1. The challenge
As a result primarily of inadequate funding over an extended period of time, and the inability of successive governments to find and deliver a workable solution, the social care sector finds itself in a parlous state:
• The high Covid-19 related death count across the sector (particularly in care homes), together with a substantial increase in running costs, has badly affected the viability of many care operators, some of whom will surely be forced to close down in the coming months.
• This issue in care homes (high mortality rate) has severely dented public confidence, leading to a reluctance of many families to place their ailing relatives into care.
And the care workforce is in an equally forlorn state:
• For nearly a year now, since the pandemic struck, care workers have been operating in the most stressful conditions, knowing that they are putting themselves and their familes at extreme risk.
• Since long before the pandemic, care workers have suffered from poor levels of public recognition and respect, with inevitable impact on morale.
• And contrary to popular opinion, care wokers not only shoulder a huge burden of responsibily in attending to vulnerable people, their job demands a high degree of skill and competence.
• Moreover, with staff vacancies now already well over 100,000, the new immigration policy (which classifies care workers as ‘unskilled’), is forecast to place even more pressure on operators and care workers alike.
• Last, but not least, in spite of the preceding points, pay in the care sector remains woefully low, with most workers earning less than £10 per hour.
As these points clearly illustrate, many of the problems faced by the care sector lie within the workforce itself, which is underpaid, under-loved and under-populated.
This paper sets out specifically to address the question, posed by the Prime Minister in October: ‘How will we care for the care workers, as they care for us?’
2. The Solution: Recognition and Reward
81% of adults in England believe care workers are undervalued.
80% say they should be better paid.
National Care Federation research. September 2020
The objective of any proposed reform should be to create a suitably structured social care sector, where workers are not expected to do a demanding and stressful job for such low pay, but where they receive similar levels of professional recognition as their counterparts in the NHS and are remunerated accordingly. Set out below are a series of practical initiatives for ways in which to re-energise and transform the carer workforce.
First of all, the sector is in urgent need of a well-defined career progression. This could be achieved by introducing a series of levels or wage bands (similar to the nursing profession), based on a combination of qualifications (via formal training and examinations) and experience. At its very simplest, it could look like this:
1.Basic (Entry) level No care specific qualification needed, but individuals to be offered formal training courses as part of the job
2.Intermediate level Achieved by completing a series of training modules and exams, plus a minimum number of hours experience
3.Advanced level Achieved by completing a series of more advanced training modules and exams, plus a minimum number of hours experience
Such a structure, with guideline wage bands being laid down for each level, would present those considering a career in care with a real incentive and purpose. For example, Tier 1 (Entry) could be set at a base level of Minimum Wage + X%, and so on for higher bands.
Introducing a whole new set of training programmes would also create an opportunity for experienced/qualified care workers to take on more work currently being carried out by nurses. This in turn would have the added benefit of taking some of the pressure off nursing homes (as opposed to purely residential homes).
And with 85% of the workforce currently female, a substantially improved perception of the social care profession may even encourage a better gender balance in future.
Another idea to improve the status of the sector is to introduce a formal national registration system for care workers, as exists for nursing.
Obviously, new higher salary levels will need to be funded. One way to do this is for government to introduce a low tax charge (eg 1 pence in the pound additional income tax, or an equivalent rise in NI). The funds raised could either be paid to care workers directly, or via tax rebates. Alternatively, money raised could be paid to care home operators/ domiciliary care companies and passed on to workers in wage packets.
3. Practicality and Timescales
Previous attempts to ‘fix social care’ have mostly foundered on the twin peaks of cost and practicality. But the beauty of this idea is that it is confined to just one big issue, the workforce, from which the whole sector can be built and transformed.
Restructuring the workforce and instigating a framework of professional qualifications is actually not that complicated, but it will take time to set up – so start it now.
And while this is progressing, put in place a financial support system. Ideas for how this could be achieved were set out above, but there will be other options to explore – including funding directly from government coffers. After all, the NHS was itself planned, formed and funded in the immediate aftermath of WW2, when treasury funds were similarly stretched.
Ultimately, society must decide and inform government how its money should be spent. And remember, only a few months ago the people made it clear: 80% of them said ‘care workers should be better paid.’
With a workforce, which is better qualified, better respected and better remunerated, social care will be transformed into a much more desirable career, where people will be proud to be a valued participant.
No more ‘Clap for Carers’, but ‘Recognition and Reward for Carers’.