We must fix the structure of social care and create a funding settlement that raises workers’ pay and skills

Until we properly recognise and reward care work, we will never have a system that provides the quality of care that everyone deserves, writes Charlotte Nichols MP



The crisis in social care is one almost universally acknowledged – an ageing population with increasingly complex care needs, and a system that already cannot meet demand and produces one of the largest turnover rates of any employment sector.

Yet, while no one seems to dispute the growing crisis, proposed solutions seem vanishingly few and far between. The Government continues to kick the proverbial can down the road, with the green paper promised in March 2017 still not having materialised, and much of the public conversation focusing simply on the issue of funding.

I don’t wish to diminish the urgency of the need for greater funding, but without fixing all that is structurally broken in social care, that funding will not necessarily flow through to care quality or care workers’ wages but will instead just fatten the Cayman Island bank accounts of sectoral behemoths like HC-One.

Outsourcing and fragmentation of the social care system has produced massive amounts of inefficiency and duplication, as the profitable care packages are high-volume, low-need – meaning there isn’t much appetite for the other tenders, so you‘ll often find a number of different providers on the same street.

Cash-starved local authorities commission for care on the assumption of national minimum wage pay rates, and care tends to be commissioned by the hour, which means that the funding stops if a care recipient goes into hospital or passes away. Underpayment of the national minimum wage is rife.

The turnover rate in social care is around 31%, double the average across the economy of 15%. In my constituency, every time the Trafford Centre advertises for temporary workers, you see a knock-on effect in local care.

“Outsourcing of the social care system has produced inefficiency and duplication”

When Amazon opened a distribution centre in Warrington, it triggered a crisis of provision locally. What does it say about how we value our care workforce that a company with a reputation for poor pay and exploitative work practices is considered preferable to remaining in social care?

Care work is an incredibly physically and emotionally demanding, skilled role. Not just for the fact that it is increasingly medicalised with care workers often performing tasks like changing stomas, PEG feeds and administering controlled drugs, and all of the risk that entails, but for the other skills needed, not least in end-of-life care. The empathy needed to provide dignity in someone’s final moments, deal sensitively with their grieving loved ones, to be bereaved over and over yourself, and have the resilience to get up for work the next morning – I know I don’t have it in me.

These are skills which are undervalued and unrewarded, in large part due to the lack of recognised qualifications that are transportable across social care and the wider health and social care sector, including child care, and few training and progression pathways to build a career.

Indeed, the only mandatory training across the sector is in moving and handling, and the pay differential between a new care worker and someone with years of experience is around 17p per hour.

Until we start to properly recognise and reward care work, we will never have a system that provides the care quality everyone deserves. That’s why I believe a new funding settlement must sit behind a sectoral plan for pay, professionalisation and skills, and a commitment to insourcing to ensure money is being spent where it is most needed.

Before coming into Parliament, I worked for a trade union and used to speak to care workers who told me they were frightened to retire, because they know what’s waiting for them when they need care. A sobering thought on a future we need to act now to avoid.

Charlotte Nichols is Labour MP for Warrington North