Background
Enabling adults with needs for care and support to live well and safely is central to social care policy making. Concerns about elder abuse and other harms to care users means criminal record checks have long been a recruitment requirement for care workers as part of preventative policies internationally (Sethi et al., Reference Sethi, Wood, Mitis, Bellis, Penhale, Iborra Marmolejo, Lowenstein, Manthorpe and Ulvestad Kärki2011). Checking processes vary widely between countries in terms of stated policy purposes, attitudes to rehabilitation and privacy (Manthorpe and Lipman, Reference Manthorpe and Lipman2015). Such policies are designed to deter people with certain serious criminal records from applying to such jobs and to alert potential employers to applicants’ histories so that informed judgements can be made about suitability and risks. However, such processes may deter applicants who might be effective care workers thereby undermining policy efforts to provide sustainable social care and to promote employment rehabilitation among offenders. In the United Kingdom (UK) (England, Scotland and Wales and Northern Ireland) this is of consequence as 11 million people have criminal records (House of Commons Work and Pensions Committee, 2016). Many of them are at risk of unemployment; the financial and social implications of this may lead to homelessness, recidivism or mental health problems (Ministry of Justice, 2013).
This article reports on a scoping review which was undertaken to shed light on this topic in the English context through consideration of national and international literature (predominantly located from the United States (US)) and to identify and discuss gaps in the evidence.
Training people who are struggling to find employment and have criminal records to work in a sector suffering workforce shortages might appear to be a logical approach for policy makers in England. However, this needs to take into consideration the climate of fear of elder abuse and unsafe care which can be partly explained by a history of high-profile scandals in care homes in England in the last decade (see e.g. Manthorpe et al., Reference Manthorpe, Njoya, Harris, Norrie and Moriarty2016).
People seeking employment as care workers in registered health and social care services in England (and Wales) must register with the Disclosure and Barring Service (DBS) (similar processes apply in Scotland and Northern Ireland). Demand for DBS checks has increased over recent years with annual requests for disclosures rising from 3.8 million in 2012 to almost six million by April 2019. The numbers of people added to the DBS-maintained lists of individuals barred from working with children or vulnerable adults has risen from approximately 54,500 in 2012 to 73,500 by April 2019 (DBS, 2019). DBS checks are not compulsory, however, for directly employed care workers, often referred to as Personal Assistants (PAs) in England, who are a small but growing part of the care workforce (Woolham et al., Reference Woolham, Norrie, Samsi and Manthorpe2019a).
The DBS has been criticised by some policy commentators for being disproportionate, failing to prevent crime or identify repeat offenders, being expensive to administer and highly stigmatising (Appleton, Reference Appleton2014). The government in England is presently (mid 2019) considering reviewing the system’s details following a successful appeal brought to the Supreme Court by four people who claimed their careers had been negatively affected by having to or failing to disclose old and minor convictions (to their employer in sectors that involve work with children and adults with learning disabilities) (Supreme Court, 2019). The Supreme Court judges ruled that the way criminal records are disclosed to employers infringed Article 8 of the European Convention of Human Rights with regards to having to disclose convictions however minor if there is more than one, and where warning/reprimands given to young offenders have been issued. Such changes indicate the shifting policy landscape surrounding rights of privacy and possibly competing rights to protection.
Such policies are also affected by Brexit (proposed separation of the UK from the European Union) which has potential implications for the long-standing problematic recruitment and retention of care workers in England (National Audit Office, 2018; Read and Fenge, Reference Read and Fenge2019). There were 985,000 care worker jobs in adult social care in England in 2016-17 (Skills for Care, 2018c). There is currently one care worker for every 3.4 people aged over seventy-five in England: to maintain this ratio as the population ages, the social care sector will need an estimated 380,000 more staff by 2026. While social care is currently recruiting 18,000 British workers annually, the sector remains highly dependent on recruitment from other countries (Global Future, 2018). Currently there are an estimated 110,000 unfilled care work vacancies in England (Skills for Care, 2018c). Although levels of morale are often high, and the work is personally rather than economically rewarding (National Audit Office, 2018), the current high levels of employment in most parts of England mean that care work may remain economically unattractive and other alternatives beckon.
