This blog can also be found as a PDF at: Social Care Briefing 2nd December 2021
How more public investment in social care would benefit the whole
country.¹
Hilary Land, Jackie Longworth, Diane Bunyan, Sue Cohen
[Authors’ postscript 2ⁿᵈ December 2021:
What the White Paper published yesterday is missing just serves to emphasise the points made in
this briefing, in particular on the value and needs of carers both paid and unpaid.]
Introduction
“Spending on social care shouldn’t be seen as taxation and costs. It is an investment. Social care
is worth £46billion to the economy and represents 6% of total workforce employment”
(www.tuc.org.uk/research-anaylsis/reports/new-deal-social-care-new- deal-workforce/)
For years UK’s social care system has suffered from the failure to fund either sufficient
domiciliary services or residential care beds. The pandemic has exposed the consequences of leaving
Local Authorities (LAs) starved of the funds to meet the growing need for care, particularly in
poorer areas with the greatest needs. Left to the private market, self-funders in residential care
have been subsidising the low fees paid by LAs. Private equity firms, provide a quarter of
residential care beds, but use a business model which invests little in staff training and pay. It
is heavily indebted, prioritising tax avoidance and high returns to their shareholders.
This Autumn the government is claiming to have ‘fixed’ the funding of social care. Emphasis is
placed on capping the total amount an individual must pay for either residential and/or domiciliary
care services and funding them in a way which avoids owner occupiers having to sell their house. A
far more effective and fairer policy would be public investment in high quality social care
services with trained staff funded out of taxation on income and wealth.
“It is time to overhaul the way we train, recruit and retain doctors, nurses and
care workers” Jeremy Hunt, former UK Health Secretary and chair of the health and social care
select committee, (FT 23 October 2021)
The social care sector in the UK (particularly in England which has no national organisation to
oversee training standards and accreditation) is characterised by low pay, zero hours contracts and
insecure employment. Seven out of ten social care workers are paid less than £10/hour. There is
little pay or career progression. Senior direct care workers receive a higher hourly rate measured
in pence rather than £s.
Investment in training is minimal. The latest White Paper in November only pledges an additional
£500 million for (workplace) training for the social care workforce. The two Health and Social Care
apprenticeships were abolished in 2017. There still are apprenticeships in Social Care but the
number starting them fell by a quarter between 2018 and 2020. Fewer than half completed them. The
apprenticeship levy has been underspent in recent years. With the shortages of workers does the
social care sector have the capacity and time to supervise and train new entrants? The
skills are there-the average years of experience in social care work is 8 years. Their invaluable
expertise could be accredited and recognised by paying them more. Could funds be found to pay
recently retired experienced staff to mentor them?
Meanwhile, the initial Training certificate introduced in 2015 to social care workers in health and
social care comprises short basic optional modules provided on-line. Its shortcomings have
consequences for the NHS as well as care homes. For example, in 2018-19 when only half chose to
study ‘awareness and safe-handling of medication’ more than 10% of older people’s admissions to
hospitals concerned over-medication. Better training could have avoided a third of these
admissions.
Central to ‘fixing’ social care is more investment in the skills, qualifications, pay and career
progression of the social care workforce comparable to public health care workers, (at least level
2 but ideally level 3). The effective integration of social and health care services requires that
the cuts in public health care workers must also be made good. Nurses have not only been lost from
hospitals. After a decade of austerity, the number of district nurses in English LAs had halved and
there were 20% (10,000) fewer nurses employed in residential care or nursing homes. Until these
issues are addressed, delayed hospital discharges will continue and grow.
It is not surprising that there is a high turnover rate (35% in 2020-21) among the social care
workforce in England (and in Bristol). However, prior to the introduction of compulsory vaccination
for residential care staff, two-thirds in England (and three quarters in Bristol) moved to another
job in social care. This suggests that high turnover rates reflect poor pay and conditions rather
than the nature of social care work itself. Factors affecting turnover rates in England (2021) bear
this out. (www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence)
• Turnover decreased with higher levels of experience working in the sector as well as
where workers had a higher number of contracted hours.
• Higher rates of turnover were found if the establishment had a history of high
turnover rates,
• Likelihood of leaving decreased as pay levels increased, access to training and to
qualifications was greater or workers had higher levels of experience.
