Researchers from King’s Business School have today published a paper urgently calling for a new deal for health and care employees that acknowledges and reflects their worth to our individual and communal well-being as highlighted by the Covid-19 pandemic. The paper says that the sector needs a new model of employment, characterised as fair care work, to tackle the challenges to working lives exposed by the crisis.

The paper Fair Care Work: A post Covid-19 agenda for integrated employment relations in health and social care, says that the contribution of frontline care workers has been reflected in the Thursday night round of applause. However, this public gesture sits uneasily with the treatment of over two million health and social care employees, mostly women, often from black and minority ethnic backgrounds who are typically in undervalued, relatively low paid and insecure employment.

The researchers urge policy makers and practitioners to consider how public sentiment can be captured in the fair treatment at work of these health and social care employees. They explore four key dimensions: pay, outsourcing, training and the position of migrant workers, who have long played a key part of the care workforce, but, given their labour market insecurity and the cost minimisation strategies particularly prevalent in outsourced care services, are often treated as ‘outsiders’.

Professor Ian Kessler, who led the research said: “These features of employment relations have cruelly hampered the capacity of health and social care providers to deal with the Covid-19 crisis. They have led to difficulties in recruiting and retaining frontline care staff, reflected in the shortfall of around 40,000 registered nurses, and arguably contributed to a lack of preparation, not least apparent in the initial shortages of personal protective equipment for staff, especially in under-resourced care homes.

“As the initial terror of this pandemic begins to subside, it feels like the right moment to start talking about how to rebuild and re-regulate our health and social care system. It not enough to just clap for our carers, it’s time to make meaningful changes to the working practices that have seen them undervalued and dismissed for far too long”.

The researchers proposed new model of employee relations is based on 4 key principles:

Integration – The fragmentation of service delivery has been mirrored in the fractured nature of employment relations both within and between the health and social care sectors. This fracturing has led to the uneven treatment of employees, with consequences for the capacity of the workforce to deliver services in a connected way, in turn, with implications for care quality.

In response, the researchers call for the greater integration of employment relations. In part, this integration centres on the alignment of employment practices between public, private and

Parity of esteem and treatment – The researchers call for a re-evaluation of job worth, with implications for pay rates. They also stress the need for a more even distribution of training resources and opportunities across occupational groups, addressing the egregious systemic behaviours casting migrants care workers as ‘the other’ rather than as ‘one of us’.

Compliance - Fair care work cannot be an optional extra. Throughout the paper the researchers argue that the right to fair care work reflects the enduring debt the community owes to the health and social care workforce for its bravery and sacrifice in dealing with Covid-19.

The paper suggests that compliance to new standards might be given effect by broadening the remit of the Care Quality Commission, and other arms-length-bodies like Health Education England, and by the regular government commissioning of monitoring exercises.

Collective employee voice – This seeks to re-affirm the longstanding public policy commitment to worker representation by trade unions and professional associations as the basis for industrial citizenship and the vehicle for workers to effectively articulate and pursue their legitimate interests.

King's Business School at The Courtauld

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Professor Stephen Bach

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