Employment in social care at a time of austerity

needs, opportunities, fairness and

risksDr. Shereen HusseinSenior Research FellowKing’s College London

What is social care?For adults and older peopleSocial care supports people of all ages With needs arising from physical, cognitive or disabilitiesAssist 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 changesFamily dynamicsLife style (nutrition and quality of life)Female (primary traditional informal carers) labour market participationCo-residency; migration and geographical proximity

Formal and informal spheres of care

Sociology of careNorms and traditionsIndividual, 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 marketsDealing 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 workforceLocal, 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’ sectorContinues growth in the market shareWide 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 statisticsEstimates 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 UKMigrants (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 societyGendered; emotional; for granted !

Responsibilities and duties of careAssumed or planned

Pricing ‘emotional’ work

The position of the care sector and labour dynamics

Secondary labour positionPay and working conditionsRecruitment and retentionAttraction of ‘flexible’ working patterns

Changing structure; place; nature, interaction with health servicesLinks to government funding (means tested)

In focus: payOne 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 sectorEthnic and gender pay-gaps are evident both within higher and lower paid groups of workersRecent 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 provisionEstimated 17,300 organisations in England alone

With number of local units estimated at 40,600Current profile of providers

While there are some ‘big’ private employers- local units are usually ‘small’ businesses74% of local units are run by the private sector, 19% the voluntary sector and 7% by local councils

Recipients of direct paymentsUsers 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 centresEmploys over 30,000 people

Provides services to at least 25,000 peopleAnnual turnover (2010): £503.6 million CQC verdict (some of the branches)

Failed standards of caring for people safely & protecting them from harmFailed staffing requirementCQC is taking action against this employer

The social care workforceTraditional profileMore demand on increased and specialised skills

Understand technologyUnderstand 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 supplyImage and statusCurrent profile

Age and genderNationality and ethnicityQualifications/ training

Local and international supplyMigrant 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 workJob demand and control

Responsibilities and pressures

Reward and job satisfactionAssumptionsWork dynamics

Support, interactions and isolation

Cultural/language sensitiveCare models

empowerment and choice)

Economics and business case

FundingReturn – large and expanding consumer base; must have commodityShare of the labour marketInteracting with different sectors

Opportunities of cross-workingGrowthLabour market composition

And .. Few bits of politicsFunding (Dilnot review); austerity measuresBig societyRe-debating responsibilities and dutiesMutual and co-operative models of servicesPersonalisation agendaHealth and Social Care Bill

ImplicationsTighter public purse reduction in fundingImmigration cap difficult access to ‘skilled’ migrant workersAusterity measures higher unemployment rates, larger pools, suitability of recruitsInterface between social care sectors and other sectors, especially health

Risks: workforceStress and burnoutRights

Trade unions/ registrationPensions

Exploitation/abuseDeskillingDiscrimination

Opportunities: workforceIncreased demand may open up employment opportunities for non-traditional groups

MenYounger peopleMigrants (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 careLength of visitsInstitutional and individual ageismRespect 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 experienceTechnology- self-managed care

Both opportunities and risksDetachment from certain individual workers (less stable workforce; more temporal)Cultural encounters

Impact: wider labour market

Boundaries between care and health sectorsPossibly other sectors as well, such as leisure and technology

Circular labour or stable workforceStepping stoneNew types of employment Interface with other labour sectors

ConclusionWorkforce representation

Documented and grey economyUnions, regulators and professional bodies

Workforce quality and stabilityFunding and the increasing role of the private sectorBusiness case and opportunityOrganisational Structure

The share of individual employersUsers’ outcomes and quality of care

Thank youShereen.hussein@kcl.ac.ukFor latest workforce analysis, see the Social Care Workforce Periodical

http://www.kcl.ac.uk/sspp/departments/sshm/scwru/pubs/periodical/index.aspx