A new Sustainable Care paper has been published today, entitled ‘Under-paid and under-valued: assessing mandatory vaccination for care home workers in England‘. To accompany the paper, its author, Tom Hunt, summarises some key points in the blog entry and video below.

Under-paid and under-valued: mandatory vaccination and the low pay and poor conditions of care home workers

From 11th November everyone working in a care home in England must be fully vaccinated against COVID-19 unless medically exempt. Employers and unions have warned for months that introducing a ‘no jab, no job’ policy could lead to thousands of care workers leaving their jobs and exacerbate chronic staff shortages in the sector. The Government’s own analysis forecast high staff departures due to the policy. Employers report that some workers have already resigned ahead of the deadline.

Despite these warnings Ministers have pressed ahead. This raises significant questions about the Government’s willingness to meaningfully engage with the concerns of care workers and about the respect and value given to care work and the people providing it. I examine these issues in my new report, Under-paid and under-valued: assessing mandatory vaccination for care home workers in England (click to download PDF), which considers why care home workers, and unions and charities who represent them, oppose the policy, and why a minority of workers are prepared to remain unvaccinated and risk their employment ending, either voluntarily or involuntarily. I argue that mandatory vaccination must be seen in the context of the ‘low pay, poor conditions’ employment model that many care workers face and a sector that has been under-funded for decades. There is a recruitment and retention crisis in the sector – over 100,000 posts are vacant – but it is better understood as a crisis of work

Improve jobs to boost jabs take-up

Employment for many care workers is low paid (median hourly pay is £9.01) with poor terms and conditions, such as a lack of sick pay, and high levels of job insecurity and unpredictability about the availability of work. 24% of workers in the sector have a zero hours contract, rising to 42% in home care. Most discussion of mandatory vaccination has failed to take the employment conditions of care home workers into account. Yet they are at the heart of the issue.

Take the issue of sick pay. Throughout the pandemic, unions and charities have called on the Government to raise the amount and coverage of statutory sick pay which only covers a quarter of the average worker’s earnings and doesn’t cover 2 million low-paid workers at all. Most of us were able to get vaccinated knowing that if we felt bad for a day or two afterwards then we would get paid time off and our future income was secure. But this doesn’t apply to many care home workers who risk having to take unpaid time off if they feel unwell; financial worries that are compounded if your shifts are unpredictable and your pay is low. Vaccine hesitancy amongst low paid care home workers can’t be properly understood or addressed without considering their pay and conditions.

Persuasion not pressure

Opponents of mandatory vaccination argue that the way to overcome vaccine hesitancy is through persuasion, support and reassurance, not pressure. Research backs this up. A 2021 study of nearly 2,000 UK health and social care workers found that pressure from employers had a negative effect on the likelihood workers would take up vaccination. A survey by UNISON also found that care workers were nearly twice as likely to decline vaccination if they had faced threats from their employer or had not received vaccination advice.

Where employers have listened to staff, provided opportunities for them to discuss concerns and ask questions, and have provided clear, tailored information and reassurance about the benefits of vaccination, they have been successful in overcoming vaccine hesitancy. Let’s not forget that the latest data shows 87% of care home workers are already fully vaccinated. When people are well informed and treated with respect they are more likely to be persuaded. By contrast, mandatory vaccination is a blunt tool that risks reinforcing not allaying concerns. Unions representing care home workers argue that their members feel ‘punished’ and unfairly targeted. The Equalities and Human Rights Commission has also warned that mandatory vaccination risks discriminating against minority groups. Their response to the Government’s consultation noted that the sector includes a large percentage of ethnic minority (21%) and female (82%) workers, and a high proportion of low-paid and precarious workers.

Most care workers are dedicated to their work, but many are exhausted and burnt-out by their experiences on the frontline during the pandemic. When the work is low-paid, has a high exposure to COVID-19, and many workers may feel under additional pressure to get vaccinated, should we be surprised if some choose to leave to find work that is potentially less stressful, safer and better-paid? Clapping for carers rings hollow if you don’t feel respected and haven’t got a pay rise.

When the work is low-paid, has a high exposure to COVID-19, and many workers may feel under additional pressure to get vaccinated, should we be surprised if some choose to leave to find work that is potentially less stressful, safer and better-paid? Clapping for carers rings hollow if you don’t feel respected and haven’t got a pay rise.

Under-paid and under-valued

Ignoring objections to mandatory vaccination has reinforced a strong sense among care workers and organisations representing them that ‘things are done to care workers, not with them’. Moreover, it adds to the view in the sector that the needs of care workers and of the whole sector are often overlooked compared to those in the NHS, as indicated by the higher level of NHS funding, political attention and public support.

This matters not just because of the impact on staff shortages but because major reforms for care are planned. A White Paper is expected by the end of 2021. If future reforms are to establish the long-term settlement the sector needs and to make care work an attractive long-term career, all stakeholders will need to be involved in their design and implementation. Care workers should be fully involved with their voices heard and their concerns listened to and acted upon. Without improvements to the pay and conditions for care workers the sector is likely to continue to experience long-term staff shortages, and immediate concerns about the risks of COVID-19 in care homes are likely to persist.

Click here to download 'Unpaid and under-valued: assessing mandatory vaccination for care home workers' PDF

Tom Hunt is Deputy Director and Policy Research Associate at the Sheffield Political Economy Research Institute (SPERI) at the University of Sheffield. He is a Senior Fellow at Unions 21. Tom is co-leader of SPERI’s Labour and Decent Work research theme. His research focuses on the changing nature of work and the effects for workers.

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