People with criminal records might therefore be a new labour pool from which care employers could draw upon. A support organisation for people with criminal records (Unlock, 2019a) highlights that 33 per cent of men and nine per cent of women in England and Wales were convicted of an offence before the age of fifty-three. The majority of them received criminal records for relatively minor offences: for example, pickpocketing, shoplifting, street robbery or robbery with no serious implications, and only eight per cent of people with criminal records were incarcerated (Skills for Care, 2018b).
In England DBS checks are undertaken at i) basic, ii) standard, iii) enhanced or vi) enhanced (with barred check) levels, depending on what role is to be undertaken and if it is required. The costs of undertaking a DBS check (usually met by the potential employer) depend on the level of check undertaken. A basic disclosure checks a person’s criminal history for ‘unspent’ convictions and cautions and is used for all types of job applicants. A standard disclosure checks an applicant’s criminal history for spent and unspent cautions, warnings, reprimands and convictions. ‘Spent’ convictions or cautions are those which, under the terms of Rehabilitation of Offenders Act 1974, can be effectively ignored after a specified amount of time. An enhanced DBS check will detail any spent or unspent convictions an applicant has, as well as any reprimands, warnings or cautions received; in addition it provides the opportunity for the local police authority to disclose any additional information they hold, if they deem it relevant. An enhanced with barred check furthermore includes the additional searching of the DBS maintained list of individuals who are barred from working with vulnerable adults or children. Automatic barring offenses include serious crimes such as murder as well as sexual offences. To knowingly employ someone barred by the DBS to work in ‘regulated’ activity (i.e. one which involves close/unsupervised work with children or adults at risk) is a criminal offence. Employers however should not reject a potential care worker based on their criminal record, as this could put them at risk of a discrimination claim under Section 10 of the Equality Act 2010. Instead, employers should request a disclosure statement or criminal record self-declaration from the job candidate, complete a criminal record risk assessment and hire or reject on the basis of this information (Skills for Care, 2018b). In general, some convictions, depending how long ago they took place, will be ‘spent’ after a fixed period (and will not be revealed on DBS checks); however, for ‘regulated activities’, convictions are never spent (or protected) and are always revealed to employers. The organisation requesting the check must have someone in place to undertake suitability decisions. Skills for Care Guidance (2018b) states that:
‘Employers shouldn’t apply a one-size-fits-all approach when determining the suitability of an applicant with a criminal record as there are a wide variety of roles across the social care sector. A person’s criminal record may indicate they’re less suited to working in regulated activity with adults. However, they could be more suited to work in an ancillary role such as administration, facilities management, etc. An assessment of an applicant’s skills, qualifications, experience and offence circumstances should be considered alongside: the environment they will be working in, the nature of the work to be carried out, the tasks the person will perform, and the level of supervision they will receive’ (ibid: 29).
The policy of personalisation, as it was implemented in England, highlighted the potential for PAs or directly-employed care workers to enrich the social care labour pool (Baxter et al., Reference Baxter, Wilberforce and Glendinning2011) by attracting people who might not have considered this area of work previously. Its implementation emphasised that people who were acquaintances, neighbours and kin might be highly suitable for this work with care users who are known to them. It stressed that choice and control of such labour would assist care users in having greater continuity of support and better outcomes. As part of this direct employment relationship (or self-employment status), checks of references, criminal record status and other matters are not mandatory but are the responsibility of employers: namely, employing care users or their proxies (e.g. such as a voluntary sector group or a local authority). PAs themselves are only able to request a basic disclosure and a third party is needed to obtain an enhanced certificate for which they must pay (Skills for Care, undated).
