Populations are ageing around the work and the fastest growing population is the very old. According to the United Nations, the number of people over the age of 80 is projected to triple from 137 million to 425 million by 2050. People are living longer and healthier lives than ever before. This is great news for everyone, but it also means that demand for social care will increase. In some cases, care will be provided by families, but there will also be an increased reliance on professional care workers in taking care of the elderly. In the UK, for example, the number of people who will need professional social care is projected to double over the next decade to 3.1 million people. Not only is demand for social care increasing, but care work itself is becoming more complex. Most elderly people are living with at least one and in many cases several long term health conditions including heart conditions, limited mobility and dementia. Care workers are relied upon to carry out work which is both important and increasingly skilled. As the United Nations Secretariat noted,
“There is a critical shortage of trained [social care] personnel. In 2015, it was estimated that there was already a global 13.6 million shortfall of formally employed caregivers…In fact, in countries where long-term care is lacking, the inappropriate use of acute care hospital services and emergency rooms is higher, and costs are therefore higher, too.” (UN Department of Economic and Social Affairs )
Given society’s reliance on care workers, there is an obvious case for ensuring care services are providing jobs to care workers which are skilled, rewarding, healthy, and delivers career pathways. However, this is not always the case. Care workers are often facing precarious work which is both stressful and mentally demanding. In the UK, 104,700 care workers are low paid (meaning they are paid less than two-thirds of median income) and a further 18,000 are underpaid (meaning they are not paid for time which they should be paid for like work-related travel).  There is an increased recognition amongst families, government, and advocacy groups that a transformation is needed in how care work is structured and valued. As a policy review in Northern Ireland said,
“We need to find a way of supporting, understanding and valuing the carers role more explicitly and honestly. Considering the immense contribution carers make, we neglect or exploit them at our peril.” (Northern Ireland Power to People report )
In both Asia and Europe, stakeholders are reforming social care work in order to ensure that workers themselves feel valued, rewarded and motivated. But what does quality work look like in social care and how can it be delivered? To answer the first question, you need to talk with care workers to learn from their experiences and hear their aspirations. Many people join the care sector because they are motivated to take care of others who need help. To answer the second question, you need to talk with ‘stakeholders’ who have a role in employing care workers, receiving care, and public and third sector bodies which commission care. In the UK, for example, 82% of care is commissioned by government: in England and Wales these are local authorities while in Northern Ireland and Scotland, care is commissioned by Health and Social Care Trusts (part of the National Health Service). While employers play a central role in managing care workers, these other stakeholders also shape their work environments and job roles.
This training module is aimed at all stakeholders: employers, trade unions, government and care workers themselves in starting a dialogue on improving the quality of work for care workers. It is based on research sponsored by Academy of Science Malaysia (ASM), the British Academy and Newton Fund and is based on two case studies: Northern Ireland (UK) and the public residential care in four different states in the peninsular of Malaysia. In Northern Ireland, the Department of Health is reviewing the delivery of social care. It covers multiple dimensions of social care including the funding of care, integration of health and social care services, informal care and building resilient communities of care. One of the main areas of the review is ‘building a professional workforce’. In Malaysia, the social care for older persons are being provided by the public, private, NGOs and also faith-based organisations. The public sector is mainly providing the welfare-based residential care for abandoned elderly and those without family members. The very high admission rate compared to the number available staffs or carers per centre and also lack of interest among the younger people to be involved as social care workers have created issues related to the quality of care that are being provided, the workload and the associated risks and work autonomy.
We spoke with care workers in workshop discussions as well as stakeholders. In Northern Ireland, we held eight workshop discussions with care workers as well as representatives from the Department of Health, Belfast Health and Social Care Trust, employers and the union UNISON. We asked care workers five questions:
- How can the quality of daily working life for social care workers be improved?
- How can social care work be made into a rewarding career?
- How can social care workers be given more control and voice over how they carry out their jobs?
- What can be done to ensure that social care workers are working in healthy work environments?
- What is the most important innovation that can be made to enhance the quality and status of social care workers?
This training module is based on these discussions. It is therefore training on care work from the perspective of care workers themselves. We will use quotes direct from care workers and other stakeholders to illustrate how care workers can Before you start, we would like you to take part in this short survey.
- UN Department of Economic and Social Affairs, The Growing Need for Long-term Care: Assumptions and realities. 2016.
- Low Pay Commission, Non-compliance and enforcement of the National Minimum Wage. 2017, London: Gov UK.
- Kelly, D. and J. Kennedy, Power to People: Proposals to reboot adult care and support in NI. 2017, Belfast: DoH.