Employment in social care at a time of austerity

1. Employment in social care at a time of austerity needs, opportunities, fairness and risks Dr. Shereen Hussein Senior Research Fellow King’s College London

2. What is social care?For adults and older people Social care supports people of all ages With needs arising from physical, cognitive or disabilities Assist in carrying out personal care or domestic routines (activities of daily living). Helps sustain paid or unpaid work, education, learning, leisure and other social support systems. Supports people in building social relationships and participating fully in society.

4. A bit of demography: Needs • Population ageing (fertility, mortalityand life expectancy) • Medical advances • Longer life expectancy to children with certain illnesses and disabilities • Social changes • Family dynamics • Life style (nutrition and quality of life) • Female (primary traditional informal carers) labour market participation • Co-residency; migration and geographical proximity

5. Formal and informal spheres of care • Sociology of care • Norms and traditions • Individual, society and government responsibilities • Working with other forms of support (social security, health and housing) • Complement, intersect but do not substitute one another

6. Welfare state: • Means-tested system. • Very broadly, people with assets over £23,250 receive no financial state support (fund their own care). • The level and type of state support for people with assets below this threshold depends on their needs and income. • The Government currently spends £14.5 billion p.a. on adult social care in England. Just over half of this is on services for older people. • Reforms, Dilnot commission report possibly not happening?

8. What is social care as a labour market sector? • Traditional and new forms of markets • Dealing with a special kind of ‘commodity’ • Expanding consumers base • Expanding ‘products’ (to meet variety of needs) • Interaction with other labour markets (e.g. technology, leisure, etc.) • Competing for certain groups of the workforce • Local, regional and international markets

9. The share of social care in the labour market • At least 7% of the total active labour force is estimated to be working in the (adult) social care sector • ‘Recession proof’ sector • Continues growth in the market share • Wide range of job roles • 72% involves direct care but other professional roles are important • Share of the private sector- profit and business case

10. A bit of statistics • Estimates of growth in users’ demands (with at least 2 million users) • At least 2 million people are estimated to be working in the sector in the UK • Migrants (especially non-EEA) constitute considerable portion of the workforce • Estimated around 20% with 40% to 60% in major cities

11. Source: SCWP Issue (12)

12. A bit of sociology: How a society value and ‘cost’ care • Value of ‘care’ work to the society • Gendered; emotional; for granted ! • Responsibilities and duties of care • Assumed or planned • Pricing ‘emotional’ work

13. The position of the care sector and labour dynamics • Secondary labour position • Pay and working conditions • Recruitment and retention • Attraction of ‘flexible’ working patterns • Changing structure; place; nature, interaction with health services • Links to government funding (means tested)

14. In focus: pay • One of the main sectors to benefit from the introduction of NMW in 1999 • Estimates of 40% of the workforce earned below NMW before the introduction • Most recent estimates indicate that at least 12-15% (150,000 to 200,000) of direct care workers are paid under the NMW • Wages significantly lower in the private sector • Ethnic and gender pay-gaps are evident both within higher and lower paid groups of workers • Recent concerns of the effect of austerity measures on individual pay levels • Travel time and cost; increased responsibility; calculating shift duration

15. Source: SCWP Issue (6)

16. Social care provision • Estimated 17,300 organisations in England alone • With number of local units estimated at 40,600 • Current profile of providers • While there are some ‘big’ private employers- local units are usually ‘small’ businesses • 74% of local units are run by the private sector, 19% the voluntary sector and 7% by local councils • Recipients of direct payments • Users as employers • Estimated at 114,500 in 2009

17. Example of a care provider: Four Seasons Health Care • Major provider of ‘health care’ • Operating over 500 care centres • Employs over 30,000 people • Provides services to at least 25,000 people • Annual turnover (2010): £503.6 million • CQC verdict (some of the branches) • Failed standards of caring for people safely & protecting them from harm • Failed staffing requirement • CQC is taking action against this employer

18. The social care workforce • Traditional profile • More demand on increased and specialised skills • Understand technology • Understand and meet the needs of specific illnesses and conditions (e,g. dementia) • Empower users- community integration, work participation etc. • Retention and relationships with quality of care

19. Workforce supply • Image and status • Current profile • Age and gender • Nationality and ethnicity • Qualifications/ training • Local and international supply • Migrant workers and immigration policies • Grey economy and domestic workers

20. In focus: men in the social care workforce • 17% of the workforce • Trend of increased prevalence (from 2000 to 2009) • Slightly younger and more evenly distributed across 30-50 years • Proportionally more of them report disabilities • Larger proportions of migrant workers are men (24%) • More likely to work with adults with LD, MH and ASD

21. Nature of care work • Job demand and control • Responsibilities and pressures • Reward and job satisfaction • Assumptions • Work dynamics • Support, interactions and isolation • Cultural/language sensitive • Care models • empowerment and choice)

22. Economics and business case • Funding • Return – large and expanding consumer base; must have commodity • Share of the labour market • Interacting with different sectors • Opportunities of cross-working • Growth • Labour market composition

23. And .. Few bits of politics • Funding (Dilnot review); austerity measures • Big society • Re-debating responsibilities and duties • Mutual and co-operative models of services • Personalisation agenda • Health and Social Care Bill

24. Implications • Tighter public purse  reduction in funding • Immigration cap  difficult access to ‘skilled’ migrant workers • Austerity measures  higher unemployment rates, larger pools, suitability of recruits • Interface between social care sectors and other sectors, especially health

25. Risks: workforce • Stress and burnout • Rights • Trade unions/ registration • Pensions • Exploitation/abuse • Deskilling • Discrimination

26. Opportunities: workforce • Increased demand may open up employment opportunities for non-traditional groups • Men • Younger people • Migrants (transit or establishing a career) – EEA migrants, learning about language and culture • Short-term and long-term opportunity • Innovative thinking!

27. Risks: service users/carers • Quality and continuity of care • Length of visits • Institutional and individual ageism • Respect and dignity • Abuse and neglect • Intentional or un-intentional • Responsibilities (as employers)

28. Opportunities: service users • More control and choice (individual budget) • New types of workers- may enrich service experience • Technology- self-managed care • Both opportunities and risks • Detachment from certain individual workers (less stable workforce; more temporal) • Cultural encounters

29. Impact: wider labour market • Boundaries between care and health sectors • Possibly other sectors as well, such as leisure and technology • Circular labour or stable workforce • Stepping stone • New types of employment • Interface with other labour sectors

30. Conclusion • Workforce representation • Documented and grey economy • Unions, regulators and professional bodies • Workforce quality and stability • Funding and the increasing role of the private sector • Business case and opportunity • Organisational Structure • The share of individual employers • Users’ outcomes and quality of care

31. Thank you • Shereen.hussein@kcl.ac.uk • For latest workforce analysis, see the Social Care Workforce Periodical • http://www.kcl.ac.uk/sspp/departments/sshm/scwru/pubs/periodical/index.aspx