Adult social care is an essential public service and a growing part of our economy. However, the social care system in England faces a workforce crisis which is set to grow in the coming years; by 2028, we estimate there will be a shortage of over 400,000 workers in social care.
The challenges of recruiting and retaining workers in the sector is inextricably linked to low pay and poor working conditions. This is itself related to the under-funding of social care and a commissioning and delivery model based on cost not quality. Providers have competed by driving down pay and conditions, and they have faced little resistance given the limited bargaining power of the workforce and the limited enforcement of employment rights. These factors are combining to create a social care workforce crisis.
If we are to solve the workforce crisis, we need to deliver a sustainable long-term funding settlement for social care and a transformation of the social care workforce model. This should be based on the establishment of decent pay and terms and conditions through sectoral collective bargaining, and a professionalisation of the social care workforce. These measures would help ensure high-quality work for care workers, and high-quality care for those who need it.
• Social care is characterised by endemic low pay. Over 500,000 workers in social care – and half of all care workers – are paid below the real living wage. The sector accounts for one in 10 of all jobs paid below the real living wage and there is evidence of widespread avoidance of the minimum wage.
• Social care is characterised by chronic levels of insecurity. One in four workers in social care – and one in three care workers – are on a zero-hours contract.
• While social care is a vital service and a skilled task, there are no effective minimum training requirements for care workers, and half of care workers have no relevant social care quali cation. There are currently limited opportunities for progression in social care.
• As a result of low pay and poor working conditions, social care is struggling to recruit and retain the workers that it needs to meet rapidly rising demand. Constraints on EU migration post-Brexit threaten to exacerbate the growing workforce crisis. Our modelling shows that – on current trends, and assuming the ending of freedom of movement – there will be a shortage of nearly 400,000 workers in social care by 2028.
2. The social care workforce crisis has a negative impact both on the workforce and on quality of care
• High-quality work and high-quality care are inextricably linked.
• The poor conditions and widespread exploitation of the social care workforce has a signi cant negative impact on workers. Care workers highlighted how low pay required colleagues to work excessive hours or multiple jobs and how the widespread use of zero-hours contracts leaves many in an insecure position.
• The poor treatment and widespread exploitation of the social care workforce has a signi cant negative impact on quality of care. Under-staffing and pressure on time leads to care needs being unmet and the lack of training inhibits the ability of workers to provide high-quality care.
3. The workforce crisis is the result of an under-funded and a dysfunctional social care system
• The chronic under-funding of social care has contributed to the workforce crisis. Government funding for local authorities has been cut by half since 2010, leading to cuts to care budgets just as demand is rising. Six in seven councils are commissioning homecare at below the minimum rate required to deliver a sustainable service.
• The growth of outsourced provision and the rise of price-based competition has driven down pay and employment standards in social care. In an under-funded and under-regulated market, care providers have seen labour as a cost to be minimised.
• The social care workforce currently has limited bargaining power to improve pay and conditions. With low levels of union membership, widespread use of zero-hours contracts and a lack of enforcement of basic employment rights, there is a power imbalance in social care, which prevents workers from winning fair pay and conditions.
• Underlying all these factors is the under-valuing of social care and
of the social care workforce. Despite the growing crisis, just one in 10 adults sees social care as an important issue. The social care workforce is under-valued due to perceptions that the work is unskilled and due to gendered norms around care work.
4. The UK needs a workforce strategy for social care based on sectoral collective bargaining
• Increasing funding for social care is a vital pre-condition for improving pay and conditions and tackling the workforce crisis. Government should set out a long-term funding settlement for social care, with a 1p increase in national insurance.
• While we have seen some improvements in pay since the introduction of the national living wage, there remains an urgent need to increase pay in social care. Government should ensure that all workers in social care are paid at least the real living wage. Raising all workers in social care to the real living wage in England would require an additional £445 million beyond current funding needs.
• Increasing funding is a necessary but not suf cient step to boosting pay and tackling the workforce crisis in social care. In order to ensure that increased funding leads to higher pay, sectoral collective bargaining should be introduced in social care to drive up employment standards. Government should establish a sector council to bring together representatives of employers and workers to negotiate a legally binding sectoral agreement, setting out minimum standards for pay and terms and conditions. Additional funding for the sector should be conditional on securing a sectoral agreement.
• Government should seek to professionalise the social care sector and boost levels of training. The Care Certi cate should become a mandatory licence to practise, and care workers should become a regulated profession in order to drive up standards and prestige.
• In order to enforce minimum standards, the Care Quality Commission (CQC) should be given a wider remit to focus on quality of employment as well as quality of care. Government should establish a minimum commissioning cost for local authorities to ensure care is not commissioned at unrealistically low levels, and ensure that local authorities have suf cient funding to meet this requirement
• If government ends freedom of movement, it should minimise the impact of Brexit by revising the Shortage Occupation List to include social care occupations and introducing a Trusted Sponsor Scheme that enables care providers who demonstrate good employment practice to be eligible for an increased range of visa benefits.
Chosen excerpts by Job Market Monitor. Read the whole story at Fair care: A workforce strategy for social care | IPPR