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Social care’s Achilles heel: How we got into a recruitment crisis

Adult social care workforce pressures are at unprecedented critical or near-critical levels. Although it is easy to blame the combination of Brexit, COVID and a resurgent labour market, Neil Eastwood argues we must also recognise and address the often overlooked systemic weaknesses inherent in our sector in order to build a resilient care workforce for the future.

Demand for direct care is escalating, with an ageing population, disability, mental health challenges, and potentially the effects of long COVID. Building a stable, compassionate and suitably qualified labour pool to satisfy this demand remains one of the biggest global challenges we face.

The pandemic has made this task even harder, and many countries have faced border closures restricting the free movement of immigrant labour for long periods. In the UK, the impact of the pandemic was made significantly worse by the timing of Brexit (some might say an entirely avoidable political decision), and the workforce pressures resulting from COVID itself were further exacerbated in England by the introduction of mandatory vaccinations, a policy journey which reminded many in adult social care of the sector’s second-class status to the NHS.

But we need to look beyond individual policies, and even the pandemic, to identify how we can repair and grow a sustainable social care workforce.

Our biggest challenge now, I would argue, is not what has happened in the past 12 months, but what has been happening, in many countries, for decades. Recent events have laid bare inequalities and undercurrents that must be tackled to secure a compassionate and adequately resourced workforce in the years ahead. The window of time available to prevent wholesale sector collapse has been shortened by the toll taken on the workforce since 2020. So, to start the conversation, I have highlighted three structural flaws we must tackle head on.

Valuing the role

  1. Societies, governments and sometimes even care providers don’t value the role of a paid care worker enough

There has long been a stigma associated with paid caring roles. Public perceptions are not helped by low wages and hard working conditions, but the underlying reasons the role is undervalued are much deeper and more entrenched.

Paid care is still stereotyped as ‘women’s work’ of secondary economic value, and ‘unskilled’, especially when compared to the NHS in general and nursing in particular. It has been proven there are both racial and class aspects that go some way to explaining how care workers, despite their clear contribution both to society and to enabling the NHS to function at all, are valued so little. In fact, it is not uncommon for ungracious comments towards care workers to be attributed to our NHS colleagues.

It is my view that our society, some sector employers, parts of the NHS and successive governments have long taken for granted, or even exploited, the implicit goodwill and charity of those who naturally have a ‘calling for care’. Care workers also regularly reinforce this image, describing themselves as ‘just a care worker’. Many care workers care for loved ones alongside their paid employment. Consequently, their entire life is characterised by service to others, in many cases without much thought for themselves.

Within our sector, there is an opportunity for all providers to become employers of choice, especially since their employees haven’t picked the job based on salary. This means creating a healthy, supportive environment on a daily basis. However, employers often fall short. Little things – kindness, fairness, a smile, recognition, praise, encouragement – should be embedded in the culture of every care provider. It can feel much of the workforce crisis is outside their control, but there are positive changes that all providers can make, and for some, action is required urgently.

The pay issue

  1. Increasing wages isn’t the panacea many think it is

There is little doubt that the underpaid care workforce is heavily subsidising the true cost of social care, often prioritising those in their care over their own needs and working longer hours than they are paid for.

Unlike the NHS, the highly fragmented structure of the largely privately owned provider market has resulted in a care workforce without a co-ordinated public voice. This has stymied the workforce’s ability to collectively negotiate for better terms and conditions, although I would question whether they would put their clients at risk to push for better pay or conditions anyway.

Those they support are equally lacking a voice – not only the older population, but also those with a long-term disability or mental health condition, who are not in a position to make the case for better wages and conditions for the care and support workers they rely on so much.

In addition, with the widely prevailing low rates of pay, the rising cost of living and increasingly unaffordable housing and transport costs, there is a risk that many more care workers will soon be in working poverty conditions and simply won’t be able to afford to do the job, despite their calling for the work. Few would argue that care workers don’t deserve higher wages – or at least parity with the equivalent NHS pay scale – but would this be the universal solution to the care workforce crisis that many believe it to be? The answer, I believe, is no.

