For years, observers have spoken of a “social care crisis” in Scotland. Coronavirus has exposed existing weaknesses in the sector and created new problems. We know the dreadful impact COVID-19 had on care homes highlighting this need for fundamental change.
In Scotland, out of a total of nearly 10,000 coronavirus deaths, more than 34% occurred in care homes. This has rightly been seen as a scandal. A new culture of care is needed to underpin the sector, not piecemeal reform. Now, as we begin to contemplate a world after COVID-19, is the moment for such reform. And initial debates and ideas look promising.
Less often discussed is how care workers have been affected by the virus and what it has meant for their working conditions and overall job quality. Scottish government statistics show that 26 care workers have died with the virus since the start of the pandemic, though it is not clear whether they contracted it at work.
At the same time, while NHS workers have been celebrated as heroes, care workers remained an afterthought. These overlooked workers were not surprised. Participants in our research project on working conditions in care homes told us they have for long felt that society cares little about the elderly, and, by extension, cares little about those who work with them. As one told us:
I don’t think society values care workers or the people we look after – they don’t treat them or us with the respect and support we deserve.
Fair and decent work
Our project explored what care workers in Scotland think about their job quality and what needs changing. Chiefly, participants claimed the important factors that “make work decent” are in short supply.
Care workers want more supportive managers who themselves are supported better; decent pay which takes into account the real skills that care work requires and is based on systematic job evaluations; decent terms and conditions including sick pay beyond the statutory minimum; and job security with a curb on casual employment.
Of course, a safer work environment was listed as important too. Many said they felt their mental and physical health mattered little in their workplaces even before COVID-19, which made the issue only more severe. One factor crucial to making work feel decent and worthwhile is purpose and meaning. Many care workers say they remain in the job because their work has an abundance of both:
It keeps you going when other aspects of the work aren’t so good. Just knowing that you’re enriching someone’s life is a reward.
The lack of social recognition is key to understanding why, overall, their job quality is low. Many interviewees were angry about care work being seen as merely “wiping bums” and requiring few skills. The lack of recognition should be understood in context of the high regard in which the NHS is held.
Despite the many years of health and social care integration at policy and strategy levels, Scottish care workers see their sector pitted against the NHS. Those working in the care sector, even care home managers, are made to feel like failures: “Why don’t you work in the NHS?”, is a question they hear too often. It is little wonder that the clap for NHS workers, during the height of the first wave of the pandemic, was perceived badly by most participants:
Social care is very hard and difficult; people forget about us and only focus on doctors and nurses. It was all about ‘save our NHS '– how about us?
Few of these findings came as a surprise as job quality problems have been noted before, by the Scottish Fair Work Convention in 2019 for example. What is striking is that so little has been done about them since. However, when interviewing representatives from local government, health and social care partnerships or industry umbrella organisations, we found that none were willing to take the lead in making decent work a priority. Responsibility for job quality always lies somewhere else.
Do we need a national care service?
Like every crisis, COVID-19 creates opportunities for change. For care workers, decent work should be on the cards now. The argument for improving job quality can be made by pointing out that consistently high-quality care – which is what everyone says they want for the most vulnerable in society – requires at least decent job quality.
The Scottish government’s Feeley Review of adult social care, set into motion in September 2020, is one of the most important initiatives regarding reform. Recommending a national care service for Scotland, the review appears to have the workforce at the heart of its thinking about a whole change in the culture of adult social care.
It recommends minimum standards around what it calls “fair work” when it comes to local authorities buying in services from care providers and coordinated workforce planning. There is an encouraging endorsement of a job evaluation exercise around care jobs – this might help to create pay parity between social care and health care.
However, such changes would not address other job quality issues, which all connect to each other. One central problem is not sufficiently dealt with: why it is that social care workers are undervalued and experience low social esteem? Here, uncomfortable cultural questions need to be raised, with generational divides and ageism creating a demand for a new culture of care that recognises those needing care and those providing it.
Such a culture can be the foundation for efforts that create high-quality social care with a workforce that enjoys decent work, recognised skills and proper respect.