Insecurity and low pay are significant issues in the care sector. Research demonstrates that zero-hour contracts, unpredictable working patterns, and low (sometimes illegally so) rates of pay are common. As we will discuss on this page, tens of thousands of social care workers are paid less than the legal minimum (Hayes 2015; Hayes 2018).
In order to understand issues of widespread insecurity and low pay in the care sector, it is important to set these within the wider context of care funding and how this affects care workers’ experiences of employment. There has been £7bn reduction in adult social care funding since 2010, with social care services having been chronically underfunded for many years (Hayes 2020). Austerity measures introduced following 2008’s global financial crisis have significantly cut spending on public services, with adult social care having been found to be most severely impacted.
At the same time, ongoing since the 1980s, social care has been increasingly marketized, with providers in competition with each other to provide services at a low cost. This has translated into an increase in the use of zero-hour contracts, and insecure and low pay jobs for care workers, whose pay and conditions have been increasingly attacked by cost-saving measures over the last few decades. Indeed, care workers’ working conditions have been described as ‘among the worst of any’.
Not only are these significant issues in and of themselves, insecurity and low pay also exacerbate other problems in the care sector. Low pay has been found to be the biggest barrier to finding and keeping care staff, and the prevalence of zero-hour contracts has been shown to typically pay £1,000 per year less than the permanent contract equivalent. To read about a day in the life of a care worker on a zero-hour contract, click here.
What is the situation?
As our population ages, care workers perform an increasingly important role in society. The job requires a broad range of skills, and can involve high pressure, intense situations and high levels of responsibility. In spite of this, the average hourly pay for a care worker is below the basic rate paid in most UK supermarkets.
Skills for care found the median wage for a care worker in 2019 to be £8.10, with around a quarter being paid the 2018 National Living Wage rate of £7.83 or less. Research demonstrates how these already low wages are often further affected by the nature of care work, and the widespread insecurity of the sector as a whole. Some care workers for whom travel time, ‘sleep ins’ or other ‘on demand’ working arrangements are required report not being paid for these services, only receiving compensation for face-to-face contact time. In some cases, care workers are required to use electronic monitoring systems which track their location and arrival/departure times, allowing employers to sharply delineate between “paid” and “unpaid” time (Hayes 2018; Hayes and Moore 2017). These issues mean that in many cases, the take-home pay of social care workers falls significantly below the requirements of UK national minimum wage law (Hayes 2018; Hayes 2015; Hayes and Moore 2016; Macdonald et al 2018). The widespread use of outsourcing in the care sector has been seen to exacerbate these issues, with agency staff receiving significantly worse pay and conditions to in-house staff (Rubery and Urwin 2011).
Reports to Government in 2018 and 2019, about the problem of modern slavery, have identified care workers are at ‘high risk of labour exploitation’ based on evidence gathering by enforcement agencies. This builds on earlier reported concerns about forced labour and exploitation in social care.
Alongside issues of low pay, recent years have witnessed an increase in the use of zero-hour contracts in the care sector. The majority of homecare workers in the UK are now employed on zero-hour contracts, and The National Audit Office (2018) reports that care work has the ‘highest prevalence of zero-hour contracts’ compared to jobs in other care intensive occupations such as nursing. Not only are zero-hour contracts a central driver of the widespread insecurity in the care sector, they are also linked with lower levels of pay, exploitation, and mental health issues such as stress, depression and anxiety.
There are also issues within the social care work force: the gender pay gap in the care industry is especially stark among higher paid staff (e.g. managers and supervisors), and researchers have pointed out pay gaps along ethnic lines, with BAME workers earning significantly less (Hussein and Manthorpe 2014).
Why is this problematic?
Not only are the above issues significant for workers, but they also have a knock-on effect on the quality of care provided.
For example, researchers have found links between the non-payment of care workers for travel time or extended visits with a deterioration in the quality of care (Atkinson and Crozier 2020). Zero-hour contracts can mean that care workers are given insufficient time for training, while unstable working schedules can lead to care workers lacking important knowledge of care recipients. Care workers feel pressure to complete their tasks within the time for which they are paid, leaving some visits short, inadequate and rushed. The care workers interviewed as part of Atkinson and Crozier’s (2020) study gave examples of this:
If it’s a half hour with someone who’s got dementia, then every time you go in you need to explain who you are, why you’re there, why you’ve got to do what you’ve got to do. That can take fifteen minutes, and then you’ve still got to wash them, dress them, do the breakfast, make the bed, empty the commode. It becomes a fifteen-minute call because you’ve spent so long trying to reassure them that you’re there to help them.
