Care Initiative talk explores treatment of Social Care workers

The Care Initiative at Green Templeton hosted Professor Lydia Hayes, Head of Kent Law School, University of Kent and Principal Investigator of Social Care Regulation at Work on Wednesday 26 January 2022. Professor Hayes spoke on The regulation of social care: Improving the treatment of workers through regulatory law.

Lecture report

Green Templeton alumna Dr Gemma Hughes (DPhil in Evidence Based Health Care, 2015) reports from the evening:

Professor Hayes shared insights from her research into the relationship between the employment conditions of care workers and the quality of care provided. Professor Hayes has previously written extensively about care and care work, and how the law shapes the working lives of people involved in providing care. In this talk, Professor Hayes gave us insights from a recent pilot study of the legal and social life of care standards regulation, funded by Wellcome. Professor Hayes, working with Dr Alison Tarrant and Dr Hannah Walters, set out to investigate the sector-specific ways in which care work is shaped by the law, especially that on the regulation of social care provision. The research investigated how the regulations that set standards for care provision in England, Scotland and Wales are interpreted in practice by inspectors, employers and workers. Conducted during and adapted to the circumstances of the pandemic, the findings suggest that implementation of social care standards regulations offers a way forward to improve conditions of employment and also the conditions of care.

Connecting employment conditions and care quality

This work is important because of the connection between employment conditions and care quality. Employment conditions in social care are poor: there is high turnover of labour, huge vacancies, a lack of workforce training, with many people on minimum wage – entitlement to which is being eroded and the rights to which are hard to enforce. Low pay means care workers have to work longer hours to make ends meet. They are under great pressure to not lose pay, which was a consequence for many who had to take time off work to self-isolate. Care workers experience health and safety risks – pre-pandemic these would typically have been musculoskeletal problems (e.g. back injury) – but more recently these are risks of infection with COVID and the consequences, including Long COVID. These problems are feminized and racialized; 85% of the 2 million or so care workers in the UK are women and there is a high proportion of Black and minority ethnic people in the workforce.

But what does this mean for care quality? The work of the research team found that the quality of relationships between care workers and the people to whom they are providing care is empirically inseparable from the terms and conditions of the care workers’ employment. Low pay, long hours and high staff turnover mean reduced continuity of care and increased risk of mistakes. Moreover, the research makes clear that regulatory law governing care provision contains job quality indicators. But the research also suggests that such job quality indicators are overlooked in practice by inspectors/managers. Better understanding of the potential of and in regulatory law to improve terms and conditions of employment could help employers’ and workers’ organisations to improve care quality.

A key link between employment conditions and care quality is staffing levels. Good staffing levels are important in shaping individual working conditions. According to social care regulation, staffing levels have to be ‘sufficient’. From interviews with managers, it seems that in practice staffing levels are calculated to ensure risk is mitigated and that basic needs are met. Interviews with care workers, however, show that they experience ‘sufficient’ staffing as being understaffed. Care workers interviewed during the research said they had ‘no time, not enough staff’, and were unable to provide all the care that they saw as needed. Shifts were covered and basic needs were met, ensuring compliance with inspection standards, but good working environments and ensuring continuity of care were not achieved.

Recognition of the problem

There has been some recognition in recent policy of these problems. Emergency responses to the pandemic resulted in additional financial support being made available, through different COVID funds, to protect care workers from the financial risk of staying away from work in order to self-isolate. Turning to international comparators for solutions is difficult due to the different systems of labour regulation in other countries. However, devolution in the UK offers us the opportunity to compare approaches where we can see examples of improvements in social care underway. For example, in Wales, there is a regulatory duty on home care providers to offer a guaranteed hours contract to all eligible workers, thus removing the prevalence of zero hours contracts which degrade care quality and undermine security of income for workers. The independent review of adult social care in Scotland, and progress towards a national care service for Scotland, promises further gains.

Professor Hayes’ work is particularly innovative because it connects the regulation of care provision with the regulation of care workers’ employment by making specific recommendations for sector-specific employment standards. These standards are: manageable workload, a safe work environment, pay that is fair and adequate, continuous training and supervision and recognition of professional status. These sector specific employment standards can, argues Professor Hayes, act as a springboard to better use of existing regulations to secure better conditions of care and so create better conditions of employment.

How likely are these standards to lead to change? Much of this comes down to political will, as evidenced by the divergence between the devolved nations. It is exciting, for those of us involved in care, to hear how Professor Hayes conceives of care as a dynamic space in which wider regulatory issues can be explored and addressed. In this space, care regulators can start thinking about how compliance with regulatory standards relates to employment conditions. However, working conditions need to be addressed in their own right, and (perhaps a more challenging step) the underpinning business models of care provision that manifest in poor working conditions through low pay and understaffing need to be overhauled and rethought.

An analysis of regulation in England, Scotland and Wales is available via the project website

A PDF of the slides Professor Hayes used at the event is also available

Created: 14 February 2022