Transfers of Undertakings and the minimum wage - care home workers falling through the safety net?

This paper presents longitudinal research conducted into awareness of and attitudes towards the UK National Minimum Wage (NMW) through the perspectives and experiences of care homes workers in the North of England. The paper also reports upon the variation of care workers’ employment contractual rights caused by transfers of ownership of these care homes. The paper’s findings add to knowledge about the significance of a NMW to care workers focussing upon the insecurities articulated by these workers caused by the sometimes rapid changes in ownership regimes in the care homes industry.. The precarious nature of this work presents its own questions too about the efficacy of TUPE rules and regulations as applied to industry and, specifically in this paper, to care home workers. TUPE rules can sometimes be presented as a ‘safety net’ to workers faced by changes in care home ownership and other professions generally

Role redesign in the National Health Service: The effects on midwives' work and professional boundaries

yesThis article examines the effects of role redesign on the work and professional boundaries of midwives employed in the National Health Service. It outlines midwives' views and experiences of attempts to change their skills and professional boundaries and, using the concept of closure, considers the implications for the midwifery profession. The findings show that role redesign is changing midwives' work and that the traditional emotional, social and caring skills associated with a midwife are being undermined by the growth in technical work. Importantly, midwives attempts to use closure have met with limited success and aspects of their work which they enjoy are being delegated to maternity support workers, while midwives' roles expand to include work traditionally performed by doctors. Midwives' concerns about the implications of work redesign for maternity care and their professional boundaries reflect the uncertainty surrounding the profession about the future role and skills of a midwife

Austerity and the Living Wage: the Case of Care Workers in England

Between 1985 to 2014 the number of people aged 85 and above doubled from nearly 700,000 to 1.5 million (Keynote, 2015). While from 2015 to 2020 the population aged over 65 will grow by 12% (1.1 million). The majority of care is now delivered by a range of private companies and providers, whose workforce are mainly care workers paid on the national minimum wage (Grant Thornton, 2014). An analysis of this sector indicates this workforce is projected to increase (Gardiner and Hussein, 2015). This paper presents findings that examine care workers' experiences of work and pay in the care sector. The Low Pay Commission expressed concern that Government reductions in Local Authority funding would affect paying the national minimum wage (Low Pay Commission, 2015:216). It is estimated that an increase in the national minimum wage would affect 275,000 care workers and require additional funding of between £753 million to £1 billion (UKHCA, 2015). An additional factor is the higher impact of the recession and austerity on women, especially in the female dominated care sector (TUC, 2015). Methodology This paper presents in-depth interviews conducted with employers, union representatives from one union and care workers and explores three areas. First, care workers' roles and work, second, issues of pay and conditions, and finally, the challenges of low pay in the care sector. Findings The findings show that care workers now undertake a wider range of tasks and roles and these are expanding. Many care workers describe enjoying aspects of their work, but felt low paid, insecure in their job and unable to change anything. Employers recognise the need to pay higher wages and provide better working conditions, but argue austerity constraints limits what they can pay. However, employers acknowledge a shortage of care workers and instability in the sector is challenging this position (Gardiner, 2016). Union representatives concurred that care workers' roles are expanding; however this additional responsibility was not reflected in their pay or conditions. The union is campaigning and targeting the care sector to raise the issue of the living wage and recruit members. These findings have implications for employers, unions and care workers for pay determination in the care sector. At the same time, attempting to balance these issues with austerity measures is challenging the provision of care, undermining care workers' pay and conditions and potentially destabilising the care sector. References Gardiner, L. (2016) Rising to the Challenge: Early Evidence on the Introduction of the National Living Wage in the Social Care Sector, Resolution Foundation. Gardiner, L. and Hussein, S. (2015) As if we cared: The costs and benefits of the living wage for social care workers, Resolution Foundation. Grant Thornton (2014) Residential Elderly Care: UK sector review. London: Grant Thornton. Keynote (2016) Residential Nursing Care Activities, Keynote Market Digest. Low Pay Commission (2015) National Minimum Wage: The Low Pay Commission Report 2105, March 2015, Cm 9017, HMSO. TUC (2015).The Impact on Women of Recession and Austerity. Trades Union Congress. United Kingdom Health Care Association (UKHCA) National living wage in the Homecare sector. http://www.ukhca.co.uk/mediastatement_information.aspx?releaseID=23267

Recruitment and retention of the health and social care digital workforce: A rapid review

