Social Care Workforce Training and Wellbeing: An Intersectional Lens for Integrated Care

Background: In England, integrated care systems (ICSs) rely heavily on the workforce to deliver coordinated, person-centred support across the health and social care sectors. Yet the workforce faces persistent shortages and inequalities that undermine its capacity and wellbeing, particularly frontline social care workers. Women make up the majority of the care workforce, who often experience poor pay, insecure contracts, and limited career progression. Migrant and minority ethnic women face further challenges, including systemic racism, restricted training opportunities, and lack of recognition of prior qualifications.

 

Therefore, this study explored the training needs and wellbeing of domiciliary care workers, in the social care sector, at the intersection of race, gender and migration. As domiciliary care workers act as a bridge between health and social care by supporting individuals in their homes, this study has implications for how ICSs can strengthen workforce capacity, skills and inclusivity.

 

Method: A robust qualitative study design was chosen to conduct thirty semi-structured online interviews with participants based in England. The sample included 18 social care workers, comprising migrant women (n=13, minority ethnic) and non-migrant women (n=5, White British), as well as 12 policymakers. Semi-structured interviews allowed for nuanced exploration of the participants unique experiences. An intersectional lens was used to understand the barriers experienced by women in the social care workforce.

 

Results: Participants reported significant stressors undermining workforce capability and sustainability. Social care workers described physical and emotional exhaustion, compounded by low pay, inadequate leave, and insecure employment. Migrant women reported discrimination, racism, and difficulties having their qualifications recognised, which restricted progression and diminished their sense of capability. Training gaps, for example, rushed onboarding, unpaid shadowing, and inconsistent refresher courses left workers feeling unprepared and undervalued. While training was generally welcomed, financial and logistical challenges limited its effectiveness.

Limitations

The diversity of workforce experiences may not be fully represented, as the study focused primarily on women. The sensitive nature of discussing race and gender may also have constrained some responses. Including men in future research would offer additional insights into gender dynamics and career progression within a female-dominated sector, strengthening understanding of how workforce inequalities affect the delivery of integrated care.

 

Implications: These findings demonstrate how entrenched inequalities in social care weaken the very workforce upon which integrated care depends. Without inclusive workforce strategies, ICSs risk compromising workforce capacity, skills and long term resilience of the workforce. Integrated care can make a positive contribution by:

• Developing and implementing inclusive workforce strategies that recognise and value diverse skills and lived experiences.
• Collaborating with wider agencies to design equitable and accessible training pathways that build workforce capability.
• Advocating for structural change in contracts, pay, and recognition of qualifications.
• Investing in a diverse workforce to strengthen capacity, skills and inclusivity across systems.

Embedding intersectional perspectives in workforce planning ensures that integrated care not only supports staff wellbeing and retention but also contributes to workforce capacity and capability as well as contribute to reducing inequalities in service delivery and outcomes.