King's College London

Background

COVID-19 is creating unprecedented challenges for health and social care systems globally. Within England, to prevent NHS Intensive Care Units (ICUs) being overwhelmed, public health services have offered advice to the public about how to minimise risk of infection, with specific advice to people living with a range of health conditions which may put them at particular risk. As well as slowing demand for scarce NHS resources, concerns have been expressed at the lack of personal protective equipment (PPE) for NHS staff and the absence of testing facilities, making cross-contamination more likely.

Though care services in the community have been less vocal in expressing concerns about the risks they run, or pose, the size of the care industry means staff will need to follow strict hygiene protocols to protect themselves and those they care for or support. Both are vital: if care staff are unable to protect themselves or those they care for, more people will require NHS treatment, and the care industry will be unable to meet the needs of all of those who depend on it.

This study built on an earlier, large study of social care Personal Assistants (PAs). PAs are a small, but growing segment of the care industry, and are a popular alternative to more orthodox care services for some disabled people. Our previous study aligned with other smaller studies, in finding that because PAs are directly employed (or directly hired, if the PA is self-employed) they offer genuine opportunities for relationship-based care, which can lead to far greater levels of person-centred care/support than are possible in more traditional care roles, and care/support relationships that could be mutually satisfying.

Our original study found, however, there were also significant problems. PAs were largely unsupported. Their working environment was usually isolated unless the PA was part of a team providing 24-hour cover. Many did not have contracts of employment, or they had contracts that did not accurately reflect the nature of the work. Most were expected to work flexible hours to suit their employer—effectively a zero-hours working relationship. And if there was a problem with their employment relationship, though support was sometimes available for their employer, PAs had no access to independent advice. Access to training was also limited for PAs paid for by Direct Payments: as no ring fencing of funds for training are made, employers tended to use their budget to pay for PAs to work for them rather than attend training. Though protective clothing was usually provided by the employer where needed, some PAs chose not to use it as they felt it ‘medicalised’ their relationship with their employer. PAs are unregulated and un-inspected.

These problematic aspects of the PA role mean that poor working practices and health and safety issues could be overlooked, ignored or disregarded. It was therefore imperative to achieve an understanding of the impact of COVID-19 on the working relationship of PAs and employers. 

Objectives

This study aimed to:

1. Explore the personal impact of COVID-19 on PAs and their families, and on attitudes to working as a PA.
2. Identify the ways in which PAs have had to adjust and adapt their work to enable them to do their job safely.
3. Describe the impact of COVID-19 on PAs paid for by Personal Health Budgets.
4. Find out more about the information and support needs of PAs specifically in relation to COVID-19.
5. Describe the impact of COVID-19 on PA relationships with other community-based professionals.

Timetable

March 2020 – September 2020

Funder

NIHR Policy Research Programme

Design and methods

The study used the prospective sample obtained for [PA-1]. 105 PAs were interviewed for that study and many indicated that they would be willing to take part in further studies, should these be possible. We aimed to recruit a smaller sample for this study of up to 50 PAs.

The data were collected via telephone interviews. It enabled research to be conducted at a time when national life was severely restricted because of the COVID-19 virus. The survey instrument consisted of up to 30 questions, each of which were focused on the impact of COVID-19 on PAs' work. All documents were reviewed by a member of the HSCWRU Patient and Public Involvement and Engagement Advisory Group.

Transcribed data were anonymised before being entered into NVivo qualitative software to assist with analysis. Framework analysis was used for this purpose.

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)