Any week now, an NHS workforce plan will be published. Already delayed several times, it is expected to set out proposals for training doctors, nurses and other health service staff in England. But the crisis of recruitment and retention in the care sector will not be addressed. If the plan encourages more care workers to seek jobs in the NHS – where pay and conditions are better – it could make the position of social care even more precarious than it already is.
This is an alarming prospect. In February, figures from the Office for National Statistics (ONS) showed that one in 10 of all vacancies in the UK are in health or care roles – a total of almost 300,000. In December last year, there were 31,870 support worker vacancies advertised nationally – more than any other job.
Difficulties in finding and holding on to workers, both for care homes and agencies that employ care workers in the home, are part of a broader recruitment problem in the public sector, which is also damaging schools. This is the result of prolonged underinvestment by successive Conservative governments, which has led to uncompetitive pay levels. Brexit also led to disruption, although gaps are increasingly being filled by workers from India and elsewhere.
But there is an additional problem in social care, and that is the low status and meagre rewards attached to it – as well as to unpaid care by relatives. Historically, care work has been undervalued because it is not regarded as productive or skilled. As in nursing, the workforce is overwhelmingly female (the latest figures are 82% in social care, and 88.6% for nurses and health visitors). Care, long viewed as women’s work when unpaid, is also predominantly done by women, particularly women of colour, when it is paid work. While researching her book Labours of Love, Madeleine Bunting met care workers who love looking after people. She also interviewed a woman who said friends would fall silent in embarrassment when she tried to talk about her job.
This is an unsustainable, and at times inhumane, situation, particularly when we know that the number of adults needing care either due to disability or old age is set to keep rising. As a society, we have to get over our disdain for tasks such as feeding, toileting and keeping other people company. Last year, eligibility for health and care visas was widened due to gaps in the workforce, and the number granted rose to 76,938 (a 142% increase since 2019). But migration is not a solution to the long-term, labour-market shift necessitated by demographic changes. Low morale, low wages, rapid turnover and the use of temporary staff feed a rolling crisis that also affects the health service.
The care workforce is fragmented, making strikes unlikely. But means must be found to improve pay and conditions. Employers should be able to attract people who take an interest and pride in their work. The creation of a professional body and register could play a part in a system change, as the Fabian Society and others have argued. New Zealand and the Netherlands are two countries where training and career structures have been improved. Additional funding is desperately needed, as it has been for years. Politicians, but also the public, must break the habit of seeing social care as low-skilled work and reform of the sector as a low priority.