Unrelenting schedules, poor pay and burnt-out staff leaving in their droves – that’s the picture that’s been painted of the UK’s social care provision by the people that know it best.
Speaking to Big Issue North, carers from across the North describe shifts with no breaks, working weeks of up to 70 hours and colleagues leaving for better paid jobs with fewer responsibilities.
And with more than 165,000 vacancies in adult social care in England, up 52 per cent in a year, campaigners are calling for increased wages in a bid to attract and retain more staff.
Dan Smith, Unison’s North West lead for social care, says it is a sector in crisis.
“Thousands of care workers are leaving the sector because of poverty pay which is having a devastating impact on our communities,” he says. “Care workers went above and beyond during the pandemic to care for our loved ones, but they’ve now been hit by a brutal cost-of-living crisis. While frontline staff are on minimum wage, private profits and director-level pay within the sector continue to sky-rocket.”
The union’s Merseyside Care Workers Demand a Pay Rise campaign is calling on councils in the Liverpool City Region to offer social care workers the Foundation Living Wage (£10.90 per hour), while a similar campaign in Greater Manchester has resulted in nine out of ten councils offering the increased salary.
But with no umbrella institution such as the NHS, organising action among social workers can prove challenging. Grace Whitfield, researcher at Sheffield University’s Centre for Care, says the nature of the work is a “big obstacle” to activism.
“People are working really long shifts on low pay and it’s difficult to convince someone to come to a union meeting after a 12 hour shift,” she says. “But also the fragmentation of the sector means that it is difficult for organisers to actually access care workers because there’s all these little small companies and unless they have a good relationship with the manager, how are they going to get into a residential home to talk to people?”
She adds that the sector has been ignored by “multiple governments, regardless of the party” for a long time.
“There is this cultural view that the NHS is very important to the UK and everyone has this affection for the NHS. But then there isn’t that same perspective towards social care and people don’t really understand how the sector functions because it is quite complex.
“But it is also very interconnected with issues in the NHS. A lot of the things which are going wrong in the NHS could be made better if they improve things in the social care sector.
“You have these knock-on effects when things go wrong with someone’s care and they end up in hospital. There has been this failure historically to acknowledge how connected the sectors are and that’s true of multiple governments.”
Earlier this month, the Department for Levelling Up, Housing & Communities, announced that it was making £15 million available over 2023 to 2024 to help support international recruitment in the adult social care sector.
In November, as part of the Autumn Statement, the Chancellor said that an additional £400 million of new ringfenced funding for adult social care would be made available to local authorities in 2023-24. The government has since added that it expects local authorities to use the additional funding to go beyond meeting inflationary pressures and to deliver “tangible improvements in adult social care services”, addressing discharge delays, social care waiting times, low fee rates, and workforce pressures.
After 40 years working in care, Claire* is ready to retire. “But I can’t,” says the Liverpool-based support worker. “I can’t afford to.”
Earning minimum wage, Claire has been known to work 60 or 70 hour weeks, “just to keep my head above water”.
She says: “They don’t even pay the living wage. I’ve never had a pay rise off a private company unless they’ve been forced to do it. We worked right through Covid and we didn’t even get a thank you.
“Everyone was frightened at the beginning. People were worried for their own families but we didn’t even get a thank you. It was ‘you will be coming in or you’ll be getting disciplined’, that type of attitude – like the stick not the carrot.”
Claire says part of the problem is that people view care work as an unskilled job that anyone can do.
“I’ve been around a long time and know that everyone can’t do care. You can get people coming in doing care but they haven’t got the same empathy for people or time for people.
“You’ve got to be a good people reader to do this job because a lot of people can’t communicate very well. So you get to know people and you can pick up signs and signals of people not being well or suffering, which we’re responsible for.”
It hasn’t always been this way. When Claire started in the field, it was viewed as a career.
“You started at the bottom but you could see opportunities to work up, which I did. I worked up to a manager but I’ve become so disillusioned that I’ve stepped down from it all now. I just do my support work and go home. There’s not the passion there that there was years ago.”