YesThe recruitment and retention of a digital health and social care workforce in the United Kingdom (UK) is challenging for several reasons that include the shortages of these employees in the National Health Service (NHS) and social care and the high demand for digital skills from other sectors (HEE, 2021a; NHS Providers, 2017). Brown (2022:7) notes that ‘high staff turnover rates, chronic recruitment and retention issues, and low morale are increasingly identified as major challenges for those working in social care’. Liu et al., (2019:5) in their report ‘NHS Informatics workforce in England: Phase 1 Project Report’ estimated that the size of the NHS informatics workforce in 2019 was between 40,640 Full Time Equivalents (FTEs) to 53,936 FTEs based on electronic staff records. However, significant shortages in digital and information technology staff in health and social care were identified that pose a challenge. This rapid review examines the strategies used to recruit and retain the health and social care digital workforce and potential solutions to issues raised

Planning the Radiology Workforce for Cancer Diagnostics

YesThe publication of the Delivery plan for tackling the COVID-10 backlog of elective care (NHSE/I, 2022:5) contained a number of ambitions, including that, by March 2024, 75% of patients who have been urgently referred by their GP for suspected cancer are diagnosed or have had cancer ruled out within 28 days. By March 2025, waits of longer than a year for elective care should be eliminated and 95% of patients needing a diagnostic test should receive it within six weeks. The report acknowledged the need to grow the workforce to achieve these ambitions and ensure a timely cancer diagnosis, while also proposing the use of digital technology and data systems to free up capacity. To assist West Yorkshire National Health Service (NHS) organisations to meet these ambitions, this report presents the findings of a ‘deep dive’ that focuses on the role of radiology in meeting the ambitions of providing timely cancer diagnosis. Aims 1. To understand current and projected demand for radiology expertise in cancer diagnosis in West Yorkshire. 2. To understand the current and projected radiology workforce in West Yorkshire and determine the gap between the projected radiology workforce and the required radiology workforce. 3. To identify possible solutions to assist in providing the radiology workforce required for West Yorkshire and explore their acceptability and potential impact. Methods A range of sources of data and methods were utilised. We examined publicly available quantitative data concerning cancer waiting times and diagnostic waiting times and activity and used this to forecast future cancer waiting times and diagnostic waiting times and activity. We examined data from Health Education England (HEE) regarding radiologists’ and radiographers’ workforce profile data for West Yorkshire, the number of radiologists completing training, and the number of radiographers graduating, and data submitted by West Yorkshire Trusts to HEE regarding their plans for growing their radiology and radiographer workforce. Interviews (N=15) conducted with radiology service managers, university academics and key strategic and operational stakeholders delivering radiology services were used to understand the current and future issues around strategic workforce planning, workforce changes and transformation, workforce roles and skills, training and education and service changes. A rapid review of the literature examining the impacts of artificial intelligence (AI) on the workload of radiology services was also undertaken. To put this work in context, we also reviewed relevant policy documents and reports. Alongside this, we consulted with the Yorkshire Imaging Collaborative (YIC) and the West Yorkshire Cancer Alliance (WYCA) and attended a series of workshops run by the Yorkshire Imaging Collaborative. Results Overall, the findings show that demand for radiology services is increasing and that both cancer waiting times and the waiting times for diagnostic tests increased, with a concurrent downward trend in activity that, if all else stays the same, is forecast to continue up to 2025. The cancer waiting times data indicate that patients were waiting longer and that their needs were not being met. Moreover, 3 the proportion of people treated within accepted cancer waiting times decreased both nationally and within the West Yorkshire region from 2013. This was exacerbated by COVID-19 which caused a further decrease nationally and for the West Yorkshire region. National data for waiting times for all diagnostic tests show a significant decline between 2006 and 2008, with a decrease in median waiting times from just under 6.0 weeks to approximately 2.0 weeks. Overall, waiting times remained stable until late 2020 when they started to rise with the longest median waiting times at just over 8.0 weeks in mid-2020. The total number of people waiting for radiology tests nationally is decreasing and is predicted to continue to do so, while in West Yorkshire the number of people waiting for radiology tests decreased until 2020 but has since been on an upward trend which is predicted to continue. Nationally, the total number of radiology tests is on an upward trend that is predicted to continue, while in West Yorkshire activity has been decreasing since well before COVID-19 and is predicted to continue to do so. Data examining the current and future workforce showed that the national figures for the total radiology and radiography workforce are small relative to other health professional groups. In West Yorkshire, 265 radiologists and 926 radiographers were employed, and staff turnover was generally low. Trusts’ forecasts for the number of radiologists and radiographers they believe they need suggest a 16% increase in the number of radiologists in post between March 2022 and March 2027 and a 25% increase in the number of radiographers in post. The numbers of radiographers and radiologists being trained in West Yorkshire suggest that this is feasible. Interview data identified a number of main themes and associated issues: delivering diagnostic cancer targets, strategic workforce planning, workforce roles and skills, service transformation, recruitment and retention, universities, artificial intelligence, collaboration, and international recruitment. Across all themes, some reoccurring issues were identified: a lack of staff, increased demands, a lack of capacity in terms of space and staff, a lack of strategic workforce planning with a focus on operational or financial plans. Respondents proposed potential solutions to some of the issues raised that included: new ways of working, upskilling, developing current and emerging roles, Community Diagnostic Centres (CDCs), greater collaboration between NHS Trusts, universities, CDCs, imaging academies and networks and the private sector, and the international recruitment of radiologists and radiographers to address workforce gaps. The rapid review findings helped to identify a number of potential benefits of use of AI in radiology, including contributing to improved workflow efficacy and efficiency of radiology services. However, this is dependent on the nature of the work and the AI function. As a result of faster AI reading, radiologists may be able to focus more on high-risk, complex reading tasks. AI can support automation of image segmentation and classification and aid the diagnostic confidence of less experienced radiologists. Respondents’ views on AI were mixed. There was acknowledgement that AI was already used to support radiology service delivery and both the benefits and problems associated were identified. The implications of AI for radiologists’ and radiographers’ roles were discussed in terms of changing work, AI being used to support or in some cases substitute radiologists and radiographers, and the need for the radiology workforce to adapt to the technological change whilst maintaining a caring servic