Implications for adult protection were initially overlooked (Ellis and Preston-Shoot, Reference Ellis and Preston-Shoot2012; Ismail et al., Reference Ismail, Hussein, Stevens, Woolham, Manthorpe, Aspinal, Baxter and Samsi2016), and it is acknowledged that there is limited oversight of the PA role, since in England care workers are not regulated or registered workers.
Thus, social care workforce policy, safeguarding policy, and employment policy (in both private and public domains) mean that people undertaking similar work to care workers employed by registered agencies are required to meet different requirements and, specific to this article, DBS checks are not compulsory for directly employed/self-employed care workers (PAs) in England. This reflects international observations that care work is associated with ‘limited coverage under labour laws and regulations’ (England and Alcorn, Reference England and Alcorn2018: 446). The rise of state-funded but directly employed care workers, often part of consumer-directed care, is also an international policy development (see O’Shea and Bindman, Reference O’Shea and Bindman2016 for discussion of the US context). Haimowitz and Rio (Reference Haimowitz and Rio2014) write that the Patient Protection and Affordable Care Act of 2010 mandates that US States establish background checks for nursing home direct care staff and, in practice, employers are required to provide individualised consideration of a candidate with a criminal record (as a constitutional right to due process).
Turning to other policy contexts there is substantial evidence that unemployment is not conducive to rehabilitation and reintegration into society by former prisoners. Policy makers have noted positive associations between participation in education/employment in prisons and reduced re-offending, which in turn reduces pressure on and expense of the criminal justice system (Ellison et al., Reference Ellison, Szifris, Horan and Fox2017; Ministry of Justice, 2018). Organisations supporting people with criminal records report continued problems in accessing employment by former prisoners, at system level due to a combination of reductions on public expenditure and the ‘irredeemably flawed’ (Her Majesty’s Inspectorate of Probation, 2019), part-privatisation of probation services in 2014 which allowed private firms to monitor low and medium-risk offenders (Dearden, Reference Dearden2018).
The government in England is currently adopting more rehabilitative policies with its adoption of Ban the Box employment strategies for civil servants (where criminal record disclosures are abandoned at initial recruitment stages). Other policy options are being canvassed such as possible reduced National Insurance contributions (taxes) for employers who recruit people with criminal records (House of Commons Work and Pensions Committee, 2016).
Low rates of unemployment in England mean that some individuals who are furthest from the workplace and wish to apply for roles in social care may also be those in need of additional support: for example, people who have just left prison, those with mental health problems, addictions, or learning disabilities. Richardson and Flower (Reference Richardson and Flower2014) considered women with criminal records face dual disadvantage – they are judged more harshly than men for their law breaking and female-dominated sectors, like social care, are also those where DBS checks are most stringently applied. Politicians, such as David Lammy MP (Reference Lammy2018) meanwhile have recently highlighted the disproportionately high numbers of people with black, Asian or minority ethnic (BAME) backgrounds in the criminal justice system in England. The care sector employs high rates of BAME workers and managers (20 per cent in 2016-17; National Audit Office, 2018) and may be rejecting potentially suitable candidates on the basis of having a criminal record.
It is in this policy context that this scoping review was undertaken. The function of a scoping review is to identify where gaps in the evidence may lie and this work aimed to establish the evidence base about the potential for individuals with criminal records to gain employment as a care worker in social care. This scoping review therefore addresses a range of policies: priorities to meet social care workforce demand, to provide choice and control to care users, to protect vulnerable adults, to promote employment among those stigmatised by criminal histories, and to reduce recidivism. Our focus on one particular question illuminates some of the possible tensions between such goals.
Method
We undertook a scoping review using a search strategy based on the mnemonic PICo: Population, phenomenon of Interest, Context and Outcome (Glasper and Rees, Reference Glasper and Rees2016). The review examined international, English language, scientific and grey literature and was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation (Tricco et al., Reference Tricco, Lillie, Zarin, O’Brien, Colquhoun, Levac, Moher, Peters, Horsley, Weeks, Hempel, Akl, Chang, McGowan, Stewart, Hartling, Aldcroft, Wilson, Garritty, Lewin, Godfrey, Macdonald, Langlois, Soares-Weiser, Moriarty, Clifford, Tunçalp and Straus2018).
