Abstract
Delegated healthcare activities (DHA) result from redesign of health and social care (H&SC) services for people receiving H&SC in either their own homes or residential homes. NHS district nurses delegate healthcare activities to independent sector adult social care workers (CWs). This cross-sector delegation has the potential to improve jobs by, for example, increasing skills. Yet little is known about DHA and job quality, particularly in a highly gendered workforce. Here, we present CW perspectives on DHA and job quality, exploring the role of gender within this.
This is an important topic. The crisis in CW recruitment and retention has spanned many decades and persistent understaffing creates serious risk to the safety and wellbeing of people who use services and carers (PUSC). Workforce shortages are often attributed to the low-skilled, low-paid and low-status nature of care work which results, at least in part, from the low value attributed to its mainly female workforce. DHA may address this.
Our findings show that some features of job quality were improved, including training that enhanced CW skills and knowledge and built confidence. Most felt that adequate resources were invested in training. Newly developed skills and confidence meant that CWs had improved autonomy and enhanced voice. Relationships with PUSC also improved and they were able to care for the whole person. However, despite training and increased skills, CW reported few career progression opportunities. Similarly, few, if any, had received pay increases to reflect their increased skills and responsibilities. There was generally grudging acceptance of this because of commitment to PUSC, but argument that they more should be paid. The extent to which job quality has improved is thus questionable. Findings also reveal limited impact on recruitment and retention, but that care improved.
We argue that gender is important to understanding these contradictions. CWs often suggest that they undertake their roles out of dedication to PUSC rather than for their earnings potential. A critical perspective might argue that improved care results from exploitation of CW’s commitment to the relational aspects of their jobs which they prioritise over pay and career. We evidence how gender enables the trade-off of certain elements of job quality for others and argue that all must be addressed so that workers, as well as those who receive care, benefit.