Claire ended up stepping down from her managerial and team leader roles because of the intense pressures of the job.
“I used to go home and I’d still be doing paperwork at home. It was having a huge impact because we had to do on call as well. I could have been in work all day until 8pm at night, get home and then get a call that our waking night had gone down and I had to go and cover that, and then I had to come into work the next day for my shift. You don’t get paid for that, for the on call, so your weekends are taken up doing it.
“It was impacting on my life totally. I wasn’t seeing my grandchildren, I wasn’t seeing my children. It was just basically work, home, work, home, work, home.”
Now she’s campaigning with the union for a living wage – though she admits that due to the “divided” nature of the industry, it can be difficult to organise action.
“I think the living wage should be forced. They keep saying they’ve put money through to the companies but that money doesn’t come through to the ground floor.
“I think it should be enforced a little bit more – this is the money and it’s ringfenced for that. If we can keep somebody out of hospital that’s saving thousands for the NHS but because these are private companies it’s more about profit.”
Underpaid, understaffed and overworked – Chloe* paints a bleak picture of life in care’s third sector.
“I’ve watched people come into this job and burn out so quickly,” says Chloe, who is based in Manchester.
She criticises the use of zero hour contracts for some care workers.
“That for me just creates more of a view that these bank staff are disposable, because they come in as quickly as they leave the door. So we can’t retain any skilled workers under those conditions.
“But also it puts everybody at risk because you’re permanently training people up who are leaving, so there seems to be a complete lack of supervision or a consistency in the quality of the service.”
Chloe, who works in supported accommodation services, describes the past couple of years as “firefighting”.
She says: “We have seen a massive increase in the complexity of the people we’re working with. Part of that is because there’s not enough hospital resources or even any kind of good rehabilitation resource in the country, and if there is any, it’s completely bed blocked. So people are being discharged a lot earlier into community services. Often, there’s not a lot of either NHS or public services to wrap around them and that’s where we step in.”
As a result of that firefighting and the ever increasing workload, Chloe says staff often end up off sick with stress – which can lead to resentment building among colleagues.
“There’s a huge stressful workload and that isn’t given any kind of appropriate support of recognition through pay. And we don’t really discuss the fact that we’re heavily understaffed all the time – we hide it behind words like ‘restructure’.
“There’s become a culture where if you go off sick or even if you take your leave, you’re taking responsibility for abandoning your team and the people you support. So that conflict is left to play out between support and care workers as opposed to other internal departments within the organisation who can avoid involvement.”
Pay in the sector is a massive problem. Chloe has been in a cycle of debt for the past 10 years and has watched as co-workers have been forced to rely on payday loans.
“We haven’t had any real pay rise since I’ve worked in this job and as we’re all aware inflation has continued to go up. We’ve had the odd token payment towards the cost of living crisis as a one-off but that’s pretty much it.”
Although she believes there’s an appetite to strike, many don’t know their rights or are “scared” to take action.
“People don’t feel secure in their job roles. And in the height of a cost of living crisis where people are already struggling to make ends meet and we have people in the service who are using other means of support in their community to eat and pay bills, people aren’t going to put their jobs at risk.”
Even though she is proud of what she does, Chloe doesn’t see a future for herself in the industry.
“I’ve not long started a family. Priorities have changed. I haven’t even touched on the fact that a lot of this is a big, big push on women. Women play that double-edged sword of we make up the majority of the workforce so we are doing that kind of caring role in work and then we’re going home to be unpaid carers at home as well – it’s a lot.
“I don’t think that’s something I can maintain or want to maintain and it’s not something that I particularly want to show my child as a healthy way to work either.”
* Name has been changed to protect identities
It is clear that Rachel Flint and her care worker Josie* like spending time with each other.
“She washes me, dresses me, beautifies me,” Flint explains. “She’s my partner in crime, she’s my confidante, she’s company – and she helps me be as independent as possible.”
Flint, who lives in Leeds, has cerebral palsy. She’s had help from care workers for most of her adult life, and live-in carers for the past two years.