The review was undertaken in September-December 2018 using the following databases: Ovid (PsychInfo; Embase, Social Policy and Practice) and Proquest (covering Proquest for Social Science Premium Collection), ASSIA (Applied Social Science Index and Abstracts) and Social Care Online. It was funded by the National Institute for Health Research (NIHR) Policy Research Programme. We hand searched the reference lists of included studies and relevant reviews. Grey literature was searched for publications related to people with criminal records (also referred to as ex or former offenders) and social care roles. Studies published from 2008-2018 and in the English language were selected to reflect recent policies. The focus of the review was on social care staff (social workers, care workers, PAs, and roles such as cook and gardener, in social care workplaces) rather than community nursing roles which in England are usually part of the NHS, not social care. Studies were excluded which referred to offenders under the age of eighteen years. Duplicates were removed; abstracts and titles of potential articles were screened and relevant grey material was selected for further investigation. Table 1 and Figure 1 present the search strategy and a flow diagram of the study and item selection.
Table 1 Search strategy and inclusion and exclusion criteria for scoping review
Figure 1. Literature review flowchart based on a PRISMA flow diagram.
A total of 9,018 items were identified of which fifty were included where the primary focus of the study was people with a criminal record and social care work. For this article twenty-one studies were included out of the fifty which focus on care workers and directly-employed care workers/PAs (see Table 2 and those studies asterisked in the references thus *).
Table 2 Literature identified about people with criminal records working in the care sector
This article addresses the primary policy question:
What is the potential for people with criminal records to undertake employment as care workers and PAs in the social care sector?
Secondary questions addressed: 1) whether people with criminal records are currently employed as care workers and PAs, and is there interest in this group in this work; 2) are employers willing to hire people with criminal records; and 3) are educators preparing people with criminal records for such work?
Findings are presented under three themes: policies affecting people with criminal records, employment policies, and education or training policies. The gaps in evidence within these categories are highlighted as pointing to future areas of research. Many different terms are used to refer to people with criminal records (e.g. ex-offenders or felons) but for ease of reading we use the phrase ‘people with criminal records’ in this present article.
Findings
Policies affecting people with criminal records
In this section we report the evidence that people with criminal records are currently employed as care workers and PAs in England and their wishes or interest to undertake such work, relating this to policy goals as outlined above.
Overall there is little evidence about whether people with criminal records are currently employed as care workers or as PAs – or if they wish to work in social care. Given the high numbers of people with criminal records in the UK, the size of the care workforce and its vacancies, it would be surprising if some people did not have jobs in the sector, but statistical information is limited. Davis (Reference Davis2017) reported that 13,000 people who applied for care jobs (which requires an application for a DBS check) had declared a criminal record. Of the approximately 60,000 offences that were noted by the DBS, more than 15,000 were for theft-related offences. A small number of these ‘would be carers’ included people convicted of serious offences; twenty-six people had been convicted of either murder, manslaughter or killing somebody while driving dangerously or carelessly. An earlier media report (Bingham, Reference Bingham2012) discussed a British Broadcasting Company (BBC) investigation of care agencies commissioned by local authorities across England and found many were failing to carry out ‘police checks’ when employing people as home care workers thereby potentially leaving care users at risk.
Information about applying for jobs as a care worker or PA is supplied by agencies supporting people with a criminal record, suggesting there is an interest in gaining employment in the sector. The charity Unlock! (2019b), for example, provides online job-seeking advice for people with criminal records on its recruitment website and presents case studies of ‘bad practice’ where people with criminal convictions were turned down for jobs incorrectly due to misuse or misunderstanding of the DBS regulations including care work. The National Association for the Care and Resettlement of Offenders (NACRO, undated) offers advice about working in the health and social care sector. NACRO advises potential applicants that factors such as nature of offence, degree of risk to service users, age of offence, seriousness of offence, and evidence of good character will be relevant and that individuals should prepare their disclosure statement and references. The care sector employment body, Skills for Care (2018b), publishes accessible guidance for employers.
