A blog entry by Dr Cate Goodlad

Summer had definitely arrived as many of the Sustainable Care team congregated for the 4th Transforming Care Conference in Copenhagen on 24th-26th June 2019.  The theme of the conference was: ‘Changing Priorities: the making of care policy and practices’, and as an international conference this offered the chance to hear about how many other countries are managing the challenges associated with Social Care.  One of the panel sessions that I attended proved to have a great deal of overlap with my own research looking at innovative providers of care delivered at home.  While there were discussions around the impact of austerity and the lack of funding as you may expect, the drive for increased marketisation to produce efficiencies and more streamlined services raised questions around the ethics of creating and perpetuating poor working conditions for care workers.  Here are some of my reflections.

England is known to have the largest outsourced adult social care provision, but it is clear is that there is increasing marketisation of home care in other European countries too.  Andrea Ciarini (University of Milan) presented a paper discussing an emerging hybrid model of outsourced care in Northern Italy, where private providers are established and owned by the public bodies to deliver social care on their behalf.  While this may offer one possible way for surpluses generated through a ‘for-profit’ business model to stay within the care system, there are tensions around the roles and responsibilities of public and private bodies.  For instance, if this is seen as a way to reduce social care costs, is it also distancing the Public body from the responsibility for care and for the welfare of care workers?  And what are the effects on job stability, working conditions and job satisfaction?  We have to ask the question therefore, is there also a moral obligation for Public bodies to ensure that care workers are treated fairly and not exploited?

In a similar vein, a further paper (Doerflinger and Pulignano, University of Leuven) discussed the moral obligations of church organisations delivering home care in Germany, which accounts for a large percentage of providers.   This highlighted the mismatch between a value-based system supporting universal rights, and the perpetuation and justification of poor working conditions for care workers.   The discussion here was around how Catholic and Protestant charitable organisations promote a discourse which repositions care work as linked to ‘service’ and a ‘vocation’, rather than as an ‘occupation’ and linked to ‘work’.  A subtle shift but one that helps to maintain the subjugation of paid care workers.  This paper also emphasised a difference between working conditions and job quality; where the former might be very poor (for example no sick pay, unpaid travel time, averaging less than the minimum wage); but job quality may be reported as very high, with care workers taking a pride in their work and frequently doing more than is expected of them or what they are paid for.

One may think that a means to address poor working conditions would be through collective bargaining and unionisation, but here I learned that the results of the Nord Care survey (Marta Szebehely, University of Stockholm and colleagues) conducted between 2005 and 2017 have demonstrated a worsening of job quality for care workers in Nordic countries, but this is despite the fact that in Sweden between 75-80% of care workers belong to a union.  Belonging to a union has clearly not been able to prevent a decline in job satisfaction or improve working conditions in an increasingly fragmented market.

Such tensions around the public-private divide and the quality of care jobs have been surfacing within my own research.  In England, at the policy level there is an increased focus on the integration of the health and social care sectors.  This is an issue I feel should receive more attention: how are we going to integrate a Publicly funded Health Service with (mostly) Privately funded Adult Social Care provision.  Care jobs are at the centre of this debate, along with the perpetual argument about whether personal care should be funded through the health service.  For anyone who has seen up close the ‘health’ work that care workers do, cannot fail to recognise the value and savings to the NHS, but until we value social care on a parity with health care, there will remain a chasm between health and social care workers’ pay and conditions.  While it is easy for people to say that the Social Care sector needs more money – and there are few who would deny this – as Catherine Needham commented in her recent blog, we also need to be aware of how that money might be spent.  It’s not just a case of employing more care workers (although this would help) but ensuring that they are recognised and valued for the work that they do, including fair pay and conditions.  The discussions at the conference served to remind everyone that there are moral and ethical dimensions to procuring care – we can’t ignore the elephant in the room.  For that care provision to be sustainable, it needs to work for all parties involved – care recipients and their families but also to be a sustainable employment for care workers.

Dr Cate Goodlad

Research Associate

Many of the Sustainable Care team attended the conference and contributed photos to the gallery below

Sustainable Care team and wider international network members in Copenhagen for Transforming Care conference

The Sustainable Care team meeting with many of our international partners