Members of Homecare Workers' Group collaborated to produce the following letter. We sent this to relevant MPs and accompanied it with the personal stories of six of our members (Anonymous E, Kate, Anonymous A, Julie, KR and Rachel). You can download our letter and stories here.
Dear Member of Parliament,
Subject: correspondence from Homecare Workers’ Group
I am writing on behalf of the members of Homecare Workers’ Group. Homecare Workers’ Group is a free and independent support network run by and for homecare workers in England. The group was established last year and currently has 270 members.
On Parliament’s return from recess, and as the new government prepares to set out its approach to managing the country’s public services, we wished to make contact. This is because the voices of frontline care workers, particularly those working in homecare, are rarely heard by politicians. Generally, our employers or individuals working higher up in the social care sector speak on our behalf. Very often, these individuals have little to no recent experience of employment as a homecare worker.
Homecare workers, otherwise known as domiciliary care workers, constitute 59% of England’s 1.2 million direct care workers and are employed by 12,808 CQC-regulated care providers. We have no set place of work, instead travelling from one client’s home to the next.
The frontline nature of our roles affords us unique insights into how social care interacts with the lives of those who draw on support, and the lives of unpaid carers. We hope now to put some of these insights to good use. Before highlighting issues that are specific to homecare workers, we feel it necessary to explore a number of overarching issues which affect the social care system as a whole, and all those whose lives are touched in some way by social care.
We invite your patience as we offer our perspective on the challenges facing social care in England.
Issues affecting the social care system as a whole
Thirty-four years ago, the 1990 National Health Service and Community Care Act triggered major changes within social care. Where before, care workers were employed directly by their local authority, today care workers are predominantly employed by tens of thousands of independent companies, whose services are procured either by Local Authorities on behalf of those in need of state-funded care, or by self-funded individuals.
1. Lack of representation for frontline care workers
This marketisation of social care dismantled formal systems of representation for care workers, since trade unions no longer have formal relationships with the vast majority of employers in the sector. Homecare workers are distinctly under-unionised as a result. Whilst Unison and GMB do their utmost on behalf of the care workforce, their scope for action is fundamentally limited by the small proportion of homecare workers who are union members. Meanwhile, there is no mandatory professional body that represents or manages a register of care workers, despite the closely-regulated and high-responsibility nature of our roles.
2. Worsening employment conditions despite increasing responsibility
Over the past three decades, the converging forces of profit-maximisation by for-profit care providers and financial efficiency on the part of Local Authorities have amounted to a steady erosion of employment conditions for frontline care workers, despite a parallel increase in the amount of responsibility involved in the work itself. It has been said that homecare workers have gone from being ‘home helps’ to ‘cheap nurses’.
3. Inadequate funding from central government to Local Authorities to meet the costs of social care
In theory, the privatisation of a public service is intended to drive up the quality of the service in question, since end consumers are free to choose the best provider for their needs. In the case of social care, this intended benefit has been impossible to realise, since the deciding consumer is not the end user of services (i.e. people who draw on social care) but Local Authorities who procure services on their behalf. The decisions made by Local Authorities are informed by the budget they have available to spend on social care, which is directly informed by the amount of funding central government chooses to distribute to them. It is well known that Local Authorities have experienced real-terms cuts in central government funding over recent years, yet even before 2010, the amount of funding available to social care services could barely keep up with the realities of rising demand for care.
4. Unmet need
As a result of their stretched budgets, Local Authorities have been forced to tighten their eligibility criteria for state-funded care when carrying out needs assessments, meaning many more people are going without the care they previously would have received and more people are forced to curtail paid employment in order to provide unpaid care for family members.
5. Poor design of care packages
Meanwhile, those who are eligible for part or fully state-funded care often find the design of their care packages unsatisfactory, and lifestyle-limiting. Where an individual’s preferred lifestyle could be well-supported by - say - two 30 minute visits a day plus one 2.5 hour visit a week to help them get out and about in the community, instead they may be assigned three 30 minute visits a day. To suggest the former arrangement would likely mean to have 30 minutes a day removed from one’s care package, since according to the needs-must way care packages are currently designed, this time may not be deemed essential.
6. Systemic undervaluation of the social value of care
This speaks to an undervaluation of the importance of social interaction for an individual’s overall health and wellbeing, which - if amended - could do much to ease the burden on our overstretched healthcare services. In conversation with other homecare workers, we regularly return to discussion of how the most important, and skilled, part of our work is meeting the unique social needs of the individuals we support. That is despite the high level of responsibility involved in tasks such as managing medication, moving and handling and personal care. A budget-informed fixation on these practical, time and task-based elements of care work to the detriment of recognising its social dimension underpins the ongoing undervaluation of care work, as well as the shameful extent of social isolation experienced by many individuals with care needs.
