Working conditions and employment in adult social care: familiar challenges, but what are possible solutions?

The adult social care sector is facing major challenges. Increasing life expectancies and rising costs of care, alongside a financial crisis, are creating unprecedented pressures on the sector. Alongside this, the sector continues to experience acute labour shortages with employers struggling to recruit, train and retain enough workers. An increasing exploitation of care workers has also been highlighted as a growing cause for concern, with evidence of predatory recruiters and intermediaries exploiting the new visa system in the care sector in particular.     

As our previous recent blog posts have highlighted, our Economic and Social Research Council funded project - “Labour Mobility in Transition (Limits)” - has been investigating how employers in four key sectors of the UK economy that have historically relied on migrant labour (food manufacturing, warehousing, hospitality and adult social care) are responding to workforce pressures following Brexit and the end of free movement of workers from the EU to the UK.  

On 11th July 2024, we held a workshop at the Carriageworks, Leeds, bringing together a range of key stakeholders in the care sector (employer sector bodies, migration advisory groups, third sector and charitable organisations) to consider the challenges facing the adult social care sector.  

The core discussions of the workshop centred on the following questions: What can be done to improve working conditions and prevent exploitation in social care, and what examples of good practice are there?  

In a wide-ranging discussion, it was clear that there are no straightforward solutions to the challenges being experienced in the sector. Many of the current issues and challenges reflect long-standing, structural and institutional constraints in the industry, and are beyond the capabilities of any individual employer, worker or organisation to address.  

Some of these issues relate to the funding model for the sector, the perception of work and employment in social care, established norms around employment contracts, work, training and development in the sector, and the employment of migrant workers. In the remainder of the blog, we briefly explore some of these issues:  

Working in adult social care and the image of the sector 

Participants pointed to well-known and long-standing issues around jobs in the sector, which continue to cause acute worker shortages and difficulties in recruiting and retaining staff. There was agreement that the sector suffers from an image problem and that it is perceived by potential and current workers as one where pay is relatively low, progression and career development opportunities are limited, and where exploitation and poor working conditions are commonplace.  

The continued use of zero-hours contracts, particularly in domiciliary care, was highlighted as a particular concern, even though the use of such contracts has declined somewhat over the last two to three years.  

The commitment and dedication of staff working in the field was highlighted by many participants. Working in adult social care is often seen as a vocation, with workers showing high degrees of professionalism, driven by a desire to make a difference. Workers often remain in adult social care in spite of rather than because of the pay and conditions of work, and employers rely upon considerable goodwill of workers.  

The realities of working in the sector include significant amounts of unpaid labour, long working hours, unpredictable weekly and hourly income, and high levels of churn and turnover amongst staff. Workers often work for multiple employers, or via intermediaries including employment agencies, creating challenges in developing a relationship with a single employer.   

Exploitation in adult social care 

The exploitation of workers in adult social care was a recurring theme raised by participants throughout the workshop. This exploitation occurs in a number of different forms, according to participants. For some, it is ‘baked in’ to the sector, and is a direct consequence of the ‘marketised’ nature of adult social care, where funding is provided for many care activities by the national government or local authorities, but where care is allocated and arranged via commissioning and competitive tendering processes.  

Workers bear the brunt of cost-saving measures caused by the competitive tendering process. This structure essentially specifies the cost of different types of care, and places ceilings and limits on wage and pay levels, as well as contract forms that employers are willing to offer workers in the sector. Funding levels, as well as the types of care that are funded frequently change, often at short notice, with employers utilizing precarious, flexible contracts with staff to reduce or spread their risks. For workers, however, this results in pay levels being largely concentrated at the minimum wage, often on insecure contracts of employment.  

Alternative approaches to commissioning care are possible. Participants in the workshop pointed to commissioning models in which contracts are awarded not just on the basis of cost and quality of care, but also taking into account the conditions of employment offered to workers. Ethical care charters with specific conditions around employment and working conditions had been backed and supported by some local authorities, unions and sector bodies. However, the effects of these on employment contracts and working conditions in the sector appear to be slow to trickle down.   

Exploitation and the visa system        

The social care sector relies extensively on migrant labour, with the most recent figures indicating that more than one in five workers (22%) in health and care jobs in the UK were migrant workers.  16% were workers from outside the EU, with 6% workers from EU countries. The number of EU workers employed in social care in the UK has declined since Brexit, and the falling supply of EU workers was recognized by participants as one contributory factor to labour shortages, something which has also been found in our recent Limits survey of employers.  

The new visa system in place in the UK, with employer sponsorship required for migrant workers to work in the UK, is seen as a significant factor contributing to, in many cases, extreme exploitation of workers in the sector. Some migrant workers find themselves facing unemployment and no access to public funds or welfare support when employers lose sponsorship licenses due to non-compliance with visa regulations. These workers are then susceptible to more exploitation as they look to find a new employer and sponsor, and face challenges in navigating the immigration system.   

The care worker visa also creates issues for migrants who are already settled in the UK and working in care. New migrants arriving on care worker visas are required to undertake a minimum numbers of hours of work per week in order to meet the salary conditions in their visa. This has a knock-on effect on other migrant workers in care whose weekly hours of work decline, with more work allocated to migrants on new care worker visas.  

Further routes to exploitation come via companies who are establishing themselves as care ‘employers’ or intermediaries, using predatory recruitment practices of workers overseas in return for significant fees, but then failing to provide genuine or anticipated employment in care when workers arrive in the UK. Participants pointed to wider evidence in the sector of exploitation of workers from the Philippines, African and other countries, including, in some cases, conditions of modern slavery, debt bondage, poor health and safety in workplaces, and little or no routes for reporting exploitative conditions.  

Developing dialogue in the social care sector 

Addressing these issues poses significant challenges, however participants highlighted the potential value of developing and engaging in ongoing and regular dialogue at a sectoral level, involving diverse stakeholders and constituents, to share knowledge, good and bad practice, highlight emerging issues, and identify possible solutions. Such dialogue was also thought to be important to reduce exploitation in the sector.  

Forums or workshops might focus on particular issues or topics, and the importance of trying to engage with and lobby policymakers and decision-making bodies in and beyond the social care sector was also stressed. Participants noted that under the new government the balance between national and local policy may change, which may require stakeholders to reconsider where the appropriate level for future engagement with policymakers and decision-making bodies lies. 

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