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Now you see them, now you don’t… The invisibility of social care Personal Assistants during the pandemic

NCF guest blog by Dr. John Woolham | NIHR SSCR Senior Research Fellow | Health and Social Care Workforce Research Unit | King’s College London

A recent study has found that social care Personal Assistants (PAs) are being overlooked when advice about Covid-19, access to personal protective equipment (PPE) and employment support is provided.

The study carried out telephone interviews with 41 social care PAs between April and May 2020, during ‘lockdown’ and at the height of the initial wave of infections. Participants from all over England, who had participated in an earlier study by the authors (based on a larger number of PAs), were invited to take part in this research. The average length of each interview was about 45 minutes.

PAs are distinctive as part of the social care workforce in that they are directly employed by the person needing support or care, or by their family. They are a small but growing segment of the social care workforce and the direct employment relationship can enable higher standards of care and support and facilitate closer, and mutually fulfilling working relationships between employer and employed.

Like other front-line staff working in NHS or care settings, the COVID-19 pandemic has had a massive impact on PAs and their working relationship with their employers, but PAs have faced additional difficulties.  Lockdown meant that everyday lives and activities of employers – mixing with others, visiting day centres, going shopping – were no longer possible, and they had to shield due to age or long standing health problems. Some PAs were asked by their employer not to come to work: many PAs said they had lost a substantial number of hours work almost overnight as employers began shielding, reducing the contact they had with care and support staff to a bare minimum. This meant substantially less income. For those who continued to work, many described how they rapidly introduced new cleanliness, hygiene and distancing regimes in the home of their employers to keep them safe. This sometimes involved considerable personal sacrifice. One PA’s husband turned down a promotion because the new role enhanced his risk of getting the virus and spreading it to her (and therefore to her employer) and he remained in his existing employment. As employers reduced the number of care workers entering their home, if the PA had kept working, some found themselves working longer shifts to carry out tasks previously carried out by other workers. Some PAs who had been asked not to come to work nonetheless kept in touch by telephone to alleviate their employer’s loneliness and isolation.

Many PAs worked for more than one employer, and although most employers were understandably very fearful of the virus, risky behaviour – usually by a member of the employer’s family – sometimes created problems. One PA, wishing to protect herself and thereby her other employers,  asked a relative to self-isolate after returning from overseas and visiting her employer, and was dismissed after 8 years of service.

The precariousness of PA working conditions was also reflected in the response of the government and local authorities to the virus. PAs were unsure if they were ‘key workers’ even though their employers depended upon them, and did not know how this status was conferred. Many also described spending hours queuing outside shops for foodstuffs and other household items as they lacked the accreditation needed to take advantage of the dedicated shopping times that most supermarkets had introduced for NHS and care staff.  Many were unable to obtain furlough money, and only some Local Authorities gave permission for employers to continue to spend their Direct Payments to pay PAs if they were not working. Many PAs lacked access to local information available to NHS and care workers about the virus, including where to access PPE. Those who did find out about NHS distribution hubs (set up to distribute PPE) found they were ineligible. Some PAs spoke of having to source and pay for the PPE they used, and finding it both difficult to obtain and very expensive. Most PAs also relied almost entirely on mainstream media for information about the virus and how to protect themselves and their employers.

Many of the problems reported in the study seemed to occur because of the ‘invisibility’ of PAs. Uniquely, they are not a regulated part of the care workforce, and not subject to any form of independent oversight. Patchy local support is available, but generally only for employers. The report calls for a greater role for Local Authorities in registering PAs (which happens in some areas but not others) as a means of identifying and contacting them in the crisis and offering information, support and resources.

A full report of the findings, completed by researchers at the Health and Social Care Workforce Research Unit at King’s College London, is available here:

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