It can’t have escaped many people’s notice that we have a General Election looming in 2015. In previous electoral years there has not been much focus from any of the main political parties on social care issues. Not traditionally seen as a vote winner, it currently occupies more centre stage positioning than in the past, partly because of a demographic imperative, but also in no small measure due to national media focus on recent care home abuse cases.
Following that media attention, the circumstances in which care workers are employed and, in particular, their training, conditions, contracts and rates of pay, have come under scrutiny. As part of Labour’s social care policy development, Ed Miliband MP, Leader of the Labour Party, commissioned Baroness Kingsmill to conduct an independent review into the working conditions of care workers. The desire was that the review would lead to recommendations that would form part of Labour’s manifesto heading into the next election, and that those proposals would aim to alleviate and, ultimately, put an end to worker exploitation within the sector. The result was the publication of Taking Care – an independent report into working conditions in the care sector.
Given the importance of the industry economically, Skills for Care estimates the market to be worth £43 billion and growing, and the vital nature of the work carried out by those employed in the care sector, the bald facts highlighted by the report are staggering:
- As many as 220,000 care workers might be being unlawfully paid less than the National Minimum Wage (NMW). An Her Majesty’s Revenue and Customs (HMRC) investigation into 80 care providers found that almost half (47 per cent) were not compliant with NMW.
- An estimated 307,000 care workers, or one-fifth of the adult social care workforce,
are on ‘zero hours contracts’, meaning their work and income is not on a stable basis.
- Nearly a third of careworkers receive no regular, ongoing training.
- Over 41 per cent of care workers do not receive specialised training to help deal with their clients’
specific medical needs, such as dementia and stroke-related conditions.
In an interview with Management Today, Baroness Kingsmill summed up the situation, ‘Care is in crisis…care workers are undervalued, underpaid, undertrained and under-regulated. They don’t have the status of nurses. They don’t have the status of child-minders. They are subject to no regulation and no registration. This workforce of 1.5 million people is almost invisible.’
To tackle the situation the report makes, amongst others, the following recommendations:
- Care managers should be registered and have a Licence to Practice.
- Eventually all care workers should be registered and have a Licence to Practice.
- The licensing system should include standards of proficiency and a commitment to continuous professional development.
- The Care Quality Commission (CQC) should have the power to prosecute providers who employ care managers or workers without a licence.
- The CQC should be required to monitor evidence of non-payment of the NMW. It should have an absolute requirement to refer cases where workers are being paid less than the legal minimum to the HMRC for investigation.
- There should be an end to zero hours contracts.
Some estimates put the social care workforce at around two million and, if demand for care increases in line with demographic projections for an ageing society, this number is likely to increase. The social care workforce has been identified over many years by the Low Pay Commission as one of the poorest paid. Submissions to the Kingsmill Review and recent studies carried out by the HMRC do nothing to dispel this view.
But the problem is not simply one of meeting legal obligations, low wages are endemic within the social care workforce. Little wonder then that turnover rates range from 20 per cent to 30 per cent per annum, surely a sign of difficult conditions and instability across the sector.
If we recognise that a system of low pay and exploitation of a workforce is likely to threaten the quality of care delivered, then we should also recognise that low pay is not the only contributing factor; poor care delivery can be the result of many different contributors. Similarly low pay is not the preserve of one particular strata of the social care spectrum, it exists in the public and private sectors, the profit making and non-profit making, the large and the small organisation. Plus, it has many drivers.
Raising the status
The call for a properly regulated workforce seems entirely sensible. This is especially so given the desire to eliminate the boundaries between health and social care. The NHS workforce is tightly regulated, and in many cases performs similar functions. Proper qualifications and the development of a career path should attract a higher quality workforce over time. This will impact on how we pay for care generally. As Independent Age said in its submission to the review, ‘A review on exploitation in the care sector cannot be divorced from a wider more fundamental look at how we pay for care and whether as a society we are prioritising public expenditure on long-term care. The two issues are inextricably linked.’
Baroness Kingsmill rightly sees this as a long-term goal with no short-term fix. The immediate call from the review is for a Licence to Practice for care managers. It is a first step towards the profession of care worker achieving the status it surely deserves. Licensing of the wider workforce will follow, should the recommendations ever be translated into legislation by whichever Government is in power. The key here will be to go further and introduce minimum standards of training and professional development, in line with other professions. Specialist care services, for example those involved with the treatment of dementia patients, would then be able to develop a specialist workforce that would automatically achieve status within the industry.
The review spells out its long term aim, ‘The ultimate objective is the professionalisation of care work. We believe that long-term changes in the sector are needed to improve the status of care workers, create opportunities for pay and raise standards across the sector.’
The need for respect
In my opinion there is, however, a more fundamental aim to be addressed alongside those highlighted by Baroness Kingsmill, and that is the need for respect. If we truly respect the requirement to care properly for our elderly, as opposed to it being politically or socially expedient, then we are more likely to give care workers the respect they deserve for the job they do. This would then transmit into the payment of commensurate wages and the desire to ensure that the sector encourages worker development through an appropriate system of qualification, registration and development. If we don’t respect the need for care then we will never truly respect those who provide it and so exploitation will continue.
The Kingsmill Review rightly highlights the long-term under-funding of the care sector, but alongside this states that many of the changes required are not about funding. This is both politic and pragmatic. Politic because there is no evidence that the coalition will suddenly shift the balance of funding in favour of the care sector, any more than either of the two main parties will, if elected to power. Pragmatic because the review focuses on changes to existing systems and practices; notably, a weak and fragmented regulatory environment, poor local authority procurement practices, and poor workforce planning and management skills within care providers. This is not surprising coming from an experienced reviewer of the labour market, well grounded in real politic.
Care work defines society
The functions carried out by care workers are vital to the survival of the current care system. They provide personal and highly intimate care to the most vulnerable members of our society, which has both economic and social benefits. However, I believe their work stands for more than that. The quality of the care we deliver to those in need defines the health and strength of our society. If we do not deliver over and above a minimum quality threshold then we will have lost our right to be called a civilised society. I do not consider this to be an extreme view or one that would not be reflected by the majority of the population, if asked. Why then do we perpetuate a system that exploits those who contribute to what defines us? The Kingsmill Review goes a long way to addressing the issue.
Chris Tarry is a freelance consultant to Carterwood.