‘We have some great people in social care, but we do not have enough of them … we need more great people and, if we want that, we are going to have to pay for it.’
This contribution from Age UK Director, Caroline Abrahams, to the Health and Social Care Select Committee hearing on dementia in May 2021, demonstrates the extent to which workforce reform has become a priority for many in the sector.
While this sentiment is clearly to be applauded, the Committee’s Chair, Jeremy Hunt, was also right to ask his next question: ‘What would you do about it?’ Because here things start to get more difficult.
For many, the key workforce issue is pay. At one level, this is a simple matter of social justice. Care workers deserve to be paid more for carrying out a difficult and, during COVID-19, dangerous job. Only the hardest of hearts would disagree with this. Yet, better pay for staff may only help transform social care if it achieves two further goals – tackling the chronic workforce problems in social care and also improving the end result: the quality of social care that is delivered.
On pay, the issue is not just the need for care work to be paid better but for it to be paid better than other, competing sectors. Care worker pay has, in fact, been rising faster than inflation for several years but vacancies have stayed high because it has risen even faster in those other, competing sectors, such as retail and cleaning.
This suggests to some that a form of national, sector-wide pay body is needed – setting a social care minimum wage, for example – though the practical difficulties of applying this in a sector that is much more complex and fragmented than the NHS should not be underestimated.
However, if you could make this – or an alternative approach to increased pay – work, it should have an impact on vacancies. We know that low pay, and particularly the perception of low pay, is a key factor in recruitment difficulties. That would also help to ease the pressure on the existing workforce. There is good evidence from the NHS that the sense of being able to do a job well is undermined by chronic workload pressures, which also of course impacts on the health and wellbeing of staff.
All of this should improve quality, too, though in itself it may not be enough to be transformative. Broader issues such as quality of management, workplace culture and access to training and career progression will not necessarily improve just because careworkers earn more.
And unless pay reforms are properly funded, they could even make the situation worse. One study found that the introduction of the national living wage was, in fact, associated with a fall in quality in some care homes. Though the study does not speculate about reasons, it seems plausible that it was because the cost of paying staff more meant corners had to be cut elsewhere.
So, as with other areas of reform, a failure to properly fund changes could scupper them. This might seem an obvious point yet, in reality, workforce reform will have to compete with other required changes, for example to eligibility, which are also essential to reform. Distributing any available extra money between these different priorities is bound to be difficult.
Untangling this complex web of workforce reform will take time. Even more important, then, that the Government gets on with it as quickly as possible.