How has this crisis happened?

Why are care workers underpaid and undervalued?

There are many reasons why care workers are treated badly. We have traditionally undervalued the work of women and care work is by and large undertaken by women whether it is paid or unpaid – 80% of the employed care workforce is female. It may also be because, as a society, we often seem to undervalue the people that they work with – older people and those with a disability. But beyond larger cultural and societal issues that cannot easily be solved by a policy recommendation, care workers are treated badly and paid badly because it does not pay to treat them any better. The UKHCA estimates that providers need to be paid £15.74 per contact hour to pay care workers the minimum wage, including on-costs, overheads, travel time and enough of a return on investment to keep them in business. Few councils pay this rate. A BBC investigation for File on Four found that only four in 101 councils approached paid at least this amount; the average payment was £12.26.

This does not excuse failure to abide by the law. But when providers are commissioned by time and task and paid by contact hour and are not getting enough to cover the time between visits, they pass some of the shortfall on to the care workers themselves. Councils also often rely on framework contracts that give little predictability of work and revenue to care providers. Care is demand led, but more predictability in revenue would give care providers the security to have more care workers on fixed hours contracts or on variable hours contracts that include an agreed set of hours with the possibility of more work. In an increasingly volatile care market, many providers are going bust, or exiting the marketplace to focus on private clients. Councils have a duty of care to social care clients and to the people who look after them. Councils should insist on open-book accounting with their providers to ensure that they can check that care workers are being paid at least the minimum wage and ideally a living wage. But if councils do not actually follow up or providers do not have clear records, there is little benefit to this approach.

Care workers deserve better

3159233339_9cf4912a1a_oThey are the care sector’s biggest asset, but this is rarely reflected in their pay and conditions. Paying a living wage to care workers has recently been the subject of debate in the sector with the report of the Demos Commission on residential Care, which recommended that the sector become a living wage sector.18 That living wage should be a real one and not eroded by illegal and poor practices like non-payment of travel time or failure to cover basic expenses required to carry out one’s job. Employers must do their part, but councils that commission services from care providers must also ensure that they do. Under no circumstances should care workers be paid less than the minimum wage. It is shocking to have to make a recommendation like this, but it must be made.

  • HMRC must be more vigorous and consistent in its enforcement of the minimum wage and must make it easier for care workers to complain through a third party, such as a union, citizen’s advice bureau or legal clinic.
  • Councils must pay providers enoughto cover at least the minimum wage. The UKHCA puts this at £15.74 an hour; however, if a council does not accept this figure it must provide an alternative model and be able to justify its decision. Councils should consider requiring Health and well being Board sign-off for any commissioning process that goes below the recommended rate.
  • Health and Wellbeing Boards should take an oversight role in this matter, as good quality home care is key to health and social care integration and preventative care.
  • Care providers must operate an open-book approach to their payment of care workers, including clear information about their profit margins. Councils should inspect this as a matter of good practice.
  • Councils should also be transparent about how their hourly rate is calculated.

In other matters, too, we must recognise the importance of care workers and their clients by providing for basic health protection. Care workers should get free influenza immunisation on the NHS and this should be routinely monitored and reported. We must also value care workers more. These people are the key to care and they should be recognised as such by having key worker status. This would help the care workforce have access to improved housing by giving them access to the HomeBuy scheme and in some areas assistance with rented accommodation. Even if this were a largely symbolic gesture in the first instance, it would be an important first step in demonstrating how much we value their work and contribution. While this status is normally available only to public sector workers, we feel that serious consideration should be given to extending it beyond councils to those working for providers commissioned by these authorities.