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Is the UK ready to invest in decent pay in adult social care?

In just five years of working in adult social care in England, Tony Micklethwait (not his real name) has amassed a catalogue of experiences illustrating how underfunding and understaffing has pushed the sector into crisis. “It’s not a job for the faint-hearted,” says the 24-year-old, who works 14-hour shifts for a private care company in Yorkshire, northern England.

Micklethwait is trained to provide one-to-one care to adults with autism in residential homes. But staff shortages mean at times he cares alone for more than one adult with complex needs. At short notice, managers have deployed Micklethwait to other sites to cover staff gaps and support adults with whom he is unfamiliar.

Some of the hardest days have seen Micklethwait deal with residents who self-harm or are aggressive. He has been forced to call the police on occasion. “A resident hit me with an iPad once – the sharp edge of it hit me right in the forehead,” he says. “We’re not meant to take on violent residents – we’re a hands-off service – but we do.” After this incident Micklethwait suffered anxiety and would arrive at work trembling.

Despite these demands his salary is just a few pence above the legal national minimum wage (NMW) for workers aged 23 or above, of £10.42 an hour.

Tackling the poverty wages paid to care workers in the United Kingdom is at the heart of solving the crisis in adult social care, according to the Trades Union Congress (TUC), which published A strategy for the care workforce in August, a landmark action plan which offers solutions to the national crisis across adult social care, childcare and early education.

It identifies “government inaction, chronic underinvestment, a fragmented and largely privatised provider landscape, and widespread exploitation of care workers by employers enabled by weak accountability and labour market enforcement mechanisms” as central to the crisis, the full scale of which became a national scandal during the Covid-19 pandemic.

But at the heart of the issue is wages. The report shows that adult care workers earn just 65 per cent of the median salary for all employees (£21,500 per annum compared to £33,000) while childcare assistants earn less than 58 per cent of the median UK salary (£19,000). Micklethwait is among nine out of ten care workers in England who earn less than £15 an hour – a rate the TUC says the government should introduce to help end the crisis.

According to Skills for Care, the employer-led workforce development body for adult social care in England, in 2021/22 out of 1.79 million posts in adult social care in England 165,000 were vacant – a 52 per cent rise in vacancies on the previous year. In addition, 24 per cent of workers are employed on zero-hours contracts, which offers no guarantee of work or minimum hours.

In the UK, social care is devolved meaning the four nations within it manage their systems separately. However, TUC policy officer for public services Abigail Hunt says there are many similarities between England, Scotland, Wales and Northern Ireland in terms of the challenges in social care: “Both the in the current system, and the challenges that social care workers face.”

Time to tackle low pay

But why are wages so low? In England, local authorities fund social care services through their own revenue. There is no national government budget for adult social care, and it is separate from the National Health Service (NHS). In 2021/22, net local authority expenditure on care was £19 billion.

A House of Lords Adult Social Care Committee report published in December 2022 recommended the government increase its financial settlement to local authorities for adult social care, and commit to “realistic, long-term and protected funding”. It also called for the government to tackle low pay. In its response, published in August 2022, the government said it had already announced several new measures, including £7.5 billion of additional funding for adult social care over two years, and allowing councils to increase local taxes to fund services. With regards to pay, it said the responsibility lay with local authorities to determine rates.

Herein lies the root of the problem, according to Hunt: the majority of local authorities outsource social care provision to private sector providers. “Essentially providers are operating for the main part for profit,” she says. “In England, in recent years we’ve seen massive underfunding of the sector. This and other factors have together created a drive to the bottom in terms of pay and conditions.”

Hunt accuses the government of bouncing responsibility for pay onto private sector providers. “There’s an absolutely critical role of the government in setting a good employment rights framework,” she says. “All roads lead back to central government. What you’re talking about with social care is a critical part of our social and economic infrastructure.”

Poor pay in the profession manifests in different ways. Pay progression is meagre. Workers of five or more years receive just 10p more an hour on average than new staff. “The sector is not rewarding skills and experience, which provides a real challenge for people wanting to stay long-term,” says Hunt.

