Dr Shereen Hussein is Principal Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s.
The year 2014 has seen growing attention given to the social care workforce, with a number of high profile reviews being published, including the Kingsmill Review ‘Taking Care’, the Unison report into home care ‘Time to care’, the Demos review of residential care and, launched today, the Burstow Commission review on the future of the home care workforce, ‘Key to care’.
The question of how to maintain a high quality social care workforce has received academic scrutiny for many years, with research highlighting the lack of career progression, low pay and status, and the inability of the sector to attract young and diverse groups of workers as some of the key issues. There are many reasons why we are in this state of ‘crisis’ but at the core is the assumption that care work is something that can be performed by ‘anyone’—it does not require a vast amount of skills and we can always find a willing worker to do it. While these assumptions go unspoken, they underline how the sector operates and derive from the perception of care work as ‘women’s’ work that comes ‘naturally’; if the family can do it why do we need a skilled professional to do it?
Well, as you might have guessed, the majority of these assumptions are indeed wrong. Care workers are increasingly required to perform many tasks that go far beyond personal care; they are caring for adults and older people with complex needs, severe dementia and communication challenges. They are expected to provide care that is tailored to the needs of the people they care for and to be sensitive to their specific circumstances. The Care Act 2014 emphasises the key principle of users’ wellbeing as central to social care, thus care workers are expected to perform their tasks with a clear understanding of how to promote dignity, protect the people they support from abuse and neglect, and respect their wishes and autonomy. Additionally, the commitment to personalisation and minimising the use of residential (care home) services means that care workers increasingly provide care in people’s own homes and their communities, usually on their own without supervision or social support. Thus, in their day-to-day activities, care workers employ a high level of knowledge and skills ranging from those related to the understanding of specific illnesses and conditions to communication and softer skills.
It is difficult then to fathom the current lack of appreciation of this workforce. From evidence of many being illegally paid under the National Minimum Wage (Hussein 2011; HMRC 2013) to increasingly fragmented working conditions, with zero hour contracts becoming commonplace. It is no surprise then that care worker vacancy and turnover rates are considerably higher than the UK labour force average (Hussein et al., in press).
In fact, one might wonder why over a million people continue to be care workers given these conditions. To understand this we need to look not only at who works in this sector, but more importantly what motivates people to do this work in the first place. Our extensive research in this area indicates the most common reason for people to work in care is their wish to help and assist others. This is expressed by several groups of workers, whether British women in their mid-forties, migrant workers in their thirties, or the few younger people aged under 25 years old. The majority relate their work to their own personal experience and the informal care they provide, or have provided, to members of their families. With this attitude many care workers go above and beyond their duties, usually continuing to finish their care tasks even when the 15-minutes allocated per visit have elapsed. But this comes at a cost: stress, lack of support and job insecurity are common themes discussed by care workers. And of course, there are some who join the sector simply because they have not gained enough qualifications to secure other jobs or because they need an employment foothold in their new migratory destination.
However, the key question remains: how can we recruit and retain a high quality workforce that is capable of meeting the exponential demand associated with an ageing population and the increasing diversity and complexity of care provision? It is simply not possible to rely on people’s goodwill and hope for the best. Especially when the current care provision structure is likely to reduce the key non-monetary reward for this workforce: getting the emotional reward from service users themselves. By operating a care commissioning system that is run by the minute and reducing the opportunity to have co-workers and supervisory support, care workers are in many cases left stressed taking their worries back home.
The sector needs to actively attract and retain high quality workers; this may be achieved first by providing basic job security and support. All the reviews into this sector call for enforcement of the basic pay level, the National Minimum Wage, and a reduction of potential exploitation through zero hour contracts and an end to inappropriate15-minute care slots. But this is only the start, care work needs to be regarded as a ‘career’ not ‘casual’ work. This can only be achieved by establishing a clear training and career path that can feed into the wider health and care sectors. In my view, care work needs to be better regulated and care workers registered, and more need to join unions and so have a collective voice and bargaining power. A more complex problem is the public perception of the value of care work. As a society we need to appreciate and value this work more by visualising ourselves in old age and imagining how we would like to be cared for and by whom.
The Social Care Workforce is currently undertaking a major project examining the workforce issues referred to in this post, the Longitudinal Care Work Study.
Hussein, S., Ismail, M. & Manthorpe, J. (in press) ‘Changes in turnover and vacancy rates of care workers in England from 2008 to 2010: Panel analysis of national workforce data’ Health & Social Care in the Community.