Improving pay and job quality in Adult Social Care

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3 Dec 2021

Becci Newton

Becci Newton, Director, Public Policy Research

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This analysis was originally published in Campaign for Learning's  Reforming Social Care: Integrating Funding, Pay, Employment and Skills Policies in EnglandThe Campaign for Learning’s report is based on seventeen contributions from experts in both the adult social care sector and the post-16 education, skills and employability sectors. 

 The Recruitment Challenge

There is undeniably a problem in securing an adult care workforce of the scale England requires. Skills for Care reports 1.67 million adult social care jobs, and 1.54 million people working in these. It is a growing sector – between 2019-20, jobs increased by 45,000, and growth of 29% is forecast by 2035 to meet the needs of our ageing population. However, the number of jobs being filled has declined. Vacancies stand at 8.2%t, slightly above pre-pandemic levels for reasons related to the pandemic and withdrawal from the European Union. Fewer people travel to the UK to take up care roles - falling from 5.2% of new starters in January-April 2019, to 1.8% in the same period in 2021 (Skills for Care, 2021).

Given the scale of opportunity, securing a job in this sector might be thought as attractive – over 100,000 vacancies were advertised on any given day in 2020/211 and, in England, care work does not require formal qualifications or registration (IES and Health Foundation, 2020). Yet still, vacancies go unfilled which Skills for Care attributes to recruitment and retention problems (Skills for Care, 2021).

A Diverse Sector

Compositionally, the workforce is predominantly female (82%) and ethnically diverse, with 21% of workers being from Black, Asian and other ethnic minorities. The average age is 44 years and over a quarter of care workers are older than 55 (Skills for Care, 2021).This figure does not include the one-in-four older female workers, and one-in-eight older male workers employed elsewhere providing unpaid adult care who are typically in their 50s and 60s (ONS, 2019). Men do not work in caregiving roles as much as women, instead being more likely to work in outreach and social work roles – this means male clients cannot necessarily access care from a male. However, there is an intersectional progression problem: proportionally more males and more white people work in senior roles than on the frontline; senior staff tend to be older while operational care workers are younger (Skills for Care, 2021). Arguably, getting on in this sector as an older woman from a minority ethnic background could be a challenge.

Pay, Job Quality and Health Constraints

Nonetheless, from one perspective care roles should be well-matched to older workers’ motivations for work that is meaningful, flexible, intellectually stimulating, sociable, and age-inclusive (IES and CfAB, 2017). However, pay and job quality are both constraints, as is the physical nature of care, given older workers’ greater propensity to experience health conditions.

Unpacking this, while hourly pay rates have increased with the National Living Wage, pay is lower than in most supermarkets, at a mean hourly wage of £8.30 in the independent sector (IES and Health Foundation, 2020). Close to a quarter of the workforce has zerohour contracts, providing insecure employment with unpredictable hours and income. News stories reporting community care workers not being paid for the travel time between the appointments with people they provide care for, technicalities of minimum wage aside, hardly build a picture of a good work sector.

Alongside low pay and precarious work, there are challenges for over-working and nondisclosure of illness to avoid loss of already low pay (IES and Health Foundation, 2020). Care workers face risk of chronic pain resulting from lifting and manual handling, particularly when working alone in a client’s home; shift work brings an increased risk of Type 2 diabetes; and poor mental health can result from older workers managing their conditions and trying to remain in work. Covid-19 has shone a light on the issues facing care workers and increased their risks as they are more likely to be in higher risk groups - older and from an ethnic minority (IES and Health Foundation, 2020).

An Outsourced Sector 

Underlying low job quality is a complex sectoral make-up ranging from multi-site, commercial businesses with turnover of tens of millions of pounds, national and local charities, to care commissioned directly by clients. The publicly-listed companies and registered charities are regulated. However, the existence of large multinationals does not guarantee high quality care, and CQC finds that low quality results from insufficient and inappropriate management and leadership. This is also likely to directly impact the quality of management that adult social care workers experience (IES and Health Foundation, 2020).

Improving Job Quality to Attract and Retain Workers 

The answer – in terms of attracting and retaining people in the sector – lies for a large part with employers improving job quality. Skills for Care finds a pay-off that could provide incentive; employers providing high levels of learning and development to staff, on average, see better outcomes in terms of lower staff turnover (reducing recruitment costs) and positive impact on care quality ratings (Skills for Care, 2021).

Stemming Funding Leaks to Improve Pay 

To improve pay requires a different focus; analyses suggest this would be possible if funding ‘leaks’ were stemmed. Allyson Pollack (2021) estimates that around £1.5bn is leaked annually in ‘dividend payments, net interest payments out, directors’ fees, and profits’ of the large, private providers and that these companies engage in tax avoidance. Better scrutiny and regulation would lead to funds being available for improved pay for adult care workers – making the sector more attractive – as well as improving care quality.

Recommendation 1: Skills for Care should work to increase the esteem of care work, through introducing ‘a good work adult social care employer kitemark’ , awarded where pay rates exceed National Living Wage rates, contracts provide stable hours, and employees are engaged regularly in learning and development.

Recommendation 2: Employers should improve progression through training managers and leaders to tackle unconscious bias, open promotion strategies and identify progression pathways; providing training, development and careers conversations for frontline carers, and identifying redeployment opportunities and providing job development for older employees in the adult care workforce.

Recommendation 3: Government and HMRC should regulate more stringently to stem tax avoidance and loss of funds, so that monies recovered can be directed to the frontline and improve employment terms and conditions in the adult social care sector.

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