A scoping review: Strategic workforce planning in health and social care

YesAim This aim of this scoping review was to undertake a detailed review of the pertinent literature examining strategic workforce planning in the health and social care sectors. The scoping review was tasked to address the following three questions: 1. How is strategic health and social care workforce planning currently undertaken? 2. What models, methods, and tools are available for supporting strategic health and social care workforce planning? 3. What are the most effective methods for strategic health and social care workforce planning? Methods The scoping review utilised the five-stage scoping review framework proposed by Arksey and O’Malley (2005). This includes identifying the research question; identifying relevant studies; study selection; charting the data and collating, summarizing, and reporting the results. The search included a range of databases and key search terms included “workforce” OR “human resource*” OR “personnel” OR “staff*”. Relevant documents were selected through initially screening titles and abstracts, followed by full text screening of potentially relevant documents. Results The search returned 6105 unique references. Based on title and abstract screening, 654 were identified as potentially relevant. Screening of full texts resulted in 115 items of literature being included in the synthesis. Both national and international literature covers strategic workforce planning, with all continents represented, but with a preponderance from high income nations. The emphasis in the literature is mainly on the healthcare workforce, with few items on social care. Medical and dental workforces are the predominate groups covered in the literature, although nursing and midwifery are also discussed. Other health and social care workers are less represented. A variety of categories of workforce planning methods are noted in the literature that range from determining the workforce using supply and demand, practitioner to population ratios, needs based approach, the utilisation of methods such as horizon scanning, modelling, and scenario planning, together with mathematical and statistical modelling. Several of the articles and websites include specific workforce planning models that are nationally and internationally recognised, e.g., the workload indicators of staffing needs (WISN), Star model and the Six Step Methodology. These models provide a series of steps to help with workforce planning and tend to take a more strategic view of the process. Some of the literature considers patient safety and quality in relation to safe staffing numbers and patient acuity. The health and social care policies reviewed include broad actions to address workforce planning, staff shortages or future service developments and advocate a mixture of developing new roles, different ways of working, flexibility, greater integrated working and enhanced used of digital technology. However, the policies generally do not include workforce models or guidance about how to achieve these measures. Overall, there is an absence in the literature of studies that evaluate what are the most effective methods for strategic health and social care planning. Recommendations The literature suggests the need for the implementation of a strategic approach to workforce planning, utilising a needs-based approach, including horizon scanning and scenarios. This could involve adoption of a recognised workforce planning model that incorporates the strategic elements required for workforce planning and a ‘one workforce’ approach across health and social care

Women take care and men take charge’: The case of leadership and gender in the Public and Commercial Services Union

This article presents the findings of a case study that aimed to understand the specific leadership styles that are valued by women and men lay representatives in the Public and Commercial Services (PCS) union and to determine the gendered implications for increasing women’s leadership and representation in trade unions. Survey responses from PCS lay representatives (reps) show the majority of women and men agreed that the leadership style they value, and makes a good union leader, is post-heroic (communal) leadership. This approach is associated with leadership characteristics such as being helpful, sensitive, and kind and are generally practised by women. This contrasts with male union leaders who are associated with a traditional, heroic (agentic) leadership style characterised by confidence, self-reliance, and decisiveness. Although some differences exist that highlight gender issues, both women and men lay reps have positive attitudes towards increasing women’s representation and participation in union leadership