Policy Research Programme - Investigating Variation in Pay in Adult Social Care

Timetable and Budget

Description	Deadline/Limit
Deadline for Stage 1 Applications	04 October 2022, 1 PM
Notification of outcome of Stage 1 Application	December 2022
Project Start	Within 2 months of outcome notification
Project Duration	12 Months
Budget	£250,000 per project

Introduction 

The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a single research project to investigate variations in pay and reward in the adult social care workforce. Up to £250,000 is available to support this research over a 12-month period, but shorter, lower cost project proposals are encouraged where feasible. 

This research should consider the following questions:

• What pay and reward systems are used across adult social care? 
• What skills-based and experience-based pay systems are used? How do these link to progression of staff? 
• How much of the variation in models and systems of pay and reward is explained by local authority (LA) background factors and variation in LA fees?
• What are the underlying causal drivers for differences in pay and reward in the sector?
• Are some models of pay and reward linked to positive outcomes for the workforce, such as improved retention or more developed skills?

This evidence will support policy makers in the Department of Health and Social Care (DHSC) by providing evidence to inform decisions on policy interventions targeted at the adult social care workforce. 

Background

The social care workforce includes over 1.5 million people caring for some of the most vulnerable people in our society, doing work that is fundamental to supporting quality of life. With an ageing population the importance of this workforce will continue to be highlighted. However, there are growing challenges. 

Workforce capacity is a key issue in adult social care. The number of filled posts in the sector has fallen by 3% (50,000 posts) between 2020/21 and 2021/22, and the number of vacant posts has increased by 55,000 (52%) over this period. Reduced workforce capacity may compromise providers’ ability to ensure continuity of care and could negatively impact the experiences of care recipients. Access to care (including for those discharged from hospital) depends heavily on workforce supply and so staff shortages represent a risk to care users, carers, NHS services, and LA finances.

Evidence consistently points to remuneration as a key driver of workforce supply, with low pay driving churn across, and out of, the sector. Pay is often cited as a principal barrier to workforce recruitment, retention and recognition. A range of evidence shows that care workers who are paid more are less likely to leave their role: The Skills for Care state of the sector report [1] demonstrates that pay is a key driver of turnover; 'Recruitment and retention in adult social care services' [2] found that a flat pay structure had made it challenging to maintain capacity in the sector; and 'Job separation and sick leave in the long-term care sector in England' [3] concluded that wages and employment conditions significantly improve staff retention in the sector.

Most of the adult social care workforce are employed by independent providers who set their pay and terms and conditions. The majority are paid at or just above the National Living Wage. Around 1 million jobs are care worker roles with relatively flat structures, and half have no relevant qualifications. 

However, there is some variation in how providers set pay within the sector. This variation has several dimensions and can be in terms of the basic hourly pay rate for care workers; differentials for more senior or experienced staff; and (a balance with) wider terms and conditions. For example, some providers may choose to pay the UK Living Wage or above for care workers, while others may have a stronger offer for more senior staff, or have lower core pay but with greater investment in training. 

We currently lack robust evidence on variation in pay models, how providers make decisions on pay, and the impact that variation in pay has on workforce and care outcomes. We want to understand the factors driving variation in pay models, including the extent to which pay decisions are driven by local conditions and LA fees. This will contribute to our understanding of the influence that government may have on pay in a private market.

Government-led initiatives to improve workforce capacity include the Workforce Recruitment and Retention Funds (WRRFs) which provided temporary funding to LAs which allowed providers to choose to support bonus pay or bring forward annual pay increases. An internal evaluation of the WRRFs is being undertaken and is not a focus of this research. 

Research required 

We require evidence to help understand variation in how pay is structured in adult social care, including variation in base pay for care workers, as well as in other factors of reward such as differentials for more experienced staff and pay-related and non-pay related benefits. It should explore geographical differences and test the extent to which local conditions and variation in LA fees explain variation in provider pay models.

We want to explore how providers make decisions about how they set pay, and which factors explain variation in pay models between providers. This will also help us to better understand the rationale used by providers when setting pay. 

The research should also investigate the relative value of different aspects of pay and reward in influencing employees’ decisions about where to work. This could be based on stated preferences or revealed preferences.

This research should include a substantial quantitative element, exploring variation in provider-level pay using existing data sources (such as the Adult Social Care Workforce Dataset and/or an individual providers’ detailed Human Resources (HR) data in partnership with a suitable provider). It would also be likely to involve undertaking qualitative research with providers and care workers, such as through surveys and focus groups. 

Case studies of individual examples of best practice would also make it possible to improve guidance to care providers on pay and reward to enable them to strengthen their workforce capacity.

Research scope

The focus of this research is national and we expect applicants to set out how they will explore geographical variations in pay and reward systems.  