• Scotland and Wales paid a £500 bonus for care workers last year. Fearful of the
increasing exodus of social carers to supermarkets etc, the government is only now proposing a £500
‘retention bonus’ to social care workers in England
The social care workforce is currently comparable in size to the health care workforce (1.5
million). It needs to increase for the following reasons:
• Just to keep pace with an ageing population by 2035 it needs to grow by 500,000. (In
the South West this is an increase from 178,000 to 240,000).
• There are higher numbers of those of working age with special needs or disabilities.
With the aid of domiciliary care services or personal assistants more could take up and stay in
paid employment. On average, LAs in England, now spend 60% of their social care budget on this
group.
• Since 2010, women’s state pension age has risen from 60 to 66years, with further
rises to come. One in four women aged between 50 and 64 have caring responsibilities and in order
to stay in paid employment need social care services just as mothers need child care services.
• Carers UK (2020) estimated that 4.5 million more people became unpaid carers during
the pandemic bringing the total in the over 13 million. The proportion of NHS staff with caring
responsibilities increased from one in five in 2019 to one in three in 2020. (NHS Staff survey
2021).
The needs of unpaid carers are rarely mentioned let alone addressed. In 2019-20 the
1.3 million carers who had given up paid employment in order to look after a close family member or
friend at least 35 hours a week, were in receipt of Carers Allowance. Currently £67.70 this is one
of the lowest benefits in the system, worth 40% of the basic state pension and 66% of statutory
sick pay. Defined in the official statistics as ‘economically inactive’ unpaid carers’ contribution
to the economy as measured in the GDP literally does not count because it is unpaid.
This briefing outlines how investment in both paid and unpaid carers would benefit a range of
national priorities including how it would:
1) Provide essential social care infrastructure support to achieve a better functioning, more
flexible and fairer economy.
2) Reduce the gender pay and pension gap.
3) Increase household spending power and thus boost local economies.
4) Increase tax revenue and reduce welfare spending by enabling more women to remain in employment
until aged 66 years, the new state pension age.
5) Allow eligibility for the state pension to rest on the presence of long-term health conditions
or full-time caring responsibilities and not on chronological age alone.
6) Create more new jobs in the social care industry sector than a similar investment in physical
industry sectors.
7) Assure investment in better skills, qualifications and pay and career progression for social
care workers.
8) Reduce pressure on hospital beds by improving the capacity of public health and social care
services, thus both delaying/avoiding admissions to hospital at the same time as facilitating the
prompt discharges of patients.
9) The healthy life expectancy of those living in the poorest areas means they are likely to be in
poor health from their early fifties, twenty years before those living in the wealthiest areas.
10) Contribute with both short and long-term policies to reduce inequalities in healthy life
expectancies. These are integral to the ‘levelling-up’ agenda with investment in towns, villages
and cities, be they north, south, east or west.
11) Contribute to the ‘green’ agenda by providing local low-carbon jobs.
1. A functioning, flexible and fairer economy
The over-fifties accounted for 73% of UK employment growth in the past 20 years, many of them key
workers. By 2018, 72% of 50-64 year-olds were in paid employment. In 2019, among those those
willing or would like to work but were not looking for it ie ‘economically inactive’, three fifths
were ‘sick, injured or disabled’ and one in six were ‘looking after home or family’ (GOV.UK, Nov
2020.)
One in three older workers are key workers and found in the public administration, education and
health sectors. Among women, care workers make up the highest proportion of night workers, followed
by nurses and midwives.
Investment in social care would enable significant numbers of women across all industry sectors to
contribute significantly more to the UK economy by increasing
both their paid working hours and their pay per hour. It is estimated that up to 1.5million jobs
could be created in the UK if 2% of GDP were invested in care industries, compared to 750,000 for
an equivalent investment in construction. (De Henau et al 2016)
In addition to producing a better functioning economy, it would also be fairer as the gender pay
and pension gap would be reduced. These issues particularly impact women from Black, Asian and
Minority Ethnic communities who are over-represented in the social care and health sectors, and
their death rates from COVID -19 among these workforces are even higher than their White
counterparts.
• The gender pay gap, whether measured in pay or weekly hours, increases dramatically
around 30 years old when women become mothers, and move from better paid jobs, either out of the
labour market altogether for a period or into lower-paid part-time jobs. For similar reasons, this
pay gap is not only sustained but also increased when a quarter of women, compared with one in
seven men, become carers between their fifties and sixties. Women in their early 50s are five times
more likely than men in this age group to be working part-time falling to twice as likely among
those in their early sixties.