There is a wide range of literature from the US describing prison inmates undertaking care worker roles in the US and the potential for any skills obtained to be applied once ‘through the gate’ or on release. Some US prisoners have been trained as specialist end-of-life care workers (Maschi et al., Reference Maschi, Marmo and Han2014). A main theme of this literature is the dedication of the prisoners to this work (e.g. Cichowlas and Chen, Reference Cichowlas and Chen2010; Loeb et al., Reference Loeb, Hollenbeak, Penrod, Smith, Kitt-Lewis and Crouse2013). Also mentioned is how, in a hyper-masculine prison environment, some inmates appreciate a rewarding, caring role and found ‘giving back’ therapeutic (Cloyes et al., Reference Cloyes, Rosenkranz, Wold, Berry and Supiano2014). However, information about whether inmates gained employment in this sector on release from prison is lacking.
In England there is some evidence that inmates are increasingly undertaking social care tasks for a cellmate or others, such as assisting with dressing, eating and mobility, due to staff shortages combined with rises in numbers of older people detained (HMIP, 2018). A report focusing on the lives of prisoners aged eighteen to twenty-one years old concluded that ‘with appropriate safeguards, prisoners could play an essential role as carers for the increasing number of elderly and other prisoners who are unable to adequately look after themselves. Despite the clear growing need, the requirement under the Care Act 2014 for that need to be met and the potential of prisoner carers to have an important part in doing so, we have found surprisingly few effective prisoner carer schemes.’ (HMIP, 2016: 7). This report also highlighted a Prison Service Instruction (PSI) (PSI 17/2015), ‘The PSI requires that all prisons have the ability to mobilise assistance from other prisoners should it be needed for a prisoner who has a care and support plan or is awaiting a care and support needs assessment’. This instruction emphasises the need for appropriate selection, risk assessment, training, support and supervision of prisoners providing care to those with disabilities or additional needs (HMIP, 2016: 5).
Finally, from England, the Prison Reform Trust (Kimmett et al., Reference Kimmett, Jacobson and Biggar2011) outlined prison volunteering opportunities which might introduce prisoners to care worker type roles: for example, supporting disabled inmates in the prison gym or swimming pool, assisting with drug misuse support, or acting as disability or suicide prevention representatives. It acknowledged that few are involved in these roles and proposed that such opportunities should be developed with the support of voluntary organisations. Already, Samaritan-run prison listening services (see for example, Dhaliwal and Harrower, Reference Dhaliwal and Harrower2009) are common features of UK prisons.
Employment policies
Very little evidence emerged about the views of employers on hiring people with criminal records. More general data from England, however, have noted that many employers have pre-conceived negative ideas; a recent survey found 50 per cent of employers would not consider employing a person with a criminal record, regardless of the offence or sentence received (House of Commons Work and Pensions Committee, 2016).
Skills for Care guidance (2018b), noted above, throws some light on care sector employers’ attitudes and anxieties about recruiting people with criminal records, underscoring the importance placed on honesty in care work. Its guidance encourages employers to examine each applicant on their merits, stating that ‘a conviction for a serious violent or sexual offence may not be particularly relevant if the position applied for does not involve contact with any people in the normal course of duties’ (2018b: 29) which is not very likely in front-line roles. Employers are asked to consider if the post involves one-to-one contact, what supervision the post-holder will receive, whether the post-holder will have responsibility for valuables or finance, and how to minimise any potential risks. They are encouraged to explore any mitigation, insight into offending, and reassurances that problems have been resolved.
