The Good Work and Care Conundrum

Friday 7th May 2021 by Caroline Masundire
Holding hands

If I were to ask any council or employment and skills partnership about their employment and skills recovery plans, I bet all of them have referenced the importance of Good Work and the role of health and social care as a key sector for employment.  I know this because I have spent the last year supporting councils and researching recovery strategies to understand how places are responding to the employment and skills challenges. 

Can Good Work be achieved in the Care sector?

Pre-pandemic the health and social care sector played an important role in employment and skills strategies, in part due to the volume of vacancies, the need for care provision and the numbers of residents employed in the sector. In areas where there was nearly full employment recruiting into health and social care positions was difficult. When I worked on a sector strategy for health and social care back in 1998, the sector, although important, was considered then to be a poor relation compared to construction, technology, manufacturing and logistics in terms of focus for growth. I am not convinced that this view had changed much since. But Covid-19 has shone a light on the health and social care sector and brought its critical role and opportunities for employment recovery into sharp focus.

However, the sector has always struggled with recruitment and retention, and domiciliary care is a particular challenge. The 2019/20 research from Skills for Care[1] highlighted that there are over 50,000 vacancies in domiciliary care at any one time, vacancy rates were at 35% and 178,000 left the sector that year. 42% of the domiciliary care workforce are employed on zero-hours contracts rising to 56% for care workers. This picture has hardly changed in the past eight years. Although there have been moves to promote a Real Living Wage, pay still lags behind. A report by the Institute for Employment Studies for the Health Foundation on Covid-19, government policy and the sector highlighted the financial challenges faced by workers who have to go off sick and rely on Statutory Sick Pay [2]. Anecdotal evidence from a consultation we led into domiciliary care workers highlighted issues of over-working and not taking sick leave even though they had a health condition.

The issues are endemic and the precarity of work in care is not a new phenomenon.

We know that having flexibility around work can be really helpful. But I do think that the care sector, particularly domiciliary care, where 84% of carers are female, the workforce is ageing and 54% work part-time, we cannot ignore that reconciling the ambitions for Good Work, care commissioning and moving people into the sector as part of economic recovery is a big challenge for places. And an issue of inequality of ethnicity (in places, London has a high proportion of workers from ethnic minorities), gender, age, health and income.

So what can be done?

Although most domiciliary care workers are in the independent sector, local authorities have a role to play as commissioners of care. We have seen commitments to embedding the Real Living Wage into contracts in London and pay has increased. But this is one dimension to applying Good Work. Carers need better conditions and greater security of their income as we know that financial insecurity is a key contributing factor for impacting on mental health [3]. We also know that the hours carers work, shift work and lack of planning can add to carers stress in moving from client to client and not having sufficient time for self-care. The pay rates set by local authorities for domiciliary care are tight and do not have sufficient flex in them to provide the kind of employer support and help permanent workers get. This results in a vacuum of support for carers that probably need it most, especially as they are generally sole workers and have limited opportunity for socialising and meeting their co-workers.

The Scottish Government recently committed to a number of fair work measures for Scottish care workers including the Real Living Wage, improving the working conditions for staff, and giving staff an effective voice about workforce conditions. The challenge ahead in Scotland will be how to fulfil these promises within the already strained financial situation of the Health and Social Care Partnerships in Scotland who will be expected to implement these commitments. [4]

Since before the pandemic we have been wrestling with how to tackle this challenge and what could be the drivers for change. There is a business case to be made to make working conditions better to tackle the high staff turnover experienced in the sector and to ensure continuity of care for people, but this will cost money.  There is also a case to be made on in-work about ensuring the health of care workers and the support they need to manage their financial situation and stay out of poverty. Again this requires investment but with constrained public finances, fulfilling Good Work promises within the sector seem to be both unrealistic and undeliverable.

Some ideas for change

Despite this we think there are opportunities for changing the status quo. Our learning from delivering the Challenge Fund for the Work and Health Unit, tested innovations for supporting people with health conditions to remain in work. This highlighted that simple and low cost solutions such as advice for employers, providing wrap around support for people who needed financial help and getting early access to support were key to prevention.

Here are some ideas for how to bring Good Work and care work closer together.

  • Firstly, we need to take a place-based approach to understand the dynamics of the sector and how to respond. Our study, although small, highlighted that most care workers lived and worked in the same local authority meaning that reaching out to them and connecting them to existing support becomes easier. This includes both advice and guidance, mental health, financial and other in-work support.
  • Secondly, most Councils are supporting local businesses through grants, business advice and support. Targeting investment and tailoring support for care businesses would be a practical way of supporting them with their recruitment and retention.
  • Thirdly, we think that any local investment or strategy needs to be scrutinised through a Good Work Assessment Lens, where councils and their partners can use all of their levers such as commissioning, social value and other gifts to ensure that Good Work can be achieved in practice across all sectors and through all pathways.
  • Finally we think that levelling up also needs to focus on sectors where pay and conditions lag behind others. True change can only be achieved if there is the financial will and means to make it happen. Someone recently mentioned at an event on future work that they felt the care sector is broken, if this is the case then lets make that investment work better.

We are really interested in talking to others about how to bridge the gap between Good Work and other sectors where pay and conditions make it difficult to do, like self-employment. Please get in touch if you would like to know more.

Caroline Masundire is a Director of Rocket Science based in our London office. You can contact her at




[3] The COVID-19 pandemic, financial inequality and mental health | Mental Health Foundation