The Research: The Rising Status of Care
This piece is part of Koreo Futures, a project looking at the future of good work. Through a series of provocations, we’re exploring some of the trends affecting work which seeks to affect social change. You can read the introduction to the project here. This first provocation is about the rising status of care and is made up of an article, this research bank, some comment from experts, a reading list, and some ideas for taking the conversation back into organisations and teams.
Technology is swiftly changing the world of work
In manufacturing, automation began as early as the 1970s and is growing consistently. Predominantly, this growth has been focused on automotive production, with more than half of the 1.8 million operational robotic units purchased by car manufacturers (IFR, 2017).
Sustained growth in the purchase of robots has also been seen in the production of plastics, rubber, food and drink, suggesting automation is becoming commonplace.
Within manufacturing, automation can be seen as the driving force behind increased domestic production and smaller manual workforces. In the US, for example, automation has allowed the total value of goods produced to increase by 73% (after inflation) since 1990, while the number of jobs in manufacturing has decreased by 30% in the same period (Martin Ford, 2015).
Elsewhere, other routine areas of work have been explored by innovators, with customer service, driverless vehicles and even legal aid becoming the focus of tech entrepreneurs (Economist, 2016).
Experts predict a range of consequences, from a future without a need for human labour (Martin Ford, 2015), to the more optimistic belief that automation will, like technological advances within the industrial revolution, increase demand for cheaper, mass produced products and therefore also increase demand for more highly-skilled workers to control the technology (James Besson, 2015).
In the short-term, it seems most likely that the gradual automation of routine tasks will cause a bifurcation of labour markets, consolidating around non-routine manual labour and non-routine cognitive labour, more resistant to change. Such a polarisation of labour could have dramatic consequences for income distribution and the overall structure of society (Economist, 2016).
Care-giving is an industry resistant to automation
Among work deemed cognitive and non-routine is care. Care-givers are required to perform a range of tasks, whilst demonstrating genuine empathy for their patients. It is these human, emotional capabilities that experts believe may never fully be replicated by artificial intelligence (Sherry Turkle, as quoted in Alec Ross, 2016).
While machines may be able to detect emotions from patient’s facial expressions, tone of voice, or even electrical brain signals (Economist, 2017), human understanding and connection is much harder to replicate (Alec Ross, 2016).
Ethical concern for those in the care of robots has been also expressed by numerous industry experts. Most prevalent is the fear that robot carers may increase the isolation of patients, as human interaction is seen as less necessary when basic care functions can be automated (Vandemeulebrouke et al., 2018).
In the event that robots are able to effectively mimic the emotional capabilities of humans, new ethical dilemmas surround the social implications of those interactions, and the potential for artificial companionship to become normal (Alec Ross, 2016).
There is also much debate over patients’ understanding of robotic capabilities, particularly in regard to monitoring, suggesting that the vulnerable may be unaware of the degree to which their robot carers are recording their behaviour.
In this context, demand for skilled carers is ever increasing, with the World Health Organisation predicting that 40 million new health-care workers will be needed by 2030 (WHO, 2016).
Changing demographics are putting pressure on social care structures
The UK population is growing significantly as a result of increased birth rates, international migration and healthcare helping us to live longer. (ONS, 2017)
It is projected that the population, now 65 million, will reach 74 million by 2039.
Despite a range of causes for population growth, the proportion of the population over 65 is increasing most dramatically.
In 1976, those aged 65 or above accounted for just 14.2% of the population, by 2016 this had grown to 18%, with experts predicting the upward trend to continue to almost 75% by 2049 (ONS, 2016).
To look at those most statistically likely to need care, the percentage of the population aged 85 or over is also growing at a dramatic pace. One in three people over 85 have difficulty completing five or more daily tasks, making carers essential for their everyday lives.
Between 2005 and 2014 the number of people aged over 85 increased by 300,000 or 30% in percentage terms (Age UK, 2016).
This demographic trend is not unusual, the UN deeming ageing populations to be one of the most significant social transformations of the 21st century (UN, 2015).
To keep pace with demographic changes, experts estimate that spending on adult social care will need to increase by at least £1.65 billion by 2020/2021 (Age UK, 2016).
Funding for adult social care did grow by 5% each year from 1994–2006 in real terms against GDP, yet this growth has not been enough to keep pace with the country’s demographic changes and the shortfall in funding has been exacerbated by cuts during austerity, with £160 million taken from social care spending from 2010–2016 (King’s Fund, 2011).
The consequences are plain to see as the UK care system falls into crisis. Between 2005 and 2012 the number of people using day care centres and receiving home care fell by 49% and 21% respectively (Age UK, 2014). This means that nearly 1 in 8 elderly people are living in the UK with care needs that are not met (Age UK, 2016).
The social care workforce is not big enough, and is subject to political uncertainty
The UK social care workforce consists of approximately 1.11 million full-time workers providing care at 20,300 organisations and 40,400 other locations. The vast majority (820,000) of these workers are in low-paid roles (Skills for Care, 2017).