7. Direct Payments remove local oversight of employment conditions
The introduction of Direct Payments in 2014 rightly intended to restore the ability of the end user to drive up the quality of social care, by allowing individuals who draw on support to engage the care provider of their choice. Yet a consequence of the policy has been to extract Local Authorities from a position of direct responsibility over the quality of employment conditions offered by many care providers who still deliver state-funded care. For example, Unison’s Ethical Care Charter, which calls for improved employment conditions for care workers, has been signed by hundreds of Local Authorities, and yet many care providers delivering state-funded care in the affected areas only engage state-funded clients who use Direct Payments. This generally means their employment conditions fall outside the monitoring remit of their local authority. As a result, well-intentioned initiatives designed to improve employment conditions for frontline care workers regularly fail to reach a significant proportion of the workforce, since Direct Payments mean their employer no longer has a direct, contractual relationship with their local authority.
8. Two-tier system of care quality and availability due to discounted rates for Local Authorities
The budgetary constraints experienced by Local Authorities means they are allowed to procure services from care providers at a discounted rate compared to the amount a care provider would charge someone who funds their own care. As a result, many care providers are not paid enough per hour of state-funded care to allow them to employ staff on decent terms, even if they wished to. This situation is well-documented over time by the Homecare Association who annually publish a minimum rate that Local Authorities should be paying for homecare services in order for care providers in their area to meet basic running costs, including a decent standard of employment for staff. This indirect enforcement of poor employment conditions as a result of inadequate central government funding for social care undermines not only the quality of care, but its basic availability. In order to remain financially viable, increasing numbers of care providers are withdrawing services from individuals whose care is state-funded, in favour of clients who pay market rate for their own care. This is creating a two-tier system of care quality and availability throughout the country, with the greatest negative impacts felt in areas of high deprivation.
Issues specific to homecare workers
9. Unpaid working time
Unpaid working time takes three main forms in homecare: unpaid travel time, unpaid overtime and unpaid extras. Unpaid travel time is the most straightforward of these to track, as it is written into our rotas, and there is strong consensus among sector leaders about the need to bring this practice to an end.
Affecting an estimated 75% of homecare workers, unpaid travel time refers to the time a worker spends travelling from one care client’s property to the next. Since in-work travel time legally counts as working time, when unpaid, a worker’s true hourly rate of pay is always lower than their contracted rate. For example, on paper a worker may be paid £14 per hour, yet they will likely earn no more than the National Minimum / Living Wage once unpaid travel time is taken into account. Many homecare employers top up wages each payroll to remain compliant with the NM/LW. In every case, this amounts to misleading rates of pay.
Where employers are deliberately unscrupulous, or unaware of their obligations around in-work travel time, homecare workers are illegally paid below the National Minimum Wage. In 2020, ten homecare workers were awarded £10,000 each in backdated pay as a result of unpaid travel time, yet this legal precedent did not prompt change throughout the sector.
Aside from unpaid travel time, unpaid working time in homecare also takes the form of care visit times not being long enough; care workers being expected to do extra tasks for clients in their own time, such as picking up prescriptions; care workers not being paid for training, and; care workers having to regularly travel to and from an office in their own time to return client paperwork and collect PPE. For low-income workers, this all adds up.
If payment for in-work travel time were enforced throughout the sector, this would likely involve many employers lowering their contracted rates of pay to a realistic level such that there would be little if any impact on staffing costs and the end cost of care. Employers cannot be expected to voluntarily lower their contracted rate of pay to a realistic level in order to start paying travel time, because they would then lose prospective staff to competitors who continue to offer a misleadingly high hourly pay rate.
10. Obscure terms of employment
Adverts for homecare jobs tend to be light on detail when it comes to describing specific terms of employment, and many use misleading techniques to attract applicants.
For example, it is commonplace for homecare job adverts to promote an attractive hourly rate of pay, yet fail to mention that gaps between care visits are unpaid. This immediately undermines the advertised pay rate. In other cases, Guaranteed Hours Contracts are promoted, but it is not stated that staff must make themselves available for work at all times of day, every day of the week, in order to access this type of contract.