Domiciliary workers travelling between appointments are generally unpaid for travel time. This can leave such workers effectively earning less than the NMW. “We see that as a kind of wage theft which urgently needs addressing,” says Hunt.

Those on zero-hours contracts rarely receive sick pay, and contracted workers such as Micklethwait are also denied this benefit. He requires a doctor’s note to receive statutory sick pay for any days not taken as annual leave. “We’re working with ill people who are more susceptible to things,” he points out. “They could be throwing up and pooping everywhere and you have to deal with it, and end up being ill yourself. Then you’re punished for being ill.” He adds that his employers would “laugh” if he asked for leave to cope with mental exhaustion.

“There are high levels of stress and burn-out because employers are not supporting workers,” says Hunt. She says a lack of training and equipment for staff means health and safety concerns in the profession are high. Care work can involve lifting patients, for example. “Injury rates are a huge issue,” says Hunt. “We don’t see investment in quite basic level technologies to, for example, aid existing immobility.”

Time to introduce collective bargaining?

To tackle these issues, the TUC wants the sector to establish a Fair Pay Agreement to negotiate minimum standards of employment in social care. A £15 an hour wage would recognise care worker’s skills and address historical discrimination. The most up-to-date research from Skills for Care shows that 82 per cent of the adult social care workforce in England is female, while 23 per cent come from a Black, Asian or minority ethnicity (BAME) background (compared to 15 per cent across all workers). “Ultimately you’re talking about, in many cases, a lot of discriminated-against women, including a disproportionately high number of BAME women, being able to put food on their plate at the end of the day,” says Hunt.

The data also shows a huge uptick in the number of migrant social care workers in the UK, due to significant and prolonged worker shortages: in 2022/23, 70,000 international care workers were recruited, up by a massive 50,000 workers from 2021/22.

The TUC estimates that a social care wage hike would boost England’s economy by £7.7 billion. This is because the net cost for the government to fund the rise would be lower than the upfront investment needed, as the UK Treasury would in return collect higher income tax and have to pay out fewer in-work benefits. “Essentially, the poverty pay that many care workers receive now is being subsidised by the government through in-work benefits,” says Hunt.

The TUC believes one way fairer wages could be achieved is if local authorities set wage rates with private providers at the tendering stage of service commissioning. Another option is for councils to bring care services in-house. “There’s a bit of a trend towards insourcing again, but it’s really the minority,” says Hunt.

In Wales, where similar challenges in social care exist, the government has committed to ensuring workers receive the UK living wage of £10.90 an hour. This rate is set by the Living Wage Foundation, and unlike the NMW, is voluntary and applies to workers over 18. However, Natalie Grayson, national care organiser with the GMB general workers’ trade union, says private care companies can choose not to take the additional money if it comes with too many constraints.

Grayson says adult social care is a failed system that needs a huge overhaul. GMB wants social care brought together under a ‘National Care Service’ that would operate on a comparable model to the NHS. “Everywhere I go within care and speak to our members, they ask us, why can NHS staff negotiate their pay on a national level, but we can’t?” she says. “The care workforce is bigger than that of the NHS, and the skill sets are very similar. Collective bargaining is the first level of investment we would like.”

In European countries, large private care providers are beginning to enter into collective bargaining discussions with the European Union, according to Grayson. In September 2022 the European Commission published a European Care Strategy recommending nations promote collective bargaining and social dialogue as a means of improving wages and working conditions.

GMB is also calling for the £15 wage through its Fight For £15 campaign and says the rise will encourage workers back into the sector. According to a survey of its members seen by Equal Times, 94 per cent believe low wages put off people working in care.

Despite the multitude of challenges, adult social care workers are committed to their roles. Surveyed GMB members overwhelmingly state the reason they work in care is “to make a difference”. Micklethwait says care work is his calling and he is proud of his work. “I know you’re not meant to use this word in care,” he says. “But I really do love my residents.”