With regards to the views of care user employers (i.e. people who directly employ care workers/PAs), only one item of literature was located (Skills for Care, undated). Overall little is known about these employers’ views on deciding whether to undertake DBS checks and responses to any disclosures (ibid). A recent study of PAs’ views (Woolham et al., Reference Woolham, Norrie, Samsi and Manthorpe2019b) found that, while the vast majority thought that such checks would be appropriate, there was no requirement to undertake them. Interviews with wider stakeholders revealed varied opinions about whether such checks were appropriate in all cases, especially given the existing close relationship between some PAs and their employers. There is some evidence that the disparity between DBS checking requirements for agency employed care workers and directly-employed care workers can cause tensions or anxiety: for example, when working as a team, or when working both as an agency-employed care worker and as a PA (Moriarty et al., Reference Moriarty, Manthorpe and Harris2018).
More substantial evidence comes from a study undertaken in New York, US, that reported on people with criminal records who were recruited to work in social care and their subsequent re-offending rates (Denver et al., Reference Denver, Siwach and Bushway2017). New York (NY) formally prevents blanket bans of people with criminal records and requires the consideration of rehabilitation and good conduct information. The authors focused on criminal background checks conducted by one state-funded agency for a set of direct‐care, non-licensed jobs in nursing homes and home health‐care agencies. Their sample included care workers (2008-2009) with recorded criminal histories who had applied for and been provisionally hired to work in such jobs, conditional on passing the state‐mandated criminal background check. The authors estimated the causal impact of receiving a clearance to work on the subsequent arrests of individuals with criminal records who had been provisionally hired to work in certain non-licensed health-care jobs in NY (n = 6,648). Findings indicated a 2.2-percentage-point decrease in the likelihood of a subsequent arrest in one year and a 4.2-percentage-point decrease over three years. Men were 8.4 percentage points less likely to be arrested over the three-year period when cleared, compared with a 2.4-percentage-point (and non-significant) effect for women. Older women in particular were driving the non-significant results for women. However, the authors noted, ‘The base rates of arrest for our sample are not trivial (22 per cent over three years), and approximately 8 per cent of the sample has a felony subsequent arrest and 5 per cent has an automatic disqualifying subsequent arrest offense within three years’ (Reference Denver, Siwach and Bushway2017: 198). They concluded that the risks of employing people who might harm those they are caring for are ‘not a simple policy choice, and it is not immediately clear how to balance these costs better’ (Reference Denver, Siwach and Bushway2017: 198). Missing from this study is whether the offenses which individuals went on to commit were against vulnerable adults or colleagues, or were unrelated to their work.
Education and training policies
A lack of UK evidence was identified about processes where people with criminal records wish to undertake entry-level qualifications such as City and Guilds, National Vocational Qualifications (NVQs) in health and social care, or the Care Certificate (for those in work). Policy makers may have a few illustrative examples of such schemes to consider but there are few conclusions to draw about cost-effectiveness and scaling up from small-scale initiatives.
One current scheme in England, funded by the Department of Health and Social Care (DHSC) via Skills for Care supported by the Growth Company, was identified. People with a criminal record were supported to undertake a Level 1 course - ‘Preparing to work in care’. The aim is for learners to then complete the Care Certificate involving a work placement (Skills for Care, 2018). Details of outcomes such as whether students obtained employment in social care following this training need to be collated.
UK Prisons have for a long time supported peer mentoring schemes for example volunteering for the Samaritans (a suicide prevention charity), providing addictions support or housing advice for those soon to be released (e.g. Buck, Reference Buck2014). Although these opportunities are usually closely monitored, it is possible some individuals might be encouraged through this experience to consider working in social care roles. Stewart (Reference Stewart2011) described two schemes in England which trained prisoners to undertake care roles in prison. These prisoners were already working with older people, people with physical and learning disabilities, and those living with mental illness. Model 1 scheme took place at Her Majesty’s Prison (HMP) Shepton Mallet with support from St. Giles Trust and comprised an NVQ level 2 in Health and Social Care. Four prisoners took part in six initial training days followed by approximately six months of portfolio development. Model 2 scheme consisted of an unaccredited, informal, three-day training course (HMP Manchester and HMP Lewes). Eight prisoners participated. Schemes were evaluated for their suitability in their specific location. Activities included providing help and support, such as befriending, fetching meals, and helping other prisoners to tidy their cells. Recently Stewart and Lovely (Reference Stewart and Lovely2017) argued that, because many prisons already use informal prisoner-carers, offering some training would support these carers’ roles and contribute to higher standards of care.
