What about the workers?
Working with people with learning disabilities is often low paid, undervalued and demanding. Why do people do it, and how can this type of employment be reformed? asks Jan Walmsley
“I wish my employer treated me as well as they expect me to treat my clients.” This comment, from a young woman working in a residential home, says a lot about what is wrong with the way we treat the learning disability workforce.
The workforce is the least regarded element of the puzzle about how to ensure a good life for people with learning disabilities. Yet it is probably the most important.
I recently spent time with five women who work with people other services have rejected. What made them stay in a such a low-paid, undervalued and difficult job? The answers were heart-warming. The pride when someone makes a tiny step forward – Frankie had that day managed breakfast at a cafe. “When we have a bad day, I’ll be able to remember that.” Another talked of going home every day with cuts and bruises, wondering if she could have done things differently to prevent yet another urinary infection, the cause of the person’s distress.
What else helped? First, knowing you can call on your mates when you need to. Next, positive management processes, including mentoring, supervision, praise when they had done well and noticing when things were not going so well. These were in place but, because of staffing shortages, not consistently practised. So the difficulties of recruitment and retention feed on themselves. It is no surprise that the first thing on the risk register of this and many similar organisations is recruitment, closely followed by retention.
A bit of history
We live with the legacy of the institutional era. The institutional workforce was technically a medical one. The medical superintendent, a psychiatrist, ruled. Nurses and auxiliaries did the hard work, and therapists would visit. Staff shortages dogged these institutions and, indeed, may have played as big a part in the decision to close them as nobler motives.
Outside institutions in the 1950s and 1960s, attempts were made to introduce training courses for people working in occupation centres (work-based centres that were precursors to day centres) and hostels, but most staff were unqualified.
In 1961, eminent academic Richard Titmuss observed prophetically: “We are drifting into a situation in which, by shifting the emphasis from the institutions to the community which in principle and with qualifications we all applaud – we are transferring care from trained staff to untrained staff or ill-equipped staff or no staff at all” (Welshman and Walmsley, 2006).
In 1979, Dame Peggy Jay, investigating nursing, advocated for a new profession – a hybrid of nursing and social work suitable for the new era. She was ignored. So we have rubbed along with an unqualified and poorly paid workforce.
Ambivalence over pay and conditions
It is easy to blame the government, and it would not be unjustified. However, there is also ambivalence within the sector about better pay and conditions. People supporting normalisation back in the 1980s regarded support workers as a route into community connections. Workers were encouraged to share family and friends, to help clients build relationships – you do not need a professional qualification for that.
Social model thinking is resolutely opposed to professionalisation and views it as preferable to employ a personal assistant with no care training baggage. Add to this the distaste for making money on the back of other people’s impairments and the low value traditionally assigned to women’s work of caring, and you have a situation ripe for underinvestment.
Inherent tensions are intensified by admirable initiatives like Stay Up Late. Who could argue that people with learning disabilities shouldn’t be able to go out and enjoy themselves, unconstrained by shift patterns? But, if you are the worker, how do you manage childcare, a social life or care for elderly relatives if you don’t know what time your shift ends?
Too much altruism: time for a rethink?
It is time to think again. We desperately need to attract and keep good people. There are great people in the sector but it relies too much on altruistic commitment and too little on good conditions of work, a half-decent salary and prospects for advancement.
We should look hard at social pedagogy – the basis of qualifications for people working in childcare and learning disability in several European countries. It makes sense to make learning part of the qualification for working in the sector we call learning disability.
It is going to take a while to get momentum to reform the learning disability workforce. In the meantime, we have an underpaid, stressed and undervalued workforce. We know that good support makes all the difference. So what can be done? Asking people endlessly to turn the other cheek and to give to others is asking a great deal, certainly more than I would be willing to do.
“It relies too much on altruistic commitment, and too little on good working conditions, salary and career prospects”
Two friends have started a social enterprise, Sustainable Source (www.sustainablesource.org.uk), which is dedicated to supporting workers. There is something important here, about giving people space and time out to replenish their reserves and understand what is happening. As a partial solution to a very pressing problem, it is worth a second look.
Jan Walmsley is an independent researcher
Reference
Mitchell D, Welshman J (2006) In the shadow of the Poor Law: workforce issues. In: Welshman J, Walmsley J, eds, Community Care in Perspective. London: MacMillan: 194