The last thing they want to feel is rushed, especially if you’re a ninety-eight year old who gets a little bit breathless. The last thing he wants is, “Come on now, we’ve got to go, we’ve got to do meds now.” And he’s like, “Hang on a minute, I haven’t had my tea yet”.
It is so wrong, but I’ve heard about times when care workers have had to feed people their lunch as they are on the commode.
Some researchers have observed the ways that rule breaking becomes ‘routine’ under increased time pressures, with care workers developing combinations of official and unofficial routines to allow them to complete as much of their workload as possible in the time allowed (Lopez 2007; Baines and Daly 2019). This can both jeopardise the health and safety of care settings as workplaces, and raise serious safeguarding issues for recipients of care.
The National Audit Office reports higher labour turnover of staff on zero-hours contracts than staff with secure contracted hours in social care. The use of zero-hour contracts can disrupt the continuity of care for individuals, who may see many different care workers throughout the course of their week, or even their day. This has been found to be especially problematic for people with dementia, for whom a continuous care relationship is very important. Research demonstrates how lower continuity of care for older people with dementia is associated with higher rates of hospitalisation and A&E visits (Amjad et al 2016). This means that improving continuity of care — i.e. allowing an ongoing, continuous caring relationship to develop between care workers and individuals requiring care — might help to prevent these additional healthcare issues. The use of zero-hour contracts is thus not only bad for workers: it can also damage the quality of care.
Amjad H, Carmichael D, Austin AM, Chang C, Bynum JPW (2016). Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare. JAMA Intern Med. 176(9), 1371–1378.
Atkinson, C. and Crozier, S. (2020). Fragmented time and domiciliary care quality. Employee Relations, 42(1), 35-51
Baines, D. and Daly, T. (2019) Borrowed Time and Solidarity: The Multi-Scalar Politics of Time and Gendered Care Work. Social Politics: International Studies in Gender, State and Society.
Hayes, L.J.B., (2020). Criminalizing Care Workers. A Critique of Prosecution for Ill-treatment or Wilful Neglect. In: Bogg, A., Collins, J., Freedland, M. and Herring, J. eds. Criminality at Work. Oxford University Press.
Hayes, L.J.B. (2018) Work-time technology in paid care work: A socio-legal analysis of employment contracts and electronic monitoring. Law and Time. In: Beynon-Jones, Sian and Grabham, Emily, eds. Law and Time. Routledge, pp. 179-195 (in press)
Hayes, L.J.B. (2015), Are the minimum wage rights of homecare workers at risk under the Care Act 2014? Industrial Law Journal 44 (4): 492–521.
Hayes, L.J.B. and Moore, S. (2017), Care in a time of austerity: The electronic monitoring of working time in homecare’ .Gender, Work & Organization 24 (4), 329.
Hayes, L.J.B. (2017), Stories of Care: A Labour of Law. Gender and Class at Work. Basingstoke: Palgrave Macmillan.
Hussein, S. and Manthorpe, J. (2014) Structural marginalisation among the long-term care workforce in England: evidence from mixed-effect models of national pay data. Ageing and Society 34(1): 21-41.
Macdonald, F., Bentham, E., & Malone, J. (2018). Wage theft, underpayment and unpaid work in marketised social care. The Economic and Labour Relations Review, 29(1), 80–96
Lopez, S. H. (2007). Efficiency and the fix revisited: Informal relations and mock routinization in a nonprofit nursing home. Qualitative Sociology 30 (3): 225–47.
Rubery, J. and Urwin, P. (2011) Bringing the employer back in: why social care needs a standard employment relationship. Human Resource Management Journal. 21(2), 122-137
If you use any material from these web pages, we suggest this is cited as follows:
Hayes, L., Tarrant, A. and Walters, H. (2020) Social Care Regulation at Work: Insecurity & Low Pay. University of Kent. [Viewed date]. Available at: <https://research.kent.ac.uk/social-care-regulation-at-work/insecurity-low-pay/>