There are a range of organisations and settings in which the social care workforce is employed. This research should consider ways to collect evidence from the workforce employed in different types of Care Quality Commission registered providers. If proposals focus on one type of provider or provider dataset, we would like the applicants to offer suggestions for how they will also gain insights from other types of providers (e.g., private and voluntary run care providers). 

Staff groups to include are primarily care workers and senior care workers where there are significant evidence gaps. Research on pay for other staff groups (e.g., nurses, social workers) employed by care providers is also of interest but this should be balanced with the need to prioritise key evidence gaps identified among direct care staff. 

Existing research

This research is expected to avoid crossover with ongoing DHSC led evidence and analysis including an evaluation of the Workforce Recruitment and Retention Funds. These funds were allocated to local authorities from October 2021 to March 2022 in order to support workforce capacity in the sector. Local authorities and providers used the funds to support some measures related to pay and reward, including bringing planned pay uplifts forwards, paying retention bonuses, and increasing overtime rates. An evaluation of the WRRFs will be published in Autumn 2022. It will not include a specific assessment of the impact of individual measures but will evaluate the programme as a whole. Officials in DHSC will, as far as possible, enable access to relevant existing research and evaluations and to relevant policy documents. 

Researchers should be aware of NIHR and other funded research with relevance to this topic, notably research funded through the NIHR Policy Research Unit in Adult Social Care and the Personal Social Services Research Units: ‘Retention and Sustainability of Social Care Workforce’ project. 

Technical requirements 

This research will likely involve a mixed methods approach, drawing on quantitative methods to explore existing data sources and primary qualitative fieldwork.

Whilst a mixed methods approach is likely to be required, given the substantive quantitative and qualitative components of our research priorities, we are not prescriptive on methodology or disciplinary background of the research team, other than to note that a range of expertise is likely to be required. 

Outputs 

It is envisaged that the main phase should include the following outputs: 

• An interim report/findings after 6 months.

• A draft publishable report and final publishable report, with executive and lay summary in a form suitable for policy colleagues in a 1:3:25 format

• A presentation of findings to DHSC colleagues and key stakeholders.

Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to meet key policy decisions and timescales, so resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting. 

Budget and duration

The maximum budget agreed for this research is for proposals up to £250k. 

We expect the research will take up to 12 months, with interim findings reporting after 6 months. 

Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.

All applications are expected to start within 2 months of funding being agreed, subject to pre-contract negotiations and specific requirements.

Management arrangements

Policymakers will need research evidence to meet key policy decisions and timescales, so resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting.

A research advisory group including, but not limited to, representatives of DHSC, other stakeholders such as Skills for Care and the successful applicants should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:

• Provide regular feedback on progress

• Produce timely reports to the advisory group

• Produce a final report for sign off

Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.

New Guidance on Health Inequalities data collection within NIHR PRP Research: 

Health Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects. We are now assessing all NIHR research proposals in relation to health inequalities. We are asking applicants to identify in their application whether or not there is a health inequalities component or theme and how this research hopes to impact health inequalities. We are also asking researchers to collect relevant data, if appropriate for the research. Our goal is to collect information on health inequalities in research and data relating to the main outcome(s) of the proposed research. Please clearly identify in this section whether or not your application has a health inequalities component or relevance to health inequalities and detail the core set of health inequalities breakdowns that will be reported; if none please explain why. We understand that research projects have different methodologies and focus on different populations, so please explain what data will be collected and reported for the methodology you plan to use. If a health inequalities component is not included, please explain why this does not fit within your proposed research. This should only be a few sentences.

For quantitative research we would ideally like researchers to provide one-way breakdowns of their main outcome(s) by the following equity-relevant variables: age, sex, gender, disability, region, 5 ONS Ethnic groups, and the 5 IMD quintile groups. If more detailed cross tabulations are appropriate, please include these. This table should be submitted to NIHR PRP at the end of the project. Due to data limitations, judgement calls may be necessary about which breakdowns to report and whether to merge categories to increase counts in particular cells; we ask you to make these judgement calls yourself, bearing in mind our data curation aim of enabling future evidence synthesis work in pooling results from different studies.  More details and an example table can be found in Appendix A. 

For qualitative research projects, this can be purely descriptive statistics giving the number of observations against the various variables.

Further details about this new request can be found in Appendix A. 

We will also be holding a Health Inequalities in NIHR PRP Research Q&A Event on 19 September 2022, more details in APPENDIX B. 

