Conclusions
Is Fair Work being delivered in Social Care?

Our assessment – fulfilling, but not always fair

For many thousands of care workers, care is a meaningful and fulfilling job. However, social care as a sector does not systematically give workers access to jobs characterised by all the dimensions that make up Fair Work. In particular, the level of wages for frontline support staff in social care is drastically low despite the work being complex and demanding.

Although there have been efforts to address the issues of low pay through adoption of the Living Wage, progress on pay is too slow. This can be perceived as an indication that care work and care workers are not sufficiently valued.

One of the strongest conclusions from the Working Group related the undervaluing of care work to the fact that it is largely undertaken by women. Women make up the majority of those who are cared for and they are also the majority of the workforce. Investing in the care sector, opening up opportunities and designing quality jobs that are fair could bring many people (especially women) into the workforce, helping to respond to the challenges of Brexit and working to reduce Scotland’s gender pay gap.

Social care is increasingly professionalised. However as productivity, skills and qualifications have increased, care work has not been additionally rewarded. Unlike social work or health, social care staff have limited access to adequate training and support, placing a predominantly female workforce under pressure in a sector which requires formal qualifications with little or no central funding for training. Too many staff are required to cover their own training costs and, due to work pressures, undertake training in their own time.

The systematic erosion in the working experiences of care workers has not happened over night. The market-led care system creates competition, commissioning and tendering practices that together depress hourly rates, and generate low pay as well as limited job security and hours sufficiency for some.

In the wider context of health and social care integration, social care stakeholders perceive their sector as secondary and at a disadvantage, not least because it is more exposed to markets and competition, unlike health. A number of other stark contrasts with NHS Scotland were prominent in these discussions, notably on support for training and professional development for NHS workers, effective voice and partnership working structures at every level of the NHS, and greater investment in appropriate terms and conditions for NHS workers. In this context, if health and social integration is to work, priority should be given to building the necessary Fair Work infrastructure – in the sector and within the Scottish Government - to support the voice of the social care sector. Collaboration in delivering this infrastructure by employers, unions, government and other relevant stakeholders is crucial.

High quality social care is vital for the quality of our society. Retaining and recruiting a high quality workforce is crucial to delivering high quality care. To compete with other employment, and to face labour supply challenges as a possible result of Brexit, care work needs to be attractive in terms of pay and the other dimensions of Fair Work. Failure to retain and recruit will lead to understaffing and additional work intensification.

A choice to invest in the workforce

Social care is an essential part of our public services and investing in frontline workers ensures the quality of care provided. While significant resources and time have been invested over the years into the present system of care, the funding, regulation, design and delivery of services have taken insufficient account of impacts on the workforce and its capacity to respond. The core of this vital service is delivered by frontline staff. Their ability to innovate and deliver personalised care depends fundamentally on their wellbeing and ability, as well as willingness, to make a difference in the work that they do. This report calls for a greater focus on investing in fair work for social care workers. Such a shift in perspective, energy and resource will not only improve the lives of the workforce, but can also deliver improved service outcomes.

Addressing problems in how the sector is organised and managed

Fair work aims to raise the bar on working conditions. Employers face constraints, however, which impact on terms and conditions. The complexity of the landscape, with thousands of care providers operating on extremely tight margins, suggests that individual employers acting by themselves are limited in how much they can do to provide fair work for their employees. During this Inquiry, both social care workers and employers described how the barriers to accessing fair work were created by the wider care system.

Low pay and challenging working conditions are, at least in part, a direct consequence of the specific organisation of the sector, where a public sector client (local authority/government) offers very low prices to multiple suppliers, resulting in competition on costs that drives both low pay and a need for hyper flexibility on the part of the worker. The resulting unpredictability of rotas, low fixed contractual hours, the absence of slack in the system, unsociable hours, downtime in the middle of the working day and the need in some cases to travel long distances between clients all combine to undermine the likelihood that social care workers experience fair work.

Turning to the need for new thinking on pay, while additional central funding (like that provided for payment of the Living Wage) is much welcomed, more strategic and systematic policy engagement is needed to address both pay development – for example, appropriate job evaluation and pay ladders – and wider terms and conditions.

However union penetration in this sector is limited, which undermines effective employee voice, and the fragmented nature of the sector exacerbates this problem. This is unlikely to change without specific intervention.

A need to rethink the commissioning of services

In this Inquiry, all roads have led back to the constraints imposed on employers by the commissioning system. There are aspects of current commissioning practice – notably non-committal hourly rate-based competitive tenders and framework agreements – that appear to be inconsistent with fair work. Without a significant rethink of the current approach to commissioning, the fair work challenges facing the sector are unlikely to change.

With regards to the auditing and monitoring of care contracts, provider organisations need to follow the Scottish Government’s Fair Work procurement guidance and be held to account for the fair work commitments contained in their bids. As yet, there has been no evaluation of how the procurement guidance impacts fair work practices. Scottish Government’s recent announcement of Fair Work First increases the need for such an evaluation.

The need for radical change

Although employers have a role to play, the main actions identified in this report are the responsibility of sector leaders, funders and commissioners of care and government.

The scale of the problems facing the social care sector requires radical thinking and whole systems interventions which include ensuring financial sustainability of the sector, fully integrating health and social care services, urgently reforming commissioning processes and addressing the lack of collective representation and collective voice of the workforce. The structure of social care, the invisibility of the workforce and scale of the challenge are such that a significant robust intervention is needed to ensure that fair work practice is applied at every level – by national and local government, by commissioners and by employers. Change needs to come from sector-wide, coordinated, national initiatives, and through systems-wide interventions. Ensuring that fair work is an integral part of health and social care reform will require both leadership from sector bodies, commissioners and government and cross-departmental leadership within the Scottish Government.

Scotland faces a choice; whether to invest in people and their experience of fair work, or continue investing in, while mitigating the impacts of, a profoundly broken commissioning and procurement system. How we procure and commission social care services shapes how we deliver and experience care – and with it, affects the lives of thousands of working people across the country, their families, and those for whom they care.