A discrete theme of the US literature is the role prisoners play in the provision of end-of-life care (Cichowlas and Chen, Reference Cichowlas and Chen2010; Loeb et al., Reference Loeb, Hollenbeak, Penrod, Smith, Kitt-Lewis and Crouse2013; Cloyes et al., Reference Cloyes, Rosenkranz, Wold, Berry and Supiano2014; Wion and Loeb, Reference Wion and Loeb2016) although there was little insight on whether this leads to employment ‘through the gate’. Wion and Loeb (Reference Wion and Loeb2016) conducted a systematic review of literature about EOL care in prisons and suggest implications for nursing practice and areas for future research. Nineteen articles were included; all but one from the US. These describe a range of training programmes, from basic to one consisting of thirty teaching hours over four weeks. Some training topics were equivalent to those covered in certified nursing assistant programmes, including infection control, universal precautions, feeding, making a bed when occupied, transferring patients, post-mortem care, patient communication, stress management, the spiritual aspects of dying, dealing with grief and bereavement, and setting boundaries.
Collica (Reference Collica2013) addressed the benefits for female prisoners working in a US prison-based peer programme for inmates with HIV. She suggested their participation reduced recidivism and reported that experience gained meant women were able to obtain paid work in health/social care in the field of HIV on release.
Discussion
This review of evidence contains limited information about the potential for people with criminal records to undertake employment in the social care sector for policy makers in England. Key gaps identified in the evidence suggest the need for more rigorous exploration and evaluation of the potential for people with criminal records to increase the social care labour pool.
DBS data from England demonstrate that large numbers of people with criminal records are interested in and apply to work in social care although there is a lack of information about how many are appointed and how employers exercise their discretion. There is scant information about directly-employed care workers (PAs) due to the exclusion of this group from mandatory DBS certification. Policy decisions in Wales about domiciliary care worker registration (only for those working for registered care agencies) (Social Care Wales, 2019) will provide policy makers in England with some further evidence about this workforce’s profile and the impact of criminal records on registration eligibility.
The wide-scale implementation of personal budgets in England elicited fears that vulnerable adults would be placed at greater risk of harm by directly-employed care workers who are not required to undergo DBS certification, but these have not generally been supported by the limited evidence from safeguarding data (Ismail et al., Reference Ismail, Hussein, Stevens, Woolham, Manthorpe, Aspinal, Baxter and Samsi2016). More recent policy changes in England have expanded the groups for whom publicly funded PAs can work, such as the introduction of joint NHS and local authority-funded budgets and NHS-funded Personal Health Budgets (Hewitt-Taylor, Reference Hewitt-Taylor2008; Alakeson, Reference Alakeson2014; Alakeson et al., Reference Alakeson, Boardman, Boland, Crimlisk, Harrison, Iliffe, Khan, O’Shea and Patterson2016; O’Shea and Bindman, Reference O’Shea and Bindman2016; Norrie et al., Reference Norrie, Bramley and Manthorpe2019). Denver et al.’s (Reference Denver, Siwach and Bushway2017) evidence about care workers’ re-offending rates has not been debated in UK social care and might serve as a reminder of the consequences of employers’ decisions and the importance of exercising their discretion and considering each case on its merits. While it points to the potential importance of effective induction, supervision and support for all care workers and particularly those appointed with criminal records and the risks that they may present, there is no evidence of this affecting recidivism or otherwise.