Increasing wages for care workers specifically, rather than using the blunt mechanism of lifting the minimum wage floor, putting aside how it would be funded and fairly delivered, is something of a conundrum.

Increasing pay significantly would certainly give an important boost to the esteem of the workforce and increase the public’s respect for the role, associating it much more with the skilled profession it is. However, increasing wages is not the panacea it may appear to be. There have been examples around the world, including the UK, where significant pay rises or one-off bonuses have been given to sections, or all, of the workforce, with surprising consequences.

Care workers are generally expected to work unsociable hours and there is evidence that, for some, an increase in their hourly rate of pay allows them to hand back weekend and evening shifts to redress this imbalance. This phenomenon was reported after 55,000 care workers in New Zealand received substantial hourly rate increases of between 15 and 50% in 2017. Pay rises also caused tensions with kitchen and cleaning staff who did not receive them, and care workers reported an increased pressure from managers to take on more responsibility. Some said they felt no more appreciated by managers than before – clearly the thing they had craved most – and employers reported no material difference in recruitment, with a general response of, ‘well, it is still a hard job that people don’t necessarily like to do’. Equally, there is evidence from the UK that ad hoc cash bonuses can serve to increase short-term absences for the very same reasons – that extra money provides an opportunity to reprioritise home over work, even for a short period.

Despite all this, I believe that increasing pay to reflect care workers’ value to society remains essential, not just from an ethical and moral standpoint, but to give the workforce the choice to address the imbalance in their lives if they choose. We just need to recognise that this may result in a reduction in capacity, which new entrants to the sector or productivity improvements must fill. So, a pay rise, or one-off payments, must go hand in hand with a national workforce strategy that puts those with a calling for care at its centre and can adequately source new workers with the right values and train and develop them.

Challenging attitudes

  1. Changing work attitudes must be addressed

Employers who have been in business for many years often bemoan the changing work ethic of care staff. It is widely noted that attitudes to work have shifted and employer loyalty has weakened. Younger people are now more focused on transferable skills than careers or long-term commitments with a single employer.

Commentators have observed societal shifts, characterised as a loss in what is called ‘social capital’ – the bonds that tie communities together. This is partly driven by the rise in social media and technological advancements, which have replaced physical help in the community with opportunities for ‘low effort’ contributions such as likes and comments supporting online causes. There is little doubt that reinvigorating a sense of real community responsibility would need to begin at school age when core values and beliefs are being formed.

I wrote in my 2017 book, ’Saving Social Care’, about the need for a national care service to create an environment in which young people could experience the intrinsic rewards of helping those more vulnerable than themselves. But education policy also needs to move away from a prioritisation of theoretical degree education for all, instead recognising the true value to society of vocational skills-based learning. The perception of social care as a last resort option for pupils of lesser academic ability must also be tackled – often this comes from the attitudes of educational staff.

Care providers must also adapt to reflect these changing attitudes to work and the tightening labour market by ensuring they always treat care workers with respect, making them feel appreciated and valued. There is now no option but to be exemplar employers in their local communities, especially considering the huge contribution this values-driven workforce makes to society.

The pandemic has finally shone a light on the commitment and contribution of care workers. Now it is time for Government, society, the NHS and our sector to grant them a voice as we work together to build a resilient care workforce for the future.


Neil Eastwood is Founder of Care Friends. Email: neil@carefriends.co.uk Twitter: @stickyneil

What do you think are the barriers to finding workforce solutions?

 

 

About Neil Eastwood

Neil Eastwood is Author of Saving Social Care and Founder and Chief Executive of Care Friends, an employee referral app for care staff launched in partnership with Skills for Care. Neil has spent many years studying the best workforce practices of social care organisations around the world. Previously he was a director at a 10,000-staff care provider

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