Last night’s BBC Panorama programme
is the latest to expose abuse in some of Britain’s residential care homes for the
elderly. Sadly, despite acknowledgement of
the need for ever tougher regulation and inspection, it’s unlikely to be the
last such horror story from a sector where the availability of low-skilled
workers and public sector financial constraints combine to create an incentive
for providers not to improve employee pay, conditions, working practices and
care quality.
I draw this pessimistic conclusion
from a study of Britain’s low wage economy, including a focus on the adult care
sector, which I recently undertook for the Joseph Rowntree Foundation (JRF). A
report based on the study was published yesterday.
As the JRF report finds, adult
care (which employs approaching 2 million people to serve our ageing population)
is by no means the lowest paying sector in the UK but offers a particularly
arduous combination of low pay, demanding work, often anti-social hours, and uncertain
contractual arrangements (the use of zero-hours contracts is endemic). This in
part reflects the fact that although care work requires a considerable amount
of ‘soft’ personal skill the workforce lacks the kind of ‘hard’ formal skill
that offers a decent return in the labour market.
Care staff need the technical
ability to assist those they serve properly and safely (sometimes including an
element of medical care) plus basic admin skills but for employees in direct
caring roles soft skill is generally more prevalent than formal qualifications.
Despite some improvement in attainment over the past decade almost 40% of
direct carers have no qualifications whatsoever, the remainder split roughly
equally between employees with NVQ level 2 qualifications (equivalent to five
or more GCSEs at A-C grade) and qualifications at level 3 (equivalent to 2 or
more A levels) or above. This outcome is not as worrying as it might at first
appear given that the personal ability of employees to treat customers with
sensitivity, due respect and to display a marked degree of empathy are likely
to be at least as important as formal skills in the care sector. Yet what’s also
clear is that far too many cash strapped employers in the sector have become
reliant on poorly trained staff that can be hired on the cheap, which at best has
proved detrimental to the general standard of care quality and at worst resulted in the serious abuse scandals.
The labour market dimension of the
poor care quality story emerges because care work provides opportunities for
individuals who have strong personal skills but sometimes lack even basic
literacy and numeracy skills. The difficulty workers with few qualifications or
hard skills face in gaining entry to higher paid employment sectors means that
those with soft skills crowd into service sectors where this kind of skill is
particularly important. But this ‘crowding’ effect creates a buyers’ market for
people with solely or mainly soft skills, allowing employers to recruit them on
very low rates of pay. Where, as in the
care sector, these recruits are predominantly women looking for part-time work
or flexible shifts close to their own homes - which further limits the number
of alternative jobs effectively open to them - the impact of labour crowding on
pay can be marked.
However, while almost everybody
is aware of the potentially adverse consequences on care quality of maintaining
a predominantly low paid, poorly qualified and low status workforce, even the
best of employers struggle to respond to calls to improve pay, staff training
and other workplace practices because of the severe funding constraints they
face. In comparison with the NHS, and regardless of hand wringing over cases of
abuse, adult social care remains a Cinderella service in terms both of status
and government spending. Cost cutting has been the principal rationale for the
UK’s shift to a commissioning and contracting out model of adult care provision
in the past two decades, with the underlying funding situation exacerbated by a
20% real terms reduction in overall local authority adult care budgets since
2010 .
The juxtaposition of the current contracting
out model with a deregulated labour market and plentiful supplies of low
skilled/low wage labour makes the maintenance of low-cost business models in Britain’s
care sector almost inevitable. This is in marked contrast with the situation in
Scandinavian countries, notably Sweden, where subcontracting of care services
to non-state providers is more limited and the government actively requires
good minimum standards of entry level qualifications to the sector. Compared to
other countries Sweden requires the highest levels of education among
caregivers and pays the highest wages. The objective of care policy is to improve
employment and working conditions in order to recruit and retain a stable care
workforce and enhance the status of care work. Moreover, countries such as
Sweden which impose higher training standards on care workers also operate
sector-wide pay regulations, often based on collective bargaining. This is
clearly a very different institutional context, both in terms of funding of
care and labour market regulation, from that which currently prevails in the
UK.
Ultimately, therefore, any
serious drive to improve pay, working conditions and service quality in the
adult care sector may require acceptance at the very least of a higher level of
funding for the sector, probably a reassessment of the current contracting systems,
and a new way of thinking about the downsides of the UK’s ultra-flexible labour
market model.
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