Employment in social
care at a time of
austerity
Dr. Shereen Hussein
Senior Research Fellow
King’s College London
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.
A bit of demography:
Needs
Population ageing (fertility, mortality and 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
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
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?
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
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
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
Source: SCWP Issue (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
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)
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
Source:
SCWP Issue
(6)
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
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
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
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
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
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)
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
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
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
Risks: workforce
Stress and burnout
Rights
Trade unions/ registration
Pensions
Exploitation/abuse
Deskilling
Discrimination
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!
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)
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
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
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
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/sc
wru/pubs/periodical/index.aspx