Little is known about the factors upon which employers base recruitment decisions when recruiting someone with a criminal record. Such information would be useful if policy changes such as behavioural and economic incentives to employ ex-offenders, e.g. a freeze on National Insurance contributions, were introduced (House of Commons Work and Pensions Committee, 2016). We do not know the percentage of PA employers or intermediary bodies that are making DBS applications before appointing their care worker(s) and what matters to them in these decisions. There is some evidence that employers are seeking to save money in recruitment processes, with DBS certification being one area affected (Moriarty et al., Reference Moriarty, Manthorpe and Harris2018).
Data about educators’ experiences recruiting people with criminal records onto entry-level health and social care education courses and preparing them for employment as a care workers are yet to be collected and reported. Also lacking is information about the progress of these individuals and whether they are relatively more or less likely than other students to complete training and gain work placements or permanent jobs. Given this gap, consideration should be given to assessing the feasibility of identifying and assessing existing initiatives and piloting new entry-level training opportunities in social care for people with criminal records.
Media sources identified in the literature are few but reveal negative attitudes towards people with criminal records working in social care, with the potential risk that they inflame existing fears about the abuse of vulnerable adults in care homes (Manthorpe et al., Reference Manthorpe, Njoya, Harris, Norrie and Moriarty2016). There may be a need to promote awareness of people with criminal records as potentially valuable workers in social care, given encouragement, training, support and supervision. Evidence collated from prisoners working as care workers especially in the US suggests they may be dedicated and loyal workers. The Skills for Care Guidance (2018b) on recruitment demonstrates the sector’s willingness to publicise the acceptability of recruiting from this group in England.
While policies in social care need to address financial rewards and status, work in the sector often brings high levels of personal fulfilment (Moriarty et al., Reference Moriarty, Manthorpe and Harris2018). Directly employed care workers report being independent, able to choose their own clients, and enjoy getting to know their employers as an important motivations. The promotion of care work by government (see DHSC, 2019) as a welcoming and non-judgemental environment reflects policy interest in sustaining the sector.
Finally, comparison of the UK and US literature throughout this article has shed light on the very different policy contexts at work, while also highlighting commonalities in approaches to protecting service users’ safety while at the same time promoting equal opportunities.
The limitations of this review should be noted. As a scoping review it considered a range of literature, but did not quality appraise it. It covered material in the English language alone and focussed on care for adults. As a scoping review, it attempted to achieve breadth rather than depth and in particular to identify gaps in the evidence. The strengths of the review are that it addresses adult social care work as a whole, including directly-employed workers, and draws on non-academic sources as well as research literature.
Conclusion
Policy makers in England face problems in recruitment and retention in social care but also problems in ensuring rehabilitation following criminal justice sanctions. There is evidence that some people with criminal records are currently employed as care workers and others may wish to work in the sector. The DBS scheme aligns policy imperatives to protect care users while also enabling those with criminal records to have employment opportunities, by giving discretion (in most cases) to employers.
The newly emerging situation of directly employed care workers and agency-employed care workers (PAs) having different DBS requirements when carrying out similar roles and using public resources devoted to the care of vulnerable people may be anomalous. It suggests that policy making sees directly-employed care workers as more informal in their work relationships and ignores the tensions that may arise from excluding some employees and employers from the rights and responsibilities of providing human labour.
We are not alone in identifying policy exhortations as diffuse and complex, and this present review suggests that only very close attention to specific relationships or contexts permits tracking of policy drivers and identification of unfolding outcomes.
Findings from our scoping review identify gaps in the literature and lay the groundwork for a new research agenda in this field. We propose that research is needed about current employment practice when employing care workers with acknowledged criminal records and suggest which initiatives might encourage, support and increase appropriate hiring of this group. More research is also needed about current practices for recruiting people with criminal records onto entry-level care worker courses and individuals’ relative outcomes in both education, apprenticeships and job seeking. Identification of current initiatives to support people with criminal records into work in the social care sector and their evaluation remain a further gap to fill which may inform policy making.
Acknowledgements
This study is funded by the National Institute for Health Research (NIHR) Policy Research Programme (Policy Research Unit in Health and Social Care Workforce: Ref. PR-PRU-1217-21002). The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