By 2030 the UK will need to recruit another 500,000 carers to keep pace with changing demographics (Gershlick et al., 2017).
Funding is not the only barrier to increasing the number of care workers — the workforce is currently facing a serious retention problem with more than 900 people leaving their jobs in social care everyday. This alarming rate of staff attrition is increasing, from 23% of the workforce in 2012/2013 to 27% in 2015/16.
Attrition of care workers can in part be blamed on their low rate of pay. In recent research by the Low Pay Commission it was found that a culmination of unpaid hours, while staff were travelling or on-call, as well as failure to factor in deductions for items such as accommodation and uniforms, meant that often workers’ salaries fell below the National Minimum Wage (Gershlick et. Al, 2017).
7% of care workers in the UK are from the EU. This percentage is significantly more than in other sectors, for example only 5.5% of NHS workers coming from other EU countries.
Uncertainty over the UK’s future relationship with the EU is already being felt in the care sector, where figures indicate that fewer EU nationals are taking up new care roles.
This is potentially a result of the low-skill and low-pay status of care in the UK, making workers more vulnerable to future changes to immigration and employment laws (Gershlick et al., 2017) (McKenna, 2017).
If changes are made which limit EU workers taking up low-paid roles, the UK will not only have to account for the huge turnover in care workers, but may also need to replace the 900,000 EU Nationals employed in the care industry.
Until recently, care has been seen as work for women
Care has historically been confined to women’s domestic realm — unpaid and undervalued. The traditional role of women as caregivers has been written into UK economic policy, encouraging nuclear families with a male breadwinner and an unpaid female carer at home to support children and elderly relatives.
It was not until the 1990s that care for children and the elderly moved into the public sphere, increasing the status of the labour of care in the UK (Himmelweit and Land, 2008).
Today, women are still responsible for 75% of unpaid care globally, while 80% of the UK’s paid care workforce are women (UN Economic and Social Council, 2016; Himmelweit and Land, 2008).
There is also a concentration of women in lower-paid care roles, with 35% of management roles filled by men (The Kings Fund, 2013).
The gender imbalance within care persists as a result of the gender pay gap, making it costlier for men to reduce their working hours to fulfil unpaid care commitments in comparison to women (Himmelweit and Land, 2008).
But there is appetite for more male care workers, with studies showing that many patients prefer to be cared for by men (Rutter, 2016).
The gendered nature of care is pervasive not just in the UK’s societal structures, but also remains in our perceptions of acceptable work.
Care work is not seen to be a masculine career and is widely considered to require additional emotional skills that men feel they may not have (The New York Times, 2017).
A recent study also found that the wives of unemployed men who considered applying for ‘feminine’ jobs discouraged their application (New York Times, 2017).
These cultural feelings towards care are irrational, Martin Green, CEO of Care England, arguing that the values that underpin care work — dignity, compassion, choice and respect — should apply equally to men and women, men often well-suited to the physical demands of care (Care England).
Where care is paid, it is paid badly and is seen as low status work
Although progress has been made, care work within the public realm is still considered of low-value.
Care workers and home carers, who account for 700,000 workers, have an average wage of £7.90 per hour, with 40% being paid at or below £7 (Office for National Statistics, 2013).
Once in a job, progression is unlikely, with no correlation between qualifications, length of service, employment status or intensity of work (Skills for Care, 2007). This is exacerbated by the privatisation of residential and domiciliary care, in which carers career paths are limited by smaller companies in local areas (Himmelweit and Land, 2008).
Almost a quarter of jobs in the adult care sector (23%) are operating on zero-hour contracts to provide for greater flexibility in the provision of care, but this translates to around 300,000 workers entitled to little job security (Skills for Care, 2015).
In a YouGov poll, 75% of people thought that care workers are under-appreciated, and wages and progression in the sector reinforces this idea.
These factors could have important repercussions for the quality of care afforded to those in need within the UK, as carers’ pride in their work has been found to be the most reliable indicator of their standard of work (Himmelweit and Land, 2008).
Low wages and low job security can often result in in-work poverty for many of those employed in care (Comensura, 2015; General Social Care Council, 2013).
On the other side of the coin, those with caring responsibilities at home face continued hardship. The working culture in the UK, where long hours and overtime are valued, mean that those with caring commitments struggle to compete and care simultaneously (Himmelweit and Land, 2008).
Those providing unpaid care, such as single parent households or those looking after a disabled or ill family member, are more likely to experience in-work poverty.
This potent combination of automation, an ageing population, and a crisis in social care, will elevate the status of care-giving as work, and with it the working conditions for care-givers. More workers will be needed to care for an ageing population, more men will become care-givers as other more easily automated forms of work dry up, and the gendered expectations around caring work will diminish to the point of irrelevance, leading to a fundamentally more equal working world.
