original study found, however, there were also significant problems. PAs were largely unsupported. Their working environment was usually isolated unless the PA was part of a team providing 24-hour cover. Many did not have contracts of employment, or they had contracts that did not accurately reflect the nature of the work. Most were expected to work flexible hours to suit their employer—effectively a zero-hours working relationship. And if there was a problem with their employment relationship, though support was sometimes available for their employer, PAs had no access to independent advice. Access to training was also limited for PAs paid for by Direct Payments: as no ring fencing of funds for training are made, employers tended to use their budget to pay for PAs to work for them rather than attend training. Though protective clothing was usually provided by the employer where needed, some PAs chose not to use it as they felt it ‘medicalised’ their relationship with their employer. PAs are unregulated and un-inspected.

These problematic aspects of the PA role mean that poor working practices and health and safety issues could be overlooked, ignored or disregarded. At the present time, it is therefore imperative to achieve an understanding of the impact of COVID-19 on the working relationship of PAs and employers. We do not know what steps PAs and their employers are taking to protect one another, or how the coronavirus may have impacted more generally on their employment relationship.

Objectives

This study aims to:

  1. Explore the personal impact of COVID-19 on PAs and their families, and on attitudes to working as a PA.
  2. Identify the ways in which PAs have had to adjust and adapt their work to enable them to do their job safely.
  3. Describe the impact of COVID-19 on PAs paid for by Personal Health Budgets.
  4. Find out more about the information and support needs of PAs specifically in relation to COVID-19.
  5. Describe the impact of COVID-19 on PA relationships with other community-based professionals.

Timetable

March 2020 – September 2020

Research team

John Woolham (PI), Caroline Norrie, Kritika Samsi, Jill Manthorpe

Funder

National Institute for Health Research Policy Research Programme

Design and methods

The study will utilize the prospective sample obtained for the earlier study of PAs, also commissioned by the Department of Health and Social Care. 105 PAs were interviewed for that study and many indicated that they would be willing to take part in further studies, should these be possible. We will aim to recruit a smaller sample for this study of up to 50 PAs (fewer if data saturation is reached before this number of interviews is completed).

The data will be collected via telephone interviews. This method was used in the earlier study and worked well. It also enables research to be conducted at a time when national life is severely restricted because of the COVID-19 virus. The survey instrument will consist of up to 30 questions, each of which are focused on the impact of COVID-19 on their work as PAs. All documents will be reviewed by a member of the HSCWRU Patient and Public Involvement and Engagement Advisory Group.

Transcribed data will be anonymised before being entered into NVivo qualitative software to assist with analysis. Framework analysis will be used for this purpose.

Outputs         

Woolham, J., Samsi, K., Norrie, C., & Manthorpe, J. (2020). The impact of the coronavirus (Covid-19) on people who work as social care Personal Assistants. London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London.

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