King's College London

Background

Social Care Personal Assistants (PAs) offer opportunities for genuine relationship-based care and support: something that care management and personalisation have largely failed to achieve. The uniqueness of the relationship between PA and the person they support or provide care for is probably attributable to the direct employment relationship between the PA and those they care for or support.

PAs are the only group of care or support workers whose employers are unregulated. They are also unrepresented by any professional association, and their isolated working conditions can make them hard to locate.

This is the third in a series of studies on PAs at the NIHR Policy Research Unit in Health and Social Care Workforce (see below for details of these and other related work). Each study drew attention both to the benefits of directly employed PAs (for both employer and for PA) but also to problematic employment conditions which the COVID-19 pandemic exacerbated.

Objectives

This new study of a sample of PAs is intended to find out what enduring impacts the COVID-19 pandemic has had for PAs and the nature of their working relationships with their employer, their employer’s family (where relevant) and other community-based professionals.

The study aims to:

1. Find out what has happened to PAs following the COVID-19 pandemic
2. Find out what has changed, if anything, in their relationship with their employer(s) and their employment conditions
3. Explore how PAs envisage their future working lives in a ‘post-pandemic’ world – and whether / how the pandemic has shaped job and career plans.

Research design and methods

This study will have a prospective, qualitative design. We will contact participants from previous studies and ask them to take part in this new one. At this stage we will seek to establish if those we contact are still working as PAs or are now in different employment: we will invite ex-PAs to take part in the study to find out why they are no longer working in this job, and any consequences this may have had. We would aim to establish a sample of 50 PAs to take part in this new study. If we are unable to recruit this target number from previous participants, we will recruit PAs who have not previously been involved in our studies to take part. We will also seek a diverse sample of PAs from across England.

At the present time, we plan to collect data by interviews conducted either by telephone or through a video-conferencing platform.

We have obtained a favourable opinion from KCL’s research ethics office, and plan to start recruiting PAs to the study in July 2021.

Service User and Carer Involvement

Our research unit’s standing advisory group of service users and carers have offered feedback on the study proposal, interview guides, information sheet and consent form and we will consult them about emerging findings.

Analysis

Data analysis will begin as soon as transcriptions are returned to the research team. We will use ‘Framework’ or an equivalent analytic induction technique to thematically analyse interviews and to focus on phenomena of interest.

Outputs

Norrie, C., Luijnenburg, O., Moriarty, J., Samsi, K., Manthorpe, J., (2023) 'You're out on a limb, on your own': Social care personal assistants' (PAs') reflections working in the Covid-19 pandemic - implications for wider health and care services, PLoS ONE 18(12): e0295385 https://doi.org/10.1371/journal.pone.0295385

As the Unit and members of the research team are a part of the NIHR Applied Research Collaboration South London, we aim to disseminate findings via their newsletter, social media channels and presentations to relevant stakeholders and the public.

Personal Assistant studies at HSCWRU

1. [PA-1] described their background and skills, the work they do, the nature of their relationship with their employers and their employment conditions. (NIHR Policy Research Programme)
2. [PA-2] re-interviewed a proportion of the PAs who took part in the first study and collected information about the impact of the COVID-19 pandemic on their working lives. (NIHR Policy Research Programme)
3. [PA-3] What enduring impacts has the COVID-19 pandemic had for PAs and the nature of their working relationships with their employer, their employer’s family (where relevant) and other community-based professionals? (NIHR Policy Research Programme)
4. Employing Personal Assistants during the COVID-19 pandemic: lessons for social care practice (NIHR School for Social Care Research)
5. Exploring working relationships between primary care and directly employed home care workers (Dunhill Medical Trust)

Note on the research team

John Woolham was Principal Investigator of the [PA-3] project until he left King's at the end of 2021. John became a Visiting Senior Research Fellow at King's in February 2022.

Following John Woolham's retirement, Martin Stevens was co-Principal Investigator of this project (with Caroline Norrie) until his death in March 2022.