Fair Care Work: A Post COVID-19 Agenda for Employment Relations in Health and Social Care

Ian Kessler, Stephen Bach, Richard Griffin and Damian Grimshaw introduce their new paper, Fair care work. A post Covid-19 agenda for integrated employment relations in health and social care, published yesterday by King’s Business School. Lead author, Professor Kessler, is Deputy Director of the NIHR Policy Research Unit in Health and Social Care Workforce. (908 words)

The courage and sacrifice of the health and social care workforce have emblazoned themselves on the national consciousness as the challenge of COVID-19 continues. While classified as ‘key workers’, along with other occupations essential to the community in times of crisis, the distinctive contribution of frontline care workers, reflected in their direct and relentless engagement with the virus, has until recently been reflected in the Thursday night applause reserved for them. This public applause sits uneasily, however, with the treatment of over two million health and social care employees, mostly women, often from black and minority ethnic backgrounds, typically in undervalued, relatively low paid and insecure employment. In a new paper, we seek to kick start a policy debate on the development of fair care work, to stimulate discussion on a refreshed employment relations (ER) agenda which acknowledges and reflects the worth of care workers to our individual and communal well-being.

The COVID-19 crisis has exposed shortcomings in ER in health and social care, considered in our paper along several dimensions. The first dimension centres on migrant workers, long a key part of the care workforce, but, given their labour market insecurities and managerial cost minimisation strategies, particularly in outsourced care services, often treated as ‘outsiders’ and forced into low paid and precarious employment. The second focuses on reward, noting the prevalence of low pay in much care work and the general reduction in real pay across health and social care following a period of pay restraint. The third explores employee training, highlighting disjoined accreditation of employee capabilities across health and social care, and a distorted pattern of resourcing which leaves swathes of the frontline workforce, especially care assistants, with scant support for skills development. The fourth concentrates on the outsourcing of services to private and voluntary sector organisations, especially in adult social care, fragmentating care delivery and leading to service provision often driven by short-term financial gain, achieved in part by depressing labour costs, and often leading to the degradation of working lives.

These features of employment relations have cruelly hampered the capacity of health and social care providers to deal with the COVID-19 crisis. They have led to difficulties in recruiting and retaining frontline care staff, reflected in the shortfall of around 40,000 registered nurses, and arguably contributed to a lack of preparation, not least apparent in the initial shortages of personal protective equipment for staff, especially in under-resourced care homes. As striking has been the ‘light shone’ by the virus on the treatment of staff daily risking their lives. Traditional distinctions between the high and low skilled, the insider home and outsider migrant, the registered and unregistered worker have crumbled. The contribution made by health and social workers to dealing with the pandemic has not been differentiated along these or any other lines, brought into sharp relief by the tragic roll-call of employees sacrificing their lives: from porters and healthcare assistants to nurses and doctors; from across the range of ethnic backgrounds; and from every part of the country.

In response, our paper calls for a new model of employment relations, characterised as fair care work and underpinned by four main principles. The first, integration, encourages a shared approach to workforce management amongst the myriad private and voluntary sector care providers, given effect, for example, by a social purpose license granted to those meeting high minimum labour and governance standards. Such integration also extends to a closer alignment in the treatment of employees in health and social care. This alignment can be seen to mirror and support ongoing moves toward the broader integration of service delivery, and is manifest in our calls for pay and training arrangements which cut across the two sectors.

The second, parity of esteem and treatment, draws upon the erosion of distinctions, noted above: calling for a re-evaluation of job worth, with implications for pay rates and increases; seeking a more even distribution of training resources and opportunities across occupational groups, and addressing the egregious systemic behaviours casting migrants care workers as ‘the other’ rather than as ‘one of us’.

The third principle emphasizes compliance, presenting elevated and consistent employment standards not as an ‘optional extra’ but as essential to the delivery of high-quality care. We suggest that compliance of such standards might be given effect by broadening the remit of the Care Quality Commission, and other arms-length-bodies like Health Education England, and by the regular government commissioning of monitoring exercises.

The fourth, collective employee voice, seeks to re-affirm the longstanding public policy commitment to worker representation by trade unions and professional associations as the basis for industrial citizenship and the vehicle for workers to effectively articulate and pursue their legitimate interests. In particular, the value of workplace employee representation and engagement on health and safety and learning issues, are presented as the basis not only for care worker well-being but for management’s capacity to deliver high quality care services.

We acknowledge our proposals remain schematic and contingent on the scale and nature of fundamental changes to the model of health and social care delivery developed in the wake of COVID-19. However, we hope our paper represents a point of departure for further debate between stakeholders on a new deal for workers in health and social care, a deal which ensures fair care work.

The new paper from Ian Kessler, Stephen Bach, Richard Griffin and Damian Grimshaw, Fair care work. A post Covid-19 agenda for integrated employment relations in health and social care was published yesterday by King’s Business School. The lead author, Professor Kessler, is Deputy Director of the NIHR Policy Research Unit in Health and Social Care Workforce.

The paper was discussed at a workshop held on 1 July 2020 (presentation slides from this meeting).