The government sounds determined to ratchet up the professionalism of domiciliary and residential care staff. But what will it take to achieve, asks Simeon Brody
“There can’t be any more of social care as the Cinderella service,” care services minister Liam Byrne told a conference last week.
“The social care workforce is going to the ball,” he continued. “We want the people who take care of England to have the same status in society as doctors and nurses and lawyers.” (news, 9 February)
The minister’s ambition to “professionalise” and improve the status of the wider social care workforce – the “forgotten workers in English society” – is laudable.
But it is also a huge task. The Commission for Social Care Inspection estimates there are 1.6 million people working in the sector, many of whom are paid poorly.
According to the CSCI, the average gross weekly pay for care assistants and domiciliary care workers in 2003 was £183. For those working in the private sector – which accounts for more than 70 per cent of the residential and home care sector – it fell to £171 and many are believed to be paid the minimum wage – currently £5.05 an hour for those 22 or older.
The disparity is not surprising when one considers statistics recently released by the Health and Social Care Information Centre (news, 9 February). It found that places in outsourced older people’s residential care homes cost 59 per cent of those in council homes.
Outsourced mental health, learning difficulties and disability services were also significantly cheaper than council-run services.
Training is also a significant concern, with the CSCI calculating that only 44 per cent of the social care workforce has any relevant qualification.
In its report in December on the state of social care, the CSCI noted that the sector was increasingly relying on migrant labour as positions became harder to fill – a situation that was not sustainable.
Against this backdrop Byrne declared last week that the wider social care workforce would begin to be professionally registered with the General Social Care Council from April next year.
An estimated 750,000 residential and domiciliary care staff, working with both adults and children, will join the first phase with day care staff expected to follow.
Registration is intended to protect the public, allowing regulators to set standards and impose sanctions. But Byrne also hopes it will increase the status of care workers, with registration giving them the same professional standing as nurses or lawyers.
GSCC chief executive Lynne Berry says public protection and improving the status of the workforce are equally important and interconnected.
People who are respected by the public will respect themselves and have increased confidence in their work, she argues.
She says many people would be shocked to learn that teachers and nurses used to be unregistered and could be employed without any formal training. The same sort of “revolution” now needs to occur in social care, she suggests.
But English Community Care Association chief executive Martin Green doubts that registration alone will necessarily improve status.
“The way in which we give people status in society is by giving them pay,” he says. Increased salaries for health care workers such as nurses increased their status in society and the same is needed for social care, he argues.
And for people on low wages a registration fee could be a disincentive to entering social care.
“They will be able to go to other places where they don’t have to register and get jobs for similar money,” he says.
Sheila Scott, chief executive of the National Care Homes Association, which represents residential providers, anticipates that, given the low wages of care workers “who have to count every penny”, employers will have to meet the cost of registration just to attract staff.
She says employers would love to pay staff more but are constantly squeezed on cost by local authorities, who are in turn squeezed by national government.
Nick Johnson, chief executive of the Social Care Association, the professional body for staff in the sector, says local authority commissioners know what it costs to run a care home and should not expect providers to do it for half the price. But he accepts that it is a “circular argument” with commissioners saying their hands are tied by lack of funding.
He suggests that the government make more money available to councils with the proviso that it is spent on improving care workers’ pay.
Johnson says employers that are financially strong enough to subsidise their services, such as Jewish Care, have been able to pay higher wages and the quality of the care is better as a result. But he believes market forces could be about to prompt a change with an older population and ageing care workforce increasing demand and limiting supply.
Employers will have to do more to attract young people into social care and registration will be part of that.
Role of commissioning
Berry suggests that if the status of care workers can be improved through registration better pay may follow as it is increasingly recognised what an important job they are doing.
She says commissioning will also need to play a role in setting benchmark costs for services.
Berry dismisses the suggestion that potential care workers will simply choose to work in a supermarket to avoid the hassle and cost of registration. She says some people who have drifted into social care may choose not to register but those who are committed will remain so.
“People make the choice of working in social care because they do want to make a real difference to the independence and dignity of individuals,” she says.
But the question of pay, training and even future pension provision will not go away. Public sector union Unison has called for resources to back up Byrne’s words and Johnson reflects that it is not just the staff who suffer from low pay.
“There’s a correlation between how well you look after your staff and how you might be considered to look after your service users,” he suggests.
It seems that registration may yet bring care workers to the professional ball, but will they be able to afford a dress?