Lilian Macer lays out what must happen to improve social care and the lot of social care workers
Today in Scotland, we see a rising tide of demand for social care services, driven by demographic changes and advances in medical technologies as people are living longer, and linked to their needs becoming more complex. This increase in demand is set against the context of a decrease in funding for Scottish local authorities who provide and commission these vital services.
Social care in Scotland currently operates in a mixed market economy with over 1,000 providers offering a myriad of terms and conditions within the sector. However, this was not always the case. Nationally-agreed terms and conditions were once the norm, until legislation in the 1990s opened up market-led provision in social care. This agenda of marketisation and competitive tendering was pivotal to the then Conservative Government’s commitment to increasing efficiency through the development of the market. So, over two thirds of adult social care jobs moved to the independent (private) sector, with a significant percentage of council provision being delivered by arm’s length bodies.
This market-driven environment is clearly focused upon balancing financial objectives and, thus, places workers and service users secondary to matters of money. Consequently, staff delivering these services have little power, choice or control in their work environment. Ultimately, this commissioning process results in poor employment practices that are not consistent with fair work. Some 20 years into the re-founding of the Scottish Parliament, we have seen both Labour and SNP governments subject our most vulnerable in our society to the vagaries of the market whilst overseeing workers’ wages, terms and conditions being driven down.
As a consequence of concerns raised during the consultation for the Fair Work Convention’s Fair Work Framework (FWF), a decision was taken to undertake a detailed inquiry into the social care sector in Scotland. The aim was to determine what was needed to implement the FWF across the social care workforce. The inquiry was established in January 2017 and over the past 18 months, alongside the chief executive of Alzheimer Scotland, Henry Simmons, I had the privilege of being one of the co-chairs of the inquiry.
The inquiry commissioned a piece of research from the University of Strathclyde on how frontline workers and their managers feel about their day-to-day work in relation to the FWF of effective voice, opportunity, fulfilment, security and respect. The primary finding is that fair work is not being consistently delivered in the social care sector. Who knew? Well, UNISON know that we have a dedicated workforce who are on precarious work contracts where they have little power or influence. Women told the inquiry they enjoy being involved in people’s lives and like that they make a positive difference. More than 200,000 people work in social care in Scotland – 7.7% of the overall workforce – with about 82% of them women. However, the inquiry found that these workers were often on zero hours contracts and expected to work excessive hours.
Without a voice mechanism, workers are less able to convey their concerns effectively, challenge employers on poor practice or make the reality of their situation visible to policy makers. That is why the inquiry’s first recommendation is that a new sector-level body be established in Scotland with representation from across key sector stakeholders to establish standard minimum fair work terms and conditions for the social care workforce and provide the opportunity for ongoing dialogue and agreement on workforce matters. The first task of this body should be to develop Fair Work First criteria for inclusion in commissioning.
The report found employers complained that it was hard to offer better employment conditions because of problems with funding or commissioning. However, the report did recognise some positive policy initiatives in recent years that have aimed to improve the situation, notably the Living Wage initiative. Yet, the report concluded that low pay is a symptom of wider structural problems arising from the commissioning system for social care itself.
Therefore, the inquiry recommended treating the problem at source. Recommending that the current commissioning practice of hourly rate based non-committal competitive tenders and framework agreements should end. Social care providers should be commissioned based on their levels of skill, expertise, understanding and application of the Fair Work Framework, and on costs based on the right numbers of staffing required and a satisfactory and fair income level for each member of staff. Commissioners should be responsible for assessing and predicting the level of demand and commissioning the right levels of staff from the provider organisation, with no expectation that the provider or worker carry the risk for working time not being required. Delivering fair work for social care workers is crucial to ensure a workforce for the future and to ensure high quality social care services to some of our most vulnerable citizens.
UNISON Scotland believes the social care sector faces a perfect storm in which the impact of years of chronic underfunding has been worsened by increasing demand and the knock-on impact of cuts to other key public services. This has produced a situation in which the needs of many of society’s most vulnerable people are not being met and in which care workers are almost universally underpaid and largely undervalued. The lack of status and chronic undervaluing of social care is not unconnected to perceptions of care as ‘women’s work’. Failure to address the gendered dynamics of the care sector and to challenge its significant voice deficit, low pay and one sided-flexibility all contribute significantly to women’s poorer quality of work and to Scotland’s gender pay gap.
Lilian Macer is the Convenor of UNISON Scotland and a member of the Fair Work Convention. The FWF can be found at opens in a new windowhttps://www.fairworkconvention.scot/wp-content/uploads/2018/12/Fair-Work-Convention-Framework-PDF-Summary-Version.pdf and the social care report at opens in a new windowhttps://www.fairworkconvention.scot/wp-content/uploads/2018/11/Fair-Work-in-Scotland%E2%80%99s-Social-Care-Sector-2019.pdf