Elevating the Cinderellas of social care

The pandemic put care workers under terrible pressure, Lisa Pelling writes. Yet unions have been able to win greater recognition for them.

It is only a little over three years since the Covid-19 pandemic came to hold the whole world in its stiffening grip. Entire societies came to a standstill. But while many of us were forced to slow down, locked down in our homes, some people had to run faster than ever—care workers.

With, as always, too many people with too great needs to attend to at once, they rushed between beds, juggling the ethical dilemmas created by constant lack of time. When entire wards were infected, the workload was unprecedented. On top came the economic pressure of having to work part-time, employed hour by hour, often at several care homes simultaneously, to try to make ends meet.

Now, as elderly people were particularly affected by the new, incurable, potentially lethal disease, a new type of stress appeared too—fear for one’s life. What if a care worker carried the virus: could she hug her kids when she got home from work?

Domestic care workers were biking in the rain to people who would need a cooked meal and a chat. But on a minute-by-minute schedule there was only time to have them swallow their pills and be off again. Yet social care always involves social contact—and, across Europe, care workers had to carry out their tasks unmasked when hospitals were prioritised for available personal protective equipment (PPE).

Significant improvements

How social care in Europe was affected by the spread of Covid-19 during the first two years of the pandemic from its origins in China (December 2019 through to December 2021) was mapped in the series On the Corona Frontline: Care Workers in Nine European Countries, initiated by the Friedrich Ebert Stiftung in the Nordic Countries, the Swedish Municipal Workers’ Union Kommunal and the think tank Arena Idé. Across Europe, care workers faced increased risk of infection and death (even compared with healthcare workers), while experiencing the huge increase in workload.

If the working conditions of care workers were brought to everyone’s attention by the pandemic, less well-known is that trade unions did actually manage to improve them. Care-worker unions across Europe were able to use the focus on the sector to advance their positions and win significant improvements in pay and conditions. In a new report, Post-pandemic Hopes and Disappointments: Perspectives of Care Worker Unions in Seven European Countries, some of these victories are listed.

In Spain, a new labour law passed to increase permanent contracts will reduce the number of care workers with precarious conditions. In Scotland, workers in adult social care will receive the Scottish Living Wage, a longstanding trade-union demand.

In Sweden, the government has responded to calls from Kommunal for specific legislation on eldercare and the registration of ‘practical nurse’ as a professional title. In Denmark, the accord on health and safety in the workplace has been improved and the government is developing a new eldercare law with the participation of FOA and other relevant trade unions.

In Germany, new legislation on staffing and a higher minimum wage for those working in the sector have been implemented. The Healthcare Development Act (with the impossibly long German name Gesundheitsversorgungsweiterentwicklungsgesetz) has also made tariff-based remuneration mandatory for all care providers, a groundbreaking social innovation.

Less positively, in England, while the pandemic has drawn attention to the shortcomings in adult social care—and employers, commissioners and unions have worked more closely together—in many ways care for the elderly has not recovered from the pandemic and remains underfunded, understaffed and undervalued. While care-worker trade unions in various countries were successful in having Covid-19 recognised as an occupational disease, in some countries, such as Spain, this will only be temporary. And while in Germany mandatory staffing levels have been increased, such mandatory thresholds are absent from the proposed law in Sweden.

Changing the narrative

To move forward, the narrative about social care—particularly the belief that it must be inexpensive—must be challenged. Eldercare often constitutes the largest item in municipal budgets, but politicians campaigning in elections prioritise promises of better schools or kindergartens over more investment in social care. This perpetuates the low status of elderly people and the lack of professional prestige of social-care workers.

We cannot accept that eldercare should cost less and less from year to year. A progressive vision should entail that it take up a larger share of our common resources—and focus on the quality of care rather than the ‘efficiency’ of its delivery.

Private-equity investments in care are often touted as a solution to the constant underfunding. But wooing risk capitalists comes at a price: private residential homes tend to have high debt-management costs, whereas the public sector can borrow more cheaply.

Scotland’s prudential borrowing regime allows local authorities to borrow what they require, militating against further privatisation. This enables preventative spending when individual needs are more minor, avoiding costly hospital treatment later.

A Unison report released in June last year revealed that directors of private investment companies across the United Kingdom were collecting 13 times the wages of the care workers they employed—highlighting the coexistence of low salaries, high profits and high remuneration for those at the top. Addressing these issues and challenging the role of private equity is critical to improving overall care and support for elderly people.

Commenting on the report, Christina McAnea, general secretary of Unison, told the Guardian:

The sector is on its knees, staff are leaving in their droves and those who rely on care are getting a raw deal. Yet many care home owners continue to see their financial fortunes soar amid this crisis. Root-and-branch reform is needed now with profiteering removed from social care.

Rolling back privatisation

In Norway, the centre-left coalition has made it a priority to roll back privatisation in welfare. In Sweden, the Social Democrats made reclaiming control of welfare a key campaign promise in the national elections last September. More inspiring still, a number of Swedish municipalities are already moving away from private providers and choosing ‘insourcing’ instead.

Trade unions were decisive in handling the consequences of the pandemic. Fighting to ensure that care workers had access to PPE, testing and vaccination, that elderly care was sufficiently staffed and that infected care workers were allowed (and could afford) to self-isolate had a significant impact on reducing the spread of the virus. In its Global Trend Analysis on the Role of Trade Unions in Times of COVID-19, the International Labour Organization concluded that ‘effective social dialogue and cooperation between governments, employers’ organisations and workers’ organizations’ were ‘indispensable’ in addressing its impact.

Care workers’ trade unions will be similarly indispensable in addressing the future challenges the sector faces.

This is a joint publication by Social Europe and IPS-Journal