“Without care workers my life would be very restricted – very cut off and closed in,” she says.
Flint and Josie spend two weeks at a time together, with Josie living in Flint’s home with her. In that time spent as housemates, the pair have very quickly developed a close bond – including a shared love for Haribo sweets.
“I’ve taught her some of my bad habits,” Flint laughs.
But despite experiencing first hand how crucial the work of carers is, Flint believes they are consistently undervalued. She’s working with the Living Wage Foundation, campaigning for increased pay.
“I don’t think experience and dedication and vocation are fairly compensated,” she says. “Carers are leaving in droves, usually to a low-priced supermarket because they care more for their staff than the care providers do.
“It’s devastating because you have to form that bond out of necessity because they’re doing such intimate things like washing and dressing. I once bumped into a former carer at Poundland behind the till and that was mortifying, knowing she’d seen me without any clothes on and seen my personal information.”
She says care work is often seen as menial, low-skilled work, “whereas it’s in fact a high skilled job. It takes a lot of dedication, it takes a lot of emotional, physical and mental strength.”
And that dedication needs to be fairly recognised.
“This is a two-headed hydra. It’s government and private care companies. The government need to bring us all up to scratch. Wales has done it so why can’t England do it? Why can’t Scotland do it? Why can’t Ireland do it?”
“I think people don’t know what carers do,” says Kristina Luciano.
Over the past 20 years, the 65-year-old support worker has had stints in just about every area of the industry, from hospitals to community care.
She says: “People might see us in the park and go: ‘Well, that’s a cushy job isn’t it? Walking through the park.’ They don’t see everything else that goes on.”
Now working in supported living, it’s her job to look after just about every aspect of her clients’ lives – from cooking and cleaning to arranging finances and administering critical medication.
“In residential homes, I’ve been attacked with a knife,” she says. “Do you know how many carers get spat at? Attacked? That’s every single day. You walk through that door and you don’t know what you’re walking into because your client might be in crisis and that’s what happens to you. I’ve been bitten, I’ve been spat at, all kinds of everything. Do I go back? Yeah, I go back because they don’t mean it.”
Although she’s contracted to work 40 hours a week, the Warrington-based support worker says you’d be hard pressed to find a care worker who sticks to their hours. Lots of people, including herself, have been known to work up to 72 hours in a week, under incredibly demanding conditions.
“You don’t get a break. You’re allowed 20 minutes – you don’t get a break at all. If you worked in an office you could go out and get sandwiches, take an hour off. Not in care you don’t. It’s constant.”
And even when she’s not at work, Luciano is thinking about the needs of her clients. If she knows they’ve had a bad day or gone to a doctor’s appointment, she’ll ring to check that they’re okay.
“And yeah, you could find out when you’re back in work. But you don’t because you live with these people. It becomes family so you go above and beyond. I don’t know of many carers who don’t go above and beyond for the people they support.”
The level of commitment is not a complaint on her part. She says the job is “amazing” and seeing clients achieve – whether it’s washing the pots or getting out in the community – is “worth a fortune”, but the low wages make it impossible to recruit and retain staff.
“We need to be recognised by the government that we are just as qualified as nurses in our job. We are more qualified than working at Asda and Tesco yet they get paid more.
“Again, I’m not trying to put anybody else’s job down. I’m trying to say recognise us, that you’re looking after people’s lives. What are we going to do without carers?”
Earning £10.50 per hour – a figure that she puts down to her “amazing” boss: she knows plenty who are on less – Luciano doesn’t feel like her years of experience or her NVQ Levels 2 and 3 are being fairly rewarded.
“I worked hard to get those,” she says, suggesting that a pay scale similar to the NHS might work as a solution. “Yet I’m paid the same as somebody who is not trained, who has just come into the company.”
Would she consider strike action?
“Not really because who is going to look after these people when I’m on the picket line? These people rely on us because they see us day in, day out. We’re their family, we feed them, if they’re ill we comfort them, we do everything for them.
“Would we like to strike? Yeah – but why can’t the government recognise us for what we do? But nobody does. So you skulk about in the shadows.”
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