Until domiciliary care work in England is organised differently and subject to improved pay and employment conditions, I hope to only ever remain a part-time member of the workforce, though this is much to my regret, given my love for the work itself.
I was four years away from taking up a job as a domiciliary care worker when the Care Act was passed in 2014. When that time eventually came, I was 22, disillusioned with a career in marketing and desperately seeking work which might imbue my working days with some form of meaning. I was lucky it was so easy to get a job as a paid care worker, but in hindsight, that is concerning, given that domiciliary care workers are almost immediately entrusted into the personal space of people who draw on support and are responsible for all manner of tasks, including the administration of medication.
Yet even before the initial shock of my first intense domiciliary care shifts had worn off, I knew I had found my calling.
It was in the peace of shutting the world out to help someone living with dementia get dressed for the day. It was in asking each person I support about their often long lives and picking up on their inevitable snippets of wisdom, all the while pushing on through our shared list of tasks. It was in finding I could be of genuine use to people in my community at a time when I had zero confidence about what I could bring to the world.
To this day, I would recommend care work to anyone seeking reconnection to the world around them and I remain committed to my role, although I now only do it part-time.
That is because, in my experience, the way the work is organised makes it unsustainable as a full time occupation: too much to do, too little time; unpaid travel time; unsociable working hours; insecure hours.
I understand that alongside the Care Act, direct payments were formalised in 2014 and became the favoured means through which people access formal care services. They are essential for allowing people agency in terms of how social care interacts with their daily life. As a care worker, a point of concern is that direct payments remove the need for a formal relationship between councils and care providers, such that poor employment conditions may go unchecked. A council might be leading the way in terms of their outward position about pay and conditions for care workers and this may be formalised in the letter of their framework agreements, but do the same terms apply when people in their area draw on support from the care provider of their choice, via direct payments? In this way, the rollout of direct payments has extracted councils from a position of responsibility over how care workers in their area are treated. Perhaps this is the only way councils can deliver adult social care within the budgetary constraints imposed on them by central government?
On the question of availability and quality of formal care services, I have been employed by a company which works with council-funded clients and I have also worked for a company which exclusively works with self-funded clients. I understand that the former is seeking to transition to also only taking on clients whose care is self-funded. Whilst working for a care provider which only took on self-funded clients ensured better pay and working conditions for me (paid travel time, minimum one hour visits) and objectively better care for those I supported, after a time I felt uncomfortable about the fact the only people I supported were those with the financial means to pay for their care in full. The financial pressures on care providers fills me with concern about the ongoing availability of formal care services for those eligible for state-funded care, particularly in areas experiencing high levels of deprivation.
I also worry about the quality of care where it does remain available to state-funded clients, given that the only care providers who continue to provide services do so in the most cash-strapped of business environments, with savings inevitably targeted at the employment conditions of care workers and this having negative implications for quality of care. On discussing this topic with other domiciliary care workers, they feel equally unhappy about this development of a two-tier system in terms of care quality and availability, and uncomfortable about their part in it should their employer move to only taking on self-funded clients.
When, in 2020, COVID-19 threw the world into disarray and domiciliary care workers carried on visiting clients as usual, my colleagues and I experienced an exceptional moment of public recognition for our work. The claps grew uncomfortable in the end as people came to realise how materially undervalued our efforts are. Forgive the digression here, but when I watched the BBC Panorama programme about the Post Office scandal in 2020, I somewhat naively assumed that meant the issue was being resolved. It was not until a fictional drama was released about the same scandal four years later that I realised no meaningful action had yet been taken to rectify that huge miscarriage of justice. I mention it because the same can surely be said of employment conditions for care workers.
The people who stopped clapping in solidarity with care workers during the pandemic would be rightly outraged if they knew that no action had been taken to improve matters in the four years since. They would be stunned to learn that the only solution our purportedly ‘tough on immigration’ government had implemented in that time involved charging people from overseas to work in social care under the same conditions which make it so hard to recruit and retain domestically. The Health and Care Worker Visa is a woeful alternative to the sustained increase in central government funding that social care so urgently needs, alongside wholesale reform of how social care is organised and commissioned in the first instance. If COVID-19 did not provide enough of a flashpoint for change for care workers, I’m not sure what will.
Until domiciliary care work in England is organised differently and subject to improved pay and employment conditions, I hope to only ever remain a part-time member of the workforce, though this is much to my regret, given my love for the work itself.
I consider it an unwise decision to commit to full-time care work under current working conditions - financially, emotionally and physically. If every care worker took the same position as mine, where would this leave us?
Over the past year, I have set up an online support network for domiciliary care workers in England: Homecare Workers’ Group. The unanimous support I have had from my current and former employers, from peers and people who have heard about it from all manner of positions in the social care sector convinces me that the appetite for change is all there. The difficulty is setting ideas into motion when matters of funding, profits and bureaucracy continue to cloud the way.