Terms of employment tend to vary from one local franchise of a national homecare chain to the next. This could explain why many job adverts are so vague: if an employer represents a national brand, it could detract from that brand's reputation to make it known that some franchises are materially better to work for than others.
By keeping prospective employees in the dark, the onus is placed on job-seekers to interrogate every potential employer, yet it can be hard to know what questions to ask if you are new to the sector, offering an explanation as to why care workers often move between jobs, undermining continuity of care every time they do so.
These obscure terms of employment also make it difficult for regulators and policy-makers to get a clear understanding of the state of employment in social care.
11. Work-related expenses
Domiciliary care workers are some of the lowest paid workers in society, yet we are typically expected to shoulder the full cost of maintaining and insuring the vehicles we use for work, paying for the mobile data we use as part of our roles and making up the shortfall of fuel costs if these are not fully reimbursed by our employer. This makes it even harder to meet the cost of living, such that hundreds of care workers now apply for emergency financial aid via the Care Workers’ Charity each year.
13. Lack of income security
Homecare workers are typically employed via zero-hours contracts, letting their employer know their preferred number of hours and what times they are available to work throughout the course of a standard week. Yet just because somebody makes themselves available to work between, say, 7am and 2pm on a given day, it does not mean they will be paid for a 7 hour shift. Instead, they are only paid for the time they spend in direct contact with clients.
Generally speaking, homecare agencies send their staff out on set ‘runs’ of client visits, but these change often and, whenever a client goes into hospital, passes away or pauses their care packages for any other reason, all workers who would have been on that client’s run lose out on hours and pay. Such gaps in runs are very common. This makes it impossible for homecare workers to predict their income for any given time period.
This lack of income security means care workers are generally not permitted to access regulated financial products such as loans and mortgages, making them vulnerable to the risks involved in using unregulated financial products.
This lack of certainty also causes some care workers to accept more hours than they can healthily manage, which is detrimental to their physical and mental wellbeing, as well as to end quality of care.
12. Additional challenges faced by homecare workers who hold a Health & Care Worker visa
When the COVID-19 pandemic shone a new light on the intense workforce challenges facing social care, the previous government responded by inviting individuals from overseas to take up roles in the UK’s care sector.
Unfortunately, individuals who hold a Health & Care Worker visa have even less of a voice than native members of the care workforce. Homecare Workers’ Group has been contacted by a significant number of Health & Care Worker visa holders who work in homecare. Conversations with such individuals over the course of the year have highlighted the following issues:
12a. 40 hour per week contracts are incompatible with humane working conditions when in-work travel time is unpaid
The Health & Care Worker visa commits individuals to a 40-hour working week. When in-work travel time is unpaid, employers must subject visa holders to a working week that is far longer than 40 hours in order to meet this condition of the visa. One visa holder who contacted Homecare Workers’ Group writes: "I am an African and we are being enslaved. I am a domiciliary care worker and I am usually engaged for 16 hours on a working day but paid for only 5 or 6 hours. This happens to all my colleagues. We need help".
12b. Illegal processing fees
The only fee a job-seeker should need to pay to engage in the Health & Care Worker visa scheme is an application fee of up to £551. However, since it was left to employers to source overseas workers independently, this created an opportunity for unscrupulous middle-men to act as recruiters. As a result, it is commonplace for visa holders to have been charged thousands of pounds in illegal ‘processing’ or ‘admin’ fees. In cases of labour abuse and modern slavery (see below) this debt is often used to silence victims.
12c. Labour abuse and modern slavery
A lack of oversight by either central or local government has left individuals who find work via the Health & Care Worker visa scheme vulnerable to exploitation by unscrupulous employers, as well as by well-meaning employers who have no prior experience of supporting overseas workers. This has led to a surge in reports of labour abuse and modern slavery within the care sector.
One visa holder who contacted Homecare Workers’ Group said: “We were contracted for 48 hours a week, but we worked 60 to 70 hours. When I arrived in the UK, I was accommodated in a substandard house that had no heating. We heated water in a kettle then into a bucket for a bath, we slept on the floor, the front main door didn't lock and we used a stone to keep the door in place. The windows had no curtains or blinds, but papers stuck to them for privacy. There were four huge bags of rubbish in the kitchen as the council had stopped collecting waste at the house”
On speaking with an advisor at the UK Modern Slavery Helpline, I was told that individuals are encouraged to seek support at night, in case the accommodation provided by their employer is monitored by CCTV, or the smartphone they are using to call from is remotely monitored.
Many visa holders are afraid to raise concerns about their employment in case their employer loses their licence to sponsor overseas workers as a result, which could mean they lose their right to remain in the UK.
