The urgency of increasing care worker pay

14 September 2022

A commentary by Duncan U Fisher, Researcher, Centre for Care.

The case for care workers to be given a pay rise and greater financial security is compelling and fits with the Professional Care Workers’ Week (PCWW) agenda. The inflation/cost of living crisis lends new urgency to this long-standing issue, and more care workers will face grave circumstances without action on pay.

The widespread strikes we’ve seen this summer aren’t happening in social care, so does this mean care workers in England are content and their pay is rising in line with inflation? Far from it…

Duncan U Fisher, Researcher, Centre for Care

A long-term strategy for the adult social care workforce is overdue. Wages for direct care workers have been classed as low-paid by the Low Pay Commission since 1988, and remuneration levels are such that ‘very low-paid’ is more fitting. The percentage of care workers paid at or close to the legal minimum is rising. A decade ago, care workers, on average, earned more than retail workers or cleaners, but they no longer do. Care workers still earn more than catering assistants and launderers, but the gap has narrowed.

This very low pay is compounded by the high prevalence of zero-hours contracts, and lack of or minimal compensation for longer service or gaining promotions or qualifications. Last year staff at the Sage Nursing Home in London went on strike, including a care worker who had been employed there for 17 years. Despite this service, she was earning £9.60 per hour when the strike began. Sick pay took on new significance during the COVID-19 pandemic, and UNISON was instrumental in care workers in the northwest securing guarantees on this issue.

In July 2020, Labour MP Paul Blomfield asked the then PM Boris Johnson if the UK Government would raise care worker pay. PM Johnson pointed to the National Living Wage (NLW) introduction and the highest-ever legal minimum pay increase. The implicit assumption was that care work was regarded as worthy only of the lowest legally permissible pay.

Pay structures should align with a range of workforce policies within a renewed, sustainable vision for care. There are, however, pay-specific measures that could be implemented before or in the absence of grander reforms:

  • Raising the hourly rate to the Real Living Wage (arguably significantly higher).

  • Removing age-related variations in pay. Younger workers are under-represented in care work, and youth unemployment is considerably higher than the overall working population, so more could be done to attract young workers.

  • Offering pay increases for length of service, promotion and gaining qualifications.

  • Introducing pay banding allows workers to chart pay progression and plan to enhance their qualifications and skills.

  • Paying decent sick pay partly in recognition of the risks involved in care work and the importance of workers being able to take time off when sick.

  • Introducing a care worker pension scheme.

The case for increasing care worker pay

Care workers ought to be paid more because of what they do, which is to support and care for people who are unable to do so on their own for many reasons. Are the rewards mentioned above for doing this work what we want as a society?

Care workers ought to be paid more because of their work’s content, which is complex, including interpersonally and emotionally. Care work is often stressful and highly demanding, involves physical work and intimate care, and is increasingly medicalised and reliant on technology. Justifications for industrial action (in other sectors) champion key workers’ societal contributions. Care work’s significance (which is not unique but deserves greater recognition) and complexity are central to the case for increased care worker pay.

Care workers ought to be paid more because of what they go through: demanding situations, which can involve unpredictability, violence and suffering, and coming face-to-face with illness and death, the risks of which the pandemic has heightened. Many care workers have strong attachments to their work and those they work with.

However, there is a sense of the pandemic - combined with austerity, Brexit and the inflation/cost of living crisis - converging towards a tipping point. Experienced figures in care work have called the staffing situation ‘the worst that it’s been’, and over the past year, vacant posts have risen by 52% to 165,000.

Care workers ought to be paid more because their work is fundamental to the health and care system. Entry-level NHS healthcare assistants earn more than most of their social care counterparts, and the former also access generous pensions and pay banding.

It is often observed that care work is not done for the money but is (and by implication, should be) a ‘labour of love’. This argument is made by those explaining or defending care worker pay, but doing care work and being paid a decent wage ought not to be mutually exclusive. Plenty of ‘caring’ people wouldn’t consider care work due to the pay, and those who leave because of it do not become uncaring (and potentially move to better-paid work where they can still act on their caring motivations).

The benefits of increasing care worker pay

Giving care workers a pay rise would benefit them financially and bring symbolic recognition. Other primary beneficiaries would be those receiving care and support, and this is central to the argument for improved pay. Job quality and care quality are intertwined, and however increased pay is implemented, it mustn’t compromise care quality or lead to service reductions or deterioration. That isn’t what care workers want: the Sage strike action was rare in UK terms, but it was borne of long-serving workers’ deep commitment.

Increasing care worker pay will likely boost recruitment and retention, and a more stable workforce generates care continuity, a key component of care quality. Staff shortages cause care poverty, where care needs go unmet, and a distinct, deepening form of social inequality is germinating. The potential benefits to care quality and coverage would have positive spin-offs throughout healthcare and broader public services.

Increasing care worker pay promises a significant boost to a growing workforce. It would bring economic benefits, including to regions with less economic diversity or where other industries have declined (in some places, health and care work comprises a growing share of overall employment). Care work is local, green, and improving it would contribute to a ‘care-led recovery’ (from the COVID-19 pandemic).

The gender pay gap is significant to gender inequality, and care work’s occupational segregation (due to women’s marked over-representation) sustains a gendered economic hierarchy. Improving pay would address this and other social inequalities (which care work’s over-reliance on minority ethnic and working-class workers perpetuates).

About the author

Duncan U Fisher, Researcher, Centre for Care.

Prior to joining the Centre for Care, Duncan worked as a Research Associate at CIRCLE, analysing alternative models of homecare provision in the UK. He then worked with Professor Mary Daly at the Department of Social Policy and Intervention, University of Oxford on a project examining the work attitudes of care home workers.