‘When it comes to care workers, don't just applaud, pay them’...but how?

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22 Apr 2020

Duncan BrownDr Duncan Brown, Principal Associate

Secretary of State for Social Care, as well as the NHS, Matt Hancock reminded us last week that we are to bang our dustbin lids every Thursday evening to thank our front-line care workers, not just our amazing hospital staff. He announced the award of a new badge to recognise ‘pride in our social care champions’.

Hardly at the top of their wish-list right now I suspect. How about addressing their PPE shortages, which are reportedly leading some to resort to bin-bags to protect themselves? An estimated 5,000 people have already died in care homes from Covid-19.

Retired consultant Dr Kirsty Muirhead echoes the views of many of us in my headline quote from last week, don’t just applaud, reward them properly too. They need it.

The Care Workforce: Reward and recognition?

This major workforce of two million people working in care jobs, which is overwhelmingly female and more likely to be from a BAME background, are paid embarrassingly badly. Research shows most are paid the National Living Wage (£8.72 per hour- below most shop assistant rates), much less than the ‘real’ living wage of £9.30 per hour, or £10.75 in London. The pay differential for those with 20 years’ service has reduced to just 15p an hour. Many are no longer paid travel time. More than half are employed on zero-hours contracts. Hardly surprisingly, it's estimated by Skills for Care that there are currently 122,000 full-time vacancies in England.

Increase their pay! But how do we afford it?

The pandemic has been preceded by a vicious crunch in social care of growing demand from an ageing population with chronic underfunding. Since 2010, councils have had their funding from central government cut by nearly half. Ian Hudspeth from the Local Government Association said last week: ‘Social care as a whole has been desperately underfunded for decades’.

Even before the pandemic, over 400 care homes had gone out of business in the last five years. The government was forced to announce last Friday that councils across England will receive a further £1.6 billion to deal with the impacts of coronavirus. Even before the crisis, the Labour party claimed that social care would require another £8bn.

Squaring the Value/Cost Circle

Based on my experience of methods of valuing roles for major workforces, including doctors and dentists and the judiciary, I see two viable ways forward.

1.      Move care staff onto the NHS’s Agenda for Change pay and career structure

First, we could move the social care workforce onto the NHS Agenda for Change pay structure. Covering one million plus NHS employees, Agenda for Change has two primary aims: to establish a fair, consistent approach to base pay management right across the Service; and to help to address skill shortages by acting as a ‘skills ladder’ of career and pay progression.

The NHS job evaluation system, which determines which pay band jobs are placed in, should be perfectly able to accommodate social care jobs without any modification necessary. It already for example, covers all health, social care and government staff in the States of Jersey.

The Kings Fund estimate that the social care workforce would need around £1.7 billion of investment to match the recent NHS pay deal, which now seems relatively modest compared to the overall coronavirus spending investments.

2.      Encourage Voluntary Action within a National Framework of Good HR/Reward Practice

A second alternative would be to reflect recent research on the business case for improved pay and conditions; and from the approach adopted in recent years for social workers. Social work a decade ago suffered from many similar issues to care workers today: poor pay and perceived attractiveness leading to major staff shortages.  In response, the Department of Health and Social Care has been progressing a five-year strategy to deliver, ‘a highly skilled, capable and confident profession’.  Actions have included: setting national  standards for specialist and advanced roles; ensuring a sustained focus on CPD to support retention, increasing funding for social work education and improving support  to newly qualified social workers.

Lincolnshire Council’s children’s services as an example, has seen improvements in the quantity and quality of internal applicants for management roles following the introduction of its Bridging the Gap programme. Cornwall’s children’s services have developed an advanced, consultant social worker role, paid at the same level as a team manager, reflecting a similar model applied nationally for teachers.

Could something similar be done for care workers, perhaps with a national training, career and pay framework? The Care Quality Commission, the integrated regulator across health and social care provision, could encourage and require aspects of the framework to be applied as part of its role in ensuring and raising care standards.

The question for us all is whether more is required – ranging from higher rates of taxation on employers, employees and the self-employed to fund improved care; through to much tougher employment standards and enforcement from a strengthened Good Work legislative agenda.

Conclusions: Pay up and skill up!

Sir Michael Marmot on twitter at the weekend wrote of the worst of the ‘inequalities exposed by the pandemic: the scandal of under-paid care workers who perform such a vital role’.

IES’s research on pay and career progression for lesser skilled workers across different sectors shows that not investing in employees is a false economy due to high employee turnover and low staff satisfaction. We have a free employer toolkit to help.

The low standing and public recognition of care work certainly seems to have shifted in a very major way in the last month. Whatever the funding difficulties, I believe this presents a real opportunity to create one very positive outcome from this horrendous virus: better pay and career progression for care workers to support better social care. The government, civil service, employers, trade unions and HR and reward professionals need urgently to get our heads together to take this opportunity.

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Any views expressed are those of the author and not necessarily those of the Institute as a whole.