12d. Difficulty switching employer
It can be very difficult for a Health & Care Worker visa holder to find alternative employment if they do attempt to move on from their sponsored employer. A new employer must be prepared to apply for a Certificate of Sponsorship on the individual’s behalf, incurring fees as part of this. The individual must then wait whilst their new CoS is processed, and whilst the details of their visa are updated. They are further reliant on their original sponsor providing them with a good reference in order to secure new employment. Support and guidance throughout this process is limited.
To be clear, systematic exploitation of overseas homecare workers is taking place in every community in this country. If you did not know about this already, you do now.
Our asks
We respectfully call for:
A sustained increase in central government funding for social care to effectively meet the rising demand for services caused by demographic trends
The enforcement of paid in-work travel time for all homecare workers, even if this means an individual’s contracted rate of pay is lowered as a result. Sector-wide enforcement is necessary to:
Ensure transparency of pay for England's 625,000 home care workers, improving retention within the workforce
Highlight cases where employers are paying illegally below the National Minimum Wage
Provide a clear foundation for productive conversations around pay, since if people think homecare workers are already paid well above the real Living Wage, they are unlikely to recognise an issue in the first place
A transition to shift-based pay for homecare workers, to ensure a basic level of income security. This has already been implemented by some best-practice employers
The establishment of a mandatory professional body for frontline care workers that is free to join
The National Association of Care and Support Workers (NACAS) already manages a register of care workers, but membership to this organisation is voluntary and its existence is poorly communicated throughout the fragmented frontline care workforce. Here, the infrastructure for a mandatory professional body representing care workers already exists.
Improved oversight and monitoring of care providers who deliver state-funded services via Direct Payments
The development of a centralised database for all jobs in social care, featuring transparent information about terms of employment
Parity of treatment with NHS employees in relation to work-related expenses
Improved pathways to help Health & Care Worker Visa holders find alternative employment within the care sector.
One member of Homecare Workers’ Group has suggested that visa holders be permitted to seek employment with any CQC-registered care provider in their local authority area
A crackdown on illegal processing fees charged to individuals who apply for a Health and Care Worker visa
We fear that the inherent complexities of the social care sector risk it being considered an impenetrable ‘Wild West’ by policy-makers. We hope this letter helps clarify where some of the key issues lie and where meaningful improvements may be possible.
We wish to emphasise that the challenges in social care are systemic, rather than a case of a few ‘bad apples’, be those employers, or workers, and we are actively collaborating with other stakeholders in recognition of this fact.
As care workers, we are tired of hearing that the solution to our sector’s challenges lies in providing better training and career pathways. This implies that the problem lies with a lack of ability on the part of individual workers. We invite anyone with this view to join us as we go about our work. If the dominant national messaging continues in this vein of emphasising a need for formalisation of skills over and above improvements to basic employment conditions, this may well drive even more committed and experienced care workers out of the sector.
In this letter we have not even touched upon who pays for social care, how much, and on what terms. Yet the cost of care shapes so many of our interactions at work: the visits that are too short because an individual is determined to leave their relatives some semblance of an inheritance; the siblings who have stopped talking because one would like to see their parent receive round-the-clock care where the other thinks it is too expensive to justify; the care workers who stay beyond the allotted visit time and again to provide people with the support they need. Every nation in the world is grappling with the same increasing demand for social care. Can we look beyond our borders for examples of workable alternatives in relation to managing the costs of care?
To be clear, the number of people in England who need homecare funded by their local authority is expected to rise by 61% between 2018 and 2038. The issues addressed in this letter may only remain neglected if those in government are prepared to accept the consequences of inaction.
Accompanying this letter are a number of contributions written by members of Homecare Workers’ Group. No brief was provided here; simply an open invitation to write to politicians. We provide these unedited, in keeping with the group’s commitment to amplifying the voices of frontline care workers.
For the sake of all those whose lives are already touched by social care and the millions more who will join them in the future, we hope to see the above issues addressed robustly and at speed by this new government. We are keen to engage in further conversations as appropriate and able to connect you with members of Homecare Workers’ Group to this end, as well as with a best-practice employer.
Yours faithfully,
Rachel Kelso
Founder of Homecare Workers’ Group
Co-signed by:
Julie S, Julia E, Ann M, Monika R, Salomey K, Kate A, Anonymous A, Olaolu A, Anonymous C, BN, Anonymous E and KR
Members of Homecare Workers’ Group
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