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Positive change for paid care workers – what, how, and when?

Duncan Fisher convened two meetings in autumn 2024 with a group of paid care workers to bring together their views on what they want to see change in their work situation.

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The election of the new Labour government has brought developments on issues facing paid adult social care (ASC) workers. A new commission will examine the funding and structure of the wider sector, but not conclude its report until 2028. The Employment Rights Bill, currently at Committee Stage, includes several measures that stand to benefit paid ASC workers and others in low-paid sectors. These include enhancing sick pay and parental leave, curbing zero-hours contracts, and introducing ASC-specific fair pay agreements. Despite this movement, understanding the views of paid care workers should be an ongoing concern. Therefore, at the Centre for Care we convened two meetings in autumn 2024 with a group of paid care workers to bring together their views on what they want to see change in their work situation. We also began to think about how we might communicate those messages to a range of relevant audiences. The group consisted of frontline workers from different care settings, including homecare and residential care. The workers brought varying levels of experience of paid care work, and of paid care work-related organising and union activity. It gave them an opportunity to connect, which they often lack due to the fragmented structure, and at times, isolating nature, of paid care work. The meetings, one online and one in person, foregrounded paid care workers’ views, which academic work does only sporadically, and which decision-making and policy actors are often reluctant to. The impetus for the meetings arose from findings from our Centre for Care paid care worker organising research, which show that paid care workers lack representation and feel that they are not listened to.

What do paid care workers want to see change about their work situation?

It is tempting to say that these workers want to change pretty much everything about their work. That may be an exaggeration, but it is certainly true that their list of desired changes is long and far-reaching. Broadly speaking, their concerns fell under two groupings: one, immediate issues related to working conditions, practices, and environments. The second was a more long-term selection around societal awareness and recognition of care and care work. Fundamental across both these groupings was that workers were questioning and challenging care and care work’s place and imagining within contemporary capitalism, particularly in relation to the social inequalities they are situated within and exacerbate.

The first area to mention where these workers desire change is to their pay and conditions. There was a sense that efforts to improve other aspects of care work and attract new workers were futile unless pay and conditions are enhanced in a meaningful way. The very low pay and high levels of zero-hours contracts are well documented, and there are promising signs that these will be addressed through the government’s Employment Rights legislation. That said, there are multiple other ways in which paid care workers are disadvantaged. The group’s homecare workers were angry about paying for a range of work-related costs essential to doing their job, such as fuel costs, car insurance and maintenance, and the minimal, or non-existent, compensation for work-necessary travel time.

A second area where workers strongly called for change was in the treatment of migrant care workers. Workers flagged migrant workers’ heightened vulnerability to exploitation, which they argued is exacerbated by conditions surrounding the Health and Social Care Worker visa. These included being tied to employers through the Certificate of Sponsorship, and the power this bestows upon employers when migrant workers require it to maintain their work visa. This then increases the precarity of their employment. Furthermore, workers voiced their fears that migrant workers’ circumstances are worsened by a lack of access to information about their rights.

The environment of care work is made more demanding, pressured, and stressful by low staffing levels, with the continuing national-level labour shortage playing out through problems at the provider and workplace level. One worker bluntly said that people leave due to the pay and conditions, and another invoked the notion of sacrifice by adding that those who remain do so ‘to the detriment of their wellbeing’. The same worker described adult social care as being ‘the Wild West’. Workers were not only concerned about numbers of workers, they also had reservations about the quality of some workers who are employed and the ease of gaining social care employment in some contexts. Closely connected to staffing levels is a fourth identified area, namely the support and wellbeing resources available to paid care workers. Workers recommended enhanced emotional support, mentoring, and confidential support services, and increased attention to paid care workers’ wider wellbeing.

Moving to the second broad grouping, this was a more long-term and less easily quantifiable agenda. A key area was the low levels of awareness and recognition of care work, and a general lack of understanding of what care workers do. Workers pointed to what they see as low awareness of the role of paid care worker among the public, including narrow understandings of it as dirty work or comprised mainly of simple tasks. They referred to negative portrayals of care work in the media, and called for education to challenge myths and stereotypes and to teach young people about the realities (including the positives) of care and care work.

A final issue raised was paid care workers’ lack of representation. Workers noted the low levels of involvement and engagement with unions and other forms of organising, and argued that workers ought to have greater access to information about unions and what they do. In addition, they lamented the lack of a recognised governing or professional body to represent the collective interests of paid care workers.

What are the prospects for change?

It is evident from these meetings that there is a lot that needs to change, and change quickly. These workers want to see these immediate issues about pay and conditions addressed. As noted, there are promising signs through new legislation, and at the Centre for Care we worked with paid care workers, including some involved in these two meetings, to put together a comprehensive submission responding to the Employment Rights Bill consultation. However, significant questions remain, including on the pace of change. There has been widespread criticism that the newly announced independent commission – key to setting priorities for overall reform of ASC – will take so long. We hope to add the growing body of evidence from our care workforce research in the Centre for Care, which foregrounds the views of workers, to this process.

These workers want to do what they can to promote the importance of care work and care workers, to change the narrative, and to educate and challenge myths and narrow perceptions. They are open to sharing these messages in different ways. Please get in touch if you would be open to the group exploring that with you, your contacts, and in your organisations.    

About the author

Duncan Fisher profile picture
Duncan Fisher Researcher, University of Sheffield

In the Centre for Care, Duncan works with Professor Liam Foster in the Care Workforce Change research group. They are currently researching care workers’ organising activities, including their role in trade unions, campaign groups and community organising. This piece introduces the study.

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