The identity of different groups of people likely to be carrying out the role of PA should be acknowledged. The potential and opportunities offered by different configurations and career patterns should be seen as a basis on which to build rather than be a barrier to development.
As the personalisation agenda advances, the role of advocacy and support broker will be of increasing importance. If personalisation is to achieve its core aims, it will be essential that those accessing individualised budgets can refer to sources of advice and support. There will need to be clarity on what can be expected from whom, for example in assisting with recruitment or in regular administration. This should avoid misunderstandings or gaps in the relationship between budget provider and recipient and between employer and PA.
The role of PA at its best offers the opportunity for creativity and flexibility. At the same time it is important that employer and PA share an understanding on roles and expectations. A balance has to be struck between excessive contractual formality and the need for clarity and open communication on the content and structure of the role. The correct form for any contract may vary according to the identity of both the employer and the PA.
There is a mismatch between the desire of PAs to access training and the reluctance of employers to facilitate this, usually because of financial constraints. Consideration should be given to mechanisms for enabling access to training, for example through core provision by the funding agency or through the allocation of an additional sum within the individual budget earmarked for this purpose.
The possibility of wholesale expansion in the role of the PA providing individualised support will present challenges in terms of rethinking traditional concepts and work patterns. It is important that the debate and the development are based on the best available evidence, as exemplified by this report, rather than on supposition or presumption.
Authors: Lorna Adams and Laura Godwin, IFF Research
The steady growth in the number of individuals receiving direct payments and the prospect of major expansion of individual budgets as the personalisation of social care progresses has provoked considerable speculation on the implications for the adult social care workforce. The aim of this study, commissioned by Skills for Care, was to explore the experiences of those involved with direct payments, providing detail both on recipients’ perspectives as employers and on the responses from the employees, and the personal assistants (PAs).
Data were collected through three surveys. The first was of the employers (those in receipt of direct payments), with 526 face-to-face interviews in 16 local authority areas between February and November 2007. This represented about 1% of the estimated 54,151 individuals receiving direct payments in England at that time. Sealed self-completion surveys were left with these employers to pass on to their PAs for self-completion. These sought factual information on demographic data, work experience training, and views on registration. Completed questionnaires were returned by 486 personal assistants.
Respondents were asked to indicate whether they would be willing to participate in a more in-depth telephone discussion and this was completed with a random selection of 100 from those offering to participate.
The data from the employer survey were weighted to reflect the spread of employers across the six different user categories in the participating authorities.
The survey yields valuable data on the PA workforce. The responses suggest there are at least 76,000 individuals working as PAs, covering 125,000 PA roles. Two-fifths have other jobs outside their PA role. The majority are female (87%), two-thirds have had experience in health and social care, and 42% have relevant qualifications.
Some 11,000 individuals have moved from previous work in domiciliary care or a nursing agency and 4,000 from care homes. About one-fifth of the PA workforce has been displaced from elsewhere, but only 2% have moved from local authority services. Seventy per cent were in their first PA role one-third were unlikely to continue as a PA beyond their current employer.
The implication of one-third having no previous employment in the area is that there were 25,000 new entrants to the field, 12% past retirement age. At the same time only half of the PAs expected to be in the role in five years, with those leaving likely to seek work in health and social care.
Job satisfaction was high among the PAs. Almost all found their work enjoyable and rewarding and individuals were happy to be flexible in their work. One-third nonetheless did not consider they were paid enough, one-fifth felt they were required to work too many hours, and more than half worked overtime.
Satisfaction levels were high among the direct payment employers. Seventy-nine per cent expressed themselves as very satisfied with their current PAs, valuing in particular their friendly and empathetic attitudes and the respect offered to them as employers. Half had previously accessed local authority services the current arrangements were rated more highly for their increased reliability and punctuality, for enabling access to more support outside the home, and greater help with healthcare tasks.
Although 18% reported a form of abuse (financial, psychological, physical or sexual) from local authority services, this reduced to 10%, the majority psychological, from PAs. Employers valued not having to rely on family and friends.
Most were confident in their role as employers, with only 27% saying they found the responsibility daunting and this reducing over time. Some 31% had difficulty with the administrative tasks, more so among older people. Nearly half of PAs were previously known to the employer and therefore a full recruitment procedure was not pursued. Among those recruiting from scratch, about one-third had difficulty in identifying an appropriate PA, increasing to two-thirds among those with learning disabilities. One-third had not checked references, carried out a CRB check or examined the POVA register. Only two-fifths had given their PAs a contractual job description.
Two areas were explored in some depth with both employers and PAs, attitudes towards training and staff development and views on registration of PAs. Employers tended to value personality over proven skills and experience, with only one-tenth specifying particular qualifications and one-fifth requiring previous experience. One-third of PAs, however, identified areas for skill development, including moving and handling, administering medication and personal care.
Employers were reluctant to fund training only 7% had paid or arranged training for PAs. The majority of employers considered the introduction of a register of PAs would be useful. They divided evenly, however, between voluntary and compulsory registration. The security of compulsory registration was balanced against the autonomy of the individual PA.
PAs, however, backed registration, with 85% saying they were not at all worried about the prospect.
The value of this study is in its provision of robust data in an area prone to assumption and speculation. It dispels the notion that use of PAs would expose employers to greater abuse, and it highlights the preference for the PA system among those who have also experienced more traditional support services. It suggests also that the reluctance of people to become employers may have been exaggerated, with anxieties decreasing over time and the potential for greater support on recruitment and administration. Most importantly, it contributes an evidence base at a time when there is wide speculation about the implications of the personalisation agenda for the future configuration of the social care workforce.
Areas of potential tension in the role of direct payments recipients as employers are revealed. The apparent disregard for contractual procedures and formal checks is particularly understandable when the PA is a friend or family member such informality, however, leaves both the employer and the PA potentially vulnerable. It is significant that PAs themselves express strong support for a registration system.
A potential scenario building on this research is that for many PAs the role should be accepted as time limited, an introduction to a continuum of work in health and social care. Individuals may see it as a stepping stone to further training in social care or nursing, a chance to respond flexibly to individual needs but also to lay the foundation for a future career and to become familiar with basic skills of personal care, moving and handling, social interaction.
It is also important to recognise the diversity of those employed as PAs. This includes a sizeable minority beyond retirement age and others who combine the role either with other health and social care work or with an unrelated post.
The challenge for the workforce of the future is to embrace the delivery of the PA role but also ensure that the quality of both work experience and individual support can be maintained.
Following the publication of Putting People First, the Department of Health has been working with partner organisations through the Adult Social Care Workforce Strategy Board on the development of an Adult Social Care Workforce Strategy. In June Putting People First – Working to Make it Happen: Adult Social Care Workforce Strategy – Interim Statementwas published. Comments can be submitted by 12 September before finalisation of the strategy in October. Views can be submitted at firstname.lastname@example.org.
Alison Petch is director of Research in Practice for Adults. Ripfa promotes the use of evidence-informed practice in the delivery of adult social care services.
This article appeared in the 24 July issue of Community Care magazine.