References and key documents

1. Skills for Care (2021). The state of the adult social care sector and workforce in England. [Accessed August 2022]
2. Moriarty, J., Manthorpe, J. and Harris, J. (2018). Recruitment and retention in adult social care services, King’s College London, Social Care Workforce Research Unit, 2018. [Accessed August 2022]
3. Vadean, F. & Saloniki, E (2021). Job separation and sick leave in the long-term care sector in England, GLO Discussion Paper, No 994, 2021. [Accessed August 2022] 

Appendix A: Further Detail on the New Guidance on Health Inequalities data collection within NIHR PRP Research

Health Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects. We are now assessing all NIHR research proposals in relation to health inequalities. We are asking applicants to identify in their application whether or not there is a health inequalities component or theme and how this research hopes to impact health inequalities. We are also asking researchers to collect relevant data related to health inequalities, if appropriate for the research. Collecting specific information about health inequalities in research submitted to the programme will allow for categorisation of health inequalities research, curation of data to aid future health inequalities research and enable policymakers to better understand the implications of health inequalities within their policy areas. This is a new request from the NIHR PRP and we will be continuing to monitor queries and adapt the process as needed. If you have any feedback on this new request, please contact us at prp@nihr.ac.uk. 

Our goal is to facilitate more widespread and consistent reporting of health inequality breakdown data relating to the primary outcomes of NIHR funded research. We would ideally like researchers to focus on the following equity-relevant variables: age, sex, gender, disability, region*, 5 ONS Ethnic groups**, and the 5 IMD quintile groups. These variables are considered an ideal, but we understand that these are subject to change depending on the sample population and specific research question.  

For qualitative research projects, this can be purely baseline characteristics of the participants, for example, the number of participants in each ethnic group. 

For quantitative research projects, if there are multiple outcomes/effects with your stakeholders, select a small number of main outcomes as appropriate to report equity breakdowns. We will not be prescriptive about the number of the outcomes, as it will depend on the number of study design types and the nature of the project aims. We are asking for one way cross tabulations of each primary outcome by these equity-relevant variables, if appropriate for your research, together with the number of observations in each cell. If more detailed cross tabulations are appropriate for your proposed research, please include these as well. This request applies to both primary data collection studies and secondary analysis of routine data, and to causal inference studies as well as descriptive studies; however, if this is not possible due to data limitations then please explain. Due to sample size and other data limitations there may be difficult scientific and/or data security*** judgement calls to make about which breakdowns to report and whether to merge categories to increase counts in particular cells; we ask you to make these judgments yourself, bearing in mind our data curation aim of enabling future evidence synthesis work in pooling results from different studies. We also ask that researchers report breakdowns for the unadjusted as well as adjusted outcomes/effects, as appropriate.

We understand that research projects may employ different methodologies, and focus on different populations. Please explain how the variables and data collection methods chosen are appropriate to the methodologies used. 

We ask that you please clearly identify in the research plan section of the application whether your application has a health inequalities component or not and detail the core set of health inequality breakdown data that will be collected, if applicable. Submission of the data collection will be a condition of the final report for all research with relevant methodologies regardless of whether the research has a health inequalities component that will need to be submitted to NIHR PRP when the grant has finished. This should only take a few sentences within the research plan section. 

* Table below uses the nine regions in England, further regions can be used if using the UK as the study population. Please report region breakdown for large samples in nationally representative descriptive studies. There is no need to report this for small sample studies, for sub-national studies, or for quasi-experimental studies where it would require time-consuming re-estimation.

** White, Mixed/ Multiple ethnic groups, Asian/ Asian British, Black/ African/ Caribbean/ Black British, Other ethnic group. If the sample size is small then it is fine to report only some of the requested equity breakdowns and to merge some of the sub-groups as appropriate.

*** For guidance on how to handle data security concerns in reporting of sensitive data please see ONS guidance.

Example data table for submission at the end of the funded research project

(N.B. If there is more than one main outcome then you will require more tables and if you adjust your outcome then you will need two tables for the adjusted outcome and unadjusted outcome. For other methodologies, variable vs number of observations may be more appropriate to record participant data). This table is for an example only. It does not contain sub variables and does not illustrate any preference for certain variables, as these will be dependent on the proposed research.

Variable		Outcome (an appropriate average for this subgroup, usually the mean)	Number of observations	Additional information about variation if appropriate, e.g. range, standard deviation
Age		-	-	-
Sex		-	-	-
Gender		-	-	-
Disability		-	-	-
Ethnic Group		-	-	-
IMD Group		-	-	-
Region		-	-	-

Appendix B: Health Inequalities in NIHR PRP Research Q&A Event

This event will take place on Monday, 19 September 2022 from 2:00 - 3:00pm. There will be a discussion from the NIHR PRP, the Department of Health and Social Care and other panellists followed by the opportunity for a Q&A session to help applicants navigate this new request. Please register for the event using the google registration form for the event. Any questions that are not answered during the session will be anonymously answered and published in a FAQ document on the health inequalities webpage.