• This pay gap is carried over into the gender pension gap. Women on average have much
smaller pension pots than men. A recent study of men and women aged over 55 found the gap between
them had grown by £26,000 during the pandemic to £186,000. (Pandemic widens pension pot gender gap
(FT,10 Aug 2021).
• The state pension scheme, which is one of the lowest in the OECD, has become less
effective in protecting women against poverty. Since 2010 the State pension age for women has been
raised to 66 years, equal to men. The DWP thus saved a total of £77 billion on pensions between
2010 and 2019.
• As a consequence of legislation in 2016, widows’ pensions have been abolished. To
qualify for means-tested pension credit both members of a couple must be of pension age. Half of
the couples affected lost on average
£5,900 in the first year saving the DWP £2billion. For a third of these couples the age difference
is at least 5 years. Those living in rented accommodation also lose access to housing benefit. Half
of the affected couples included at least one person in receipt of a disability benefit, so the
loss of free travel to medical appointments is significant.
• It has become even more important for employers to recognise that carers need
entitlement to paid and unpaid leave and the right to work flexibly. They also need domiciliary
care services to enable them to combine paid employment with care as well as to provide them with
some respite.
2. Social care as infrastructure in the Industrial Strategy
The aim of the Industrial Strategy is to boost productivity by backing businesses to create good
jobs and increase the earning power of people throughout the UK with investment in skills,
industries and infrastructure. Investment in universal social care would further all these
ambitions.
The social care sector was privatised thirty years ago. The Voluntary sector and local government
providers now comprise a very small proportion. Many providers are small or medium sized private
companies or social enterprises. The fees paid by LAs are insufficient to cover costs and in poorer
parts of the country there are fewer self- funders to cross-subsidy them to keep them viable. The
market is unstable and
provides the least in the areas of greatest need. A quarter of residential care beds are provided
by private equity companies using a business model inappropriate for the social care sector while
enabling them to extract £1.5 billion a year from it.
Increasing the numbers, status and pay of social care workers would particularly benefit local
economies as this is where they spend most if not all of their earnings.
• Social care as infrastructure would boost productivity by enabling businesses to
increase quality skilled employment not only in the social care sector, but also in the retention
of older women-and men in full-time/flexible employment
• Investing in universal social care requires investment everywhere across the whole
country, increasing employment in every area. Investment in physical infrastructure does not have
the same direct geographical spread.
• Investing in worker qualifications and pay would also have the effect of raising
local pay rates more generally through competition for workers.
3. The Green New Deal
Interest in how the transition to a just, green economy will further women’s equality requires
seeing that investment in the social care sector is part of the ‘green’ economy. The Women’s Budget
Group together with the Women’s Environmental Network are in the process of a two-year consultation
and analysis of how intersectional and gender inequalities will be addressed in a Green New Deal.
Critical to this analysis are:
• Inclusive employment practices furthering equality in New Deal Opportunities.
• Greening care.
• Making automation and high-tech yield advantages to everyone.
• Democratising community involvement in decision making at a local level.
The success of these strategies is increasingly dependent on investment in care as infrastructure,
which supports the rest of the economy at least as much as physical infrastructure such as roads.
• Eurostat found that jobs in care are 30% less polluting and jobs in education 62%
less polluting than those in construction.
• Being local, social care jobs require less travel so cause less carbon emission. If
organised by LAs instead of by un-co-ordinated, competing domiciliary agencies, care workers could
be allocated to clients in ways which reduce the distance as well as time spent travelling between
them.
4. The Levelling-up agenda
• Levelling up is needed in more disadvantaged neighbourhoods and communities.
Investment in local high quality social care in these areas would enable older women to access
better employment skills and training
• The multiplier effect increases the labour availability in other sectors locally,
encouraging further investment from companies looking to expand.
• Health improves (mental and physical) putting less strain on families and on both
community health services as well as hospitals.
• There is evidence that women in ethnic minorities, in particular, would like training
and employment in local social care settings. Older people want social care to be culturally
sensitive as well as local, high quality and affordable.
As the Women’s Budget Group say in the forward to their report of the Commission on a gender equal
economy2: “An economy which has the well-being of individuals, communities and the planet at its
centre; an economy which values care, both paid and unpaid, as the activity that nurtures us all;
an economy which ensures that no- one faces discrimination, violence, or poverty, and in which
no-one is left behind or pushed behind. This new economy is a caring economy.”
