Social care is delivered by people, informal carers and workers, not robots. This means improving the quality of care in Scotland has to seriously address workforce issues.
I was facilitating a session today at the 'Social Care: An Ambitious Future' conference in Edinburgh. The conference covered a wide range of issues relating to the crisis that is our grossly underfunded social care system in Scotland. My session was on workforce issues
Let's start by understanding the workforce. 189,670 people are employed in the social care sector, which accounts for approximately 7.4% of Scottish employment. The typical weekly hours worked by staff is close to full-time at 32.5, with women accounting for 85% of the workforce. The biggest employer is the private sector with 41% of the workforce. The public sector makes up 31% and the voluntary sector employs 27% of the workforce. This is a growing workforce as demands on the sector grow. However, all providers report increasing difficulties with the recruitment and retention of staff.
Part of the reason for this is the precarious nature of work in the sector. While the workforce is predominantly employed on permanent contracts (79%), there are significant numbers (around 12%) employed on Zero-Hours contracts. This number understates the actual level of precarious work because of the prevalence of Nominal-Hours contracts. These are contracts where staff are contracted to work a set number of hours, but in practice work significantly more.
The biggest immediate problem is pay. The vast majority of care workers are employed in Class 2 (entry level) care worker positions which covers routine care and support work and which typically pays the National Minimum Wage (NMN) (£6.70 over 21) or just above. Shockingly, some providers even attempt to avoid their legal obligations to pay the NMW. For example last week UNISON won a victory over MiHomecare. Staff there were notionally paid the legal minimum, but the company did not pay for the time they spent travelling between clients’ homes — meaning that they received less than the minimum wage.
There have been efforts to establish an industry floor of £7 an hour in Scotland, but this has run into some legal difficulties over State Aid provisions. It has also been overtaken by events with the introduction of the new UK National ‘Living’ Wage set at £7.20 for workers age 25 and over from April 2016.
The Resolution Foundation has highlighted the impact of the new NMN provisions in their report 'Care to Pay'. They calculate that this will directly affect up to 1 million frontline care workers across the UK by 2020 and increasing the annual household incomes of those affected by more than £800. But this comes at a cost – in particular the National 'Living' Wage will increase payroll costs associated with frontline care workers by £23 billion by 2020, on top of £17 billion of costs already implied by the increase in the National Minimum Wage (NMW). There are also additional training, pension and sleepover payments that are not being fully funded, including for those funded through Self Directed Support
There is an agreed ambition from stakeholders to see all employers in the sector become Scottish Living Wage employers – currently £8.25 in Scotland. The latest Scottish Government statutory procurement guidance on workforce matters sets out how this can be achieved legally through procurement. The wide support for this measure recognises that the payment of the living wage and a general improvement of terms and conditions will be required to deliver a social care workforce consistent with our aspirations for quality care.
Of course fair remuneration is only one aspect of fair work. UNISON’s Ethical Care Charter is referenced in recent Commission reports and the Scottish Government’s vision for social work. The Charter covers, training, induction, zero-hour contracts and time to care properly - as well as payment for travel time, travel costs, occupational sick pay and other necessary expenses such as mobile phones.
We published a new briefing on the Ethical Care Charter last week and how all councils in Scotland could implement it. The barriers are no longer legal, they are largely financial. The Scottish Government's draft budget makes some provision for additional funding routed through the NHS budget. However, it remains to be seen how much of this actually reaches social care services given the pressures on NHS provision. Even George Osborne recognised the problem in allowing English councils to raise the Council Tax. There is no such relief in Scotland where the regressive Council Tax freeze drags on, together with further cuts to council budgets.
At today's conference there was a recognition that we need to raise the profile of social care to get the same level of public, and then political, support as the NHS. With a growing elderly population, increasingly socially isolated, there is some enlightened self interested to be tapped into here to build the case for proper funding. Social care is a universal good that we will all need at some stage, part of the fabric of the society we want to see. We also have to debate if there should be at least a national framework, if not a national service, for social care.
Finally, care workers also have strong views about the quality of care. A UNISON survey of Scottish homecare workers exposed the shocking reality of the country’s care services. The majority of workers polled in the survey - Scotland: It’s Time to Care – said that the service is not sufficient to meet the needs of the people they care for, both from the time they can spend and the quality of care they can provide.
Social care plays a vital and growing role in our society. Yet increasing demand, falling real terms funding, and increasingly complex care needs has put the sector under significant strain. At the heart of this cocktail of challenges sits the workforce, which experiences low wages and poor working conditions. Most care workers are highly committed to the work they do, but such conditions are putting them under significant strain. If we want a social care system that can meet the needs of our ageing population and treat recipients in a dignified way, then we need to invest in the workforce that provides it.