Stephen Allan, Florin Vadean, Olena Nizalova
Staff play a key role in supporting people who use social care services. Employment conditions, including pay, contract type and training, are therefore likely to influence not only a person’s decision of whether to work in social care, or change employer, but also the care outcomes of those supported by social care staff. However, there is little evidence for this in England.
Using data from the Adult Social Care Survey (ASCS), which anonymously gathers the views of people receiving social care support which is paid for, or managed, by local authorities, this study looked to statistically analyse how much pay and conditions influence care outcomes.
To put the findings in monetary terms, we estimated how much it would cost to increase a person’s life by one year with perfect health. In economics, this is called the cost per quality-adjusted life year (or cost per QALY). We used the Adult Social Care Outcomes Toolkit (ASCOT) to quantify care outcomes. This is a social care-related quality of life measure which has taken into account the views of the general population. Given the anonymous nature of the ASCS data, we linked staffing information to this data by the local authority where each person lived. In the analysis, we also controlled for other factors likely to influence the quality of life of individuals, such as their levels of needs, wealth and informal care support from family and friends.
We found that the average hourly pay of care workers, more often than not, had a positive influence on the quality of life of those supported by social care. We also found a negative influence of zero hours contracts on quality of life, but only for some statistical models, whilst there was little evidence that training had any influence. For example, we found that the average person receiving local authority supported social care would have a 1.3% higher social care-related quality of life score if they were living in a local authority paying on average £1 more per hour to care workers than the national average. This would cost (in terms of the wage increase only) almost £1,500 more per person supported by the local authority. From this information, we estimated that it would cost £115,000 to increase a person’s life by one year with perfect health – the cost per QALY. For context, the social value of a QALY set by the government, that is how much we would be willing to pay as a country, is £70,000, which indicates that the wage increase would be a quite expensive way to achieve better care outcomes. However, estimates of the cost per QALY varied by support setting (community or care homes) and by the size of wage increase. They were also based on a number of assumptions, and many benefits, such as how a wage increase would affect staffing, and costs, such as higher national insurance contributions for employers, were not included.
This work provides evidence about how policies aimed at improving staff retention and filling job vacancies could have knock-on effects on the care outcomes of those supported by social care. The results suggest that improving wages in social care could be one way to improve care outcomes. In addition, by putting monetary value to these improvements in care outcomes, we can begin to show how valuable social care staff are in the delivery of social care. This will ultimately enable appropriate decisions on the level of funding for social care in England.
