Homecare workers witness the realities of care every day, yet their voices have rarely shaped the policies that govern the sector. Rachel Kelso, founder of Homecare Voices, a network representing current and former homecare workers, explores why listening to those delivering care is essential to meaningful reform.
Homecare workers know what a difference compassionate, responsive social care can make to people’s lives. Yet our voices have rarely shaped ‘the system’.
The perspectives that have traditionally shaped narratives around homecare tend to fall into two camps. Care providers emphasise the need for professionalisation of the direct care workforce as the only way to address the sector’s chronic recruitment and retention challenges. Those who draw on social care call for improved personalisation of services, fearing that professionalisation may undermine the relational aspect of high-quality social care.
A perspective that has been missing is that of actual, direct homecare workers. Not our managers, nor our employers, but the people who spend their working lives in other people’s homes.
Our Behind Closed Doors survey, submitted as evidence to the Casey Commission, sought to bring that perspective into the conversation. What we found suggests that policies designed to ensure people lead decent, dignified and respectable working lives may not be reaching homecare workers as intended. Unpaid working time, inadequate mileage rates and a lack of reimbursement for other work-related expenses combine to expose homecare workers to a very real risk of National Minimum Wage underpayment. Meanwhile, only 13% of more than 500 respondents reported receiving the legal minimum of 11 consecutive hours’ rest between one working day and the next.
These are not simply employment issues. They are issues that shape the quality of care itself. Homecare workers must be well-rested, financially secure and stable in their own lives if they are to build strong relationships with the people they visit, supporting them through the most intimate, mundane, joyful and ordinary days of their lives.
Unlike many sectors, homecare workers are also uniquely constrained in how we respond to poor treatment. We are unlikely ever to go on strike because the thought of leaving the people we support in the lurch is, for many, inconceivable. Instead, we either internalise the role of the selfless ‘angel’ or ‘martyr’, absorbing pressures through goodwill, or we eventually reach the painful conclusion that enough is enough and leave a vocation we genuinely love.
During a recent conversation, someone observed that many migrant homecare workers have experienced exploitation similar to that faced by overseas fruit-pickers, including being charged illegal recruitment fees to secure employment in the UK. Exploitative practices are unacceptable in any occupation, but I found myself reflecting on an important distinction. One works with fruit; the other with people. Homecare workers’ basic pay and employment conditions should reflect the significance of that responsibility.
The speed at which Homecare Voices was engaged by national policymakers indicates that routes to speak meaningfully with homecare workers are otherwise hard to come by, despite there being more than 600,000 of us in England alone. It is essential that everybody involved in the day-to-day practice of care is represented when systems are designed or reformed. Care workers must be in the room alongside those who draw on social care and unpaid carers, so that the frameworks being constructed offer decent lives for every person involved.
Changing this requires action at every level.
Care providers should embrace honest conversations with members of staff, explaining that the pressures within adult social care are far bigger than any single company, making clear that there will be no repercussions should somebody wish to share a challenge they are facing, and sticking to that promise fiercely. Better still, recognise a trade union like Unison or GMB that can provide a hands-free and more impactful route to collective advocacy for your staff.
Commissioners must seek out unmediated contact with care workers at the companies they contract out to, to understand what their working life looks like and where improvements might be possible. Policymakers should be dogged in finding out what’s happening ‘on the ground’, refuse to be put off by the sheer number of care providers and commit to taking social care out of the ‘too difficult’ box once and for all.
Structural reform alone, however, will not be enough.
Among members of Homecare Voices, one theme comes up time and again: the way society perceives care workers. Based on common experiences of disrespect when at work, and on the fact that our pay and conditions have been neglected for so very long, we suspect that whilst it is never said aloud, many people look down on care workers and view us as fundamentally ‘beneath’ them.
Changing that perception begins by recognising that homecare workers are not simply delivering policy; we are living its consequences every day. The realities of homecare cannot be fully understood through reports, commissioning frameworks or workforce statistics alone. They must also be understood through the experiences of the people providing care.
The consequences of substandard pay and employment conditions on the quality and availability of adult social care have already unfolded. People vote with their feet when it comes to jobs. There is a reason Homecare Voices is a network of both current and former homecare workers.
It does not have to stay this way. Imagine if every homecare worker were paid explicitly for all of their working time—or better still, by the shift—never having to wonder whether they have been illegally underpaid. If mileage were reimbursed at a fair, sector-wide rate comparable to that of the NHS’s. If local authorities took a proactive approach to monitoring actual pay and conditions rather than absolving responsibility to HMRC. From a homecare worker’s perspective, these are some aspects of social care that might look different if policymakers considered all of the people involved in caring relationships.
A direct care workforce that is treated with fairness, trust and respect is not simply better for workers. It is the foundation upon which high-quality homecare, and meaningful social care reform, depends.
