Decent Work in Scotland's Care Homes: The Impact of Covid-19 on the Job Quality of Front Line Workers

Abstract

Background

During the first wave of the 2020 Covid-19 virus pandemic in Scotland, 46% of those who died of the coronavirus (a total of 4,482 people) died in care homes. Alongside these, at least 14 care home workers also died of the virus. While it is not possible to say whether they acquired the virus at work, it is clear that care home workers were at significant risk of becoming infected. In the wake of this crisis, many have argued for inquiries into care home deaths and social care more generally. We think that such inquiries must also address the job quality of the care home workforce and assess what needs to be done to assure ‘decent work’ for care workers. In other words, we think that job quality cannot be ignored when the quality of social care and the care system are under scrutiny. We also think that until decent work is a reality for all care workers, we will not see the high quality of care that we all profess to want and need to avoid future catastrophes such as that seen in the first wave of the Covid-19 pandemic.

The research This report stems from a research project, financed by the British Academy, that sought to establish what care workers, in the wake of the Covid-19 crisis, think about job quality in the care home sector and what needs to change to improve it. Many of the insights in this report build upon what care home workers told us in interviews. In addition, what key stakeholders from government, industry umbrella organisations, and trade unions told us in interviews also helped us write this report.

The findings

Care workers’ experience during the first wave of the Covid-19 outbreak in Scotland demonstrates that pre-existing issues and deficits in the care sector related to job quality were amplified during the crisis. Out of seven job quality factors specifically examined in this report, care workers told us that five factors had worsened during Covid-19. These relate to ‘supportive managers’, ‘terms and conditions’, ‘a safe work environment’, ‘decent pay’ and ‘job security’. Some care workers told us that they experienced more ‘social recognition’ at some points during the crisis.

However, some also told us about how they felt blamed for the care home deaths and how they had, during the crisis, been an ‘afterthought’ to health care and health care workers. This confirmed their belief that care workers are generally forgotten or ignored, but quickly blamed when things go wrong. One last factor of importance to ‘make work decent’, that around the ‘purpose and meaning’ of work, was reinforced by the Covid-19 crisis. In fact, for many care workers this factor is key for staying in care work.

In the view of care workers, how Covid-19 unfolded for them confirmed long-held beliefs that existing attitudes towards older people – attitudes characterised by agism and lack of valuing them – translate directly into a lack of recognition for those who care for them. Care workers told us how they have experienced the chronic under-financing of the care sector and its consequences on the quality of care and on job quality.

Societal attitudes towards older people, translating into a lack of recognition for care workers and inadequate resourcing, coupled with an absence of collective voice and sectoral bargaining, are, in essence, what care workers consider to be key barriers to ‘more decent work’.

Among stakeholders, there was genuine concern for, and sympathy with, the views of front line workers. However, there seems to be confusion about where the responsibility for leading ‘decent work change’ sits. This is complemented by what appears to be a widespread expectation that ‘others’ take on this responsibility.

What needs to change?

Decent work improvements for care workers require a dedicated approach and specified institutionalised ‘regime’ for job quality improvement. Other social care sectors also require such a dedicated approach – each sector is too complex to allow a ‘one-size-fits-all’ approach. All decent work factors, in particular the seven factors focussed on in this report, should be seen as interdependent and should be addressed by all stakeholders in a coordinated way.

The integration of health and social care may have resulted in joint strategic and policy initiatives and joint commissioning processes, but now needs to extend to the whole workforce. This need is reflected in the unacceptable differences in parity and esteem between care workers and health care workers. The same is true for pay levels and access to employee support services, including mental health support. The widespread absence of the latter proved particularly problematic in the Covid-19 crisis, given the very difficult experiences of many care home workers.

Overall, Scotland lacks a ‘culture of care’ which values older people specifically, but also other people needing social care. Covid-19, has again demonstrated this absence. A culture change is necessary. As crises can be catalysts for change, the right consequences drawn from the Covid-19 crisis will make decent work in social care a possibility.

Amongst the first steps could be the application of the concept of ‘social value’ to care work – this concept refers to how, for example, highly paid jobs do not necessarily create more social value than low-paid ones but may, in fact, destroy more than they create. The use of this concept could result in the calculation that decent pay for care workers should equal a wage which is commensurate with skills, responsibilities, tasks and competencies, plus a social value premium that accounts for how important the work that care workers do is.

The call for action

Quick fixes to the problem of job quality in the care sector will not simply emerge; nor will problems be solved by fixing only parts of the existing structures and operations.

Starting at the top, the culture needs to change. A culture of care would drive institutions and operations in a more sustainable direction and potentially pave the way for finding new ways of resourcing social care. This will require the courage to accept responsibility and the need for co-operation across all stakeholders, with front line care workers having a central place in this process of change.

We think it is critical that front line voices are systematically allowed to influence efforts towards creating a culture of care in Scotland in order to improve job quality in the care sector. An ongoing research process, which listens to front line workers and stakeholders should be considered an investment in enabling such improvements.

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https://research-portal.uws.ac.uk/en/publications/9a233d32-611a-4338-882d-eea3fc81b0d3