In this blog, we throw light on the exploitation of care workers for political profit during the coronavirus pandemic. Across England, Scotland and Wales, between 75% and 97% of the care workforce is employed in the private sector, yet this workforce performs a public service in which the state is morally, legally and financially embedded. The exploitation of care workers by employers is well-documented in accounts of chronic low pay and zero-hours contracts. However, the exploitation of care workers is less frequently analysed as exploitation by the British state. Examining the ways in which the state takes unfair advantage of social care workers reveals that exploitation is a problem that runs far deeper than is captured by indicators such as non-payment to workers of a real living wage.
Over recent months, our research about social care regulation at work has required that we keep up to date with the sporadic issuing and rescinding of formal guidance to the social care industry about coronavirus. It has prompted us to pay attention to the mechanisms through which the state profits or benefits from the deployment of care workers, both on the ground and in political discourse. In the argument set out below our focus is on political discourse.
Since March, government channels have adopted a novel standpoint when communicating with the public about our national systems of health and social care. Health has been narrated through the prism of the hospital and citizens have been on the receiving end of a mantra in which we protect the NHS in order to protect the health of the nation. Protect the NHS is code for Protect our Hospitals. Not once have we been urged to take collective action to protect the capacity of care homes or to ensure homecare services do not buckle under excessive pressure. To do so would not make sense – the public is inured to a status quo in which being overwhelmed is the default position for social care services and political leaders do nothing in response. There are stark structural differences between our national systems of social care and our health services delivered through the NHS. Despite its flaws, the NHS is an organisation for which the public demonstrate a genuine sense of national pride and ownership. However, social care is an amorphous industry based on cost-competition between thousands of private companies that contract with the state for the provision of care to individuals and are regulated at arm’s length.
During the pandemic, politicians have sought to deflect attention away from the stark differences between health and social care. They have not been able to appeal to a public sense of responsibility for protecting the resilience of the social care market for fear of drawing attention to its ideological fallibility. Accordingly, politicians have narrated key messages about social care services through the prism of the care home worker. It is the care home worker herself that has been deployed as a totem of national pride and as a proxy for the social care industry. During the pandemic, political discourse about the figure of the care home worker has emphasised her apparent attributes of vulnerability, excessive need, heroic endurance and subordination to the needs of others. This provides a lens through which the routine exploitation of care workers by the state can be explored.
The Sacrifice of our Care Worker Heroes
Perhaps the most extreme example is the exploitation of care workers’ physical health that has occurred through March, April and May. Analysis by the Office of National Statistics revealed that the highest incidence of death by occupation among women workers was in social care. To the benefit of the nation, the state took advantage of care workers’ health without making good on the obligations, both legal and moral, that should have mitigated the risks to their lives by occupational exposure to coronavirus. In place of mitigation, those risks were intensified by failing to provide care workers with the security of a wage income if they got ill.
In law, failures to protect workers’ health and safety represent failings by employers to meet their legal obligations. However, in the maelstrom of the pandemic response, the state has assumed responsibility for the acquisition and distribution of personal protective equipment for the social care industry. Thus, employers have been protected by the state from allegations that they may have failed their workers and residents. The Secretary of State for Health and Social Care has also spoken repeatedly of the health and social care workforce as ‘one family’. The legal fact of privatisation has been hidden from view in political discourse. Along with other Ministers, the Secretary of State has spoken as though the state has a direct and close relationship with a national social care workforce. This has obscured the fact that privatisation was designed to enable the state to wash its hands of the social care workforce. There is no national social care workforce and labour costs and working conditions are constantly driven down by the fragmentation of social care workers across an industry comprised of thousands of private organisations.
In public political discourse, care home workers are lauded as heroes, at the same time as the political economy of the social care industry strips them of value, dignity and respect. This might look like a clash of values, but these messages are not contradictory. The identification of care workers as heroes sets them apart from the general population as a class of people to be admired. Heroes can be admired for any number of attributes: skill, masterful intelligence, bravery or physical prowess. For care home workers, admiration accrues for their endurance in difficult circumstances and for being kind in the face of adversity. These qualities mean that their poor terms and conditions of work are integral to the basis upon which admiration is due. As heroes, sacrifice is part of what it means to be a care home worker.
The Thursday evening ‘clap for the NHS’ quickly morphed into a ‘clap for our carers’ and has provided political cover for the exploitation of care workers by the state. The Clap subsumed appreciation for care home workers (aka social care services) within a ritual designed to communicate the national unity of appreciation for work done in our hospitals (aka the NHS). We have applauded these workers as one family. In the context of unavailable gowns, masks and hand sanitiser, we have applauded the sacrifice of those who have been killed at work, as though no-one is to blame for these tragedies. Indeed, the BBC ran a headline in which care workers killed by occupational exposure to coronavirus were described on workers’ memorial day as ‘the fallen’.
The Clap has bolstered a sense of ‘keep calm and carry on’, of ‘stiff upper lip’ and it has reinforced military metaphors about armies of heroes in a war against a deadly assailant. Our national memory of World War I is informed by pictures of the crowds who lined the streets of towns and villages to cheer and applaud young men marching to war. While other countries have applauded key workers, in the UK we have seen this phenomenon co-opted as a national performance that is orchestrated by Government ministers. The Secretary of State Tweets about it, the Prime Minister comes out of Number 10 for the TV cameras, and sections of the press have explained that he ‘leads millions of Britons in paying tribute’ while the leader of the opposition is accused of ‘photo opportunity’ faux clapping.
A further rhetorical function of identifying care home workers as heroes is apparent in news stories about care home workers entering into on-site lockdown at their places of work. These stories serve to extend the narrative of subordination to the needs of others by portraying the sacrifice of care home workers: those who put the interests of residents above the interests of their own families. Care workers have been photographed smiling amidst the recently installed bunks that have secured their presence on-site even when off-shift. Others have let news crews join them at their impromptu campsites set up in the grounds of a residential care home. Their accounts of subordination to the needs of others echo gendered aspects of the routine devaluing of care work. When paid care work is regarded as a substitute for the work assumed of women in families, the identities of care workers as waged workers is obscured. This is significant in the context of widespread breaches of employment and safety rights.
The stripping away of care workers’ rights-based identities serves to emphasise human vulnerability. Yet the very largest corporations in the social care industry seek to portray themselves as vulnerable too. Chains of care homes that are operated by private equity financiers and have paid little or no corporation tax for years are requesting tax payer bailouts because beds lie empty due to COVID-19 deaths. In mid-March the sector regulators of care quality in England, Scotland and Wales each decided to suspend routine inspection of care services as a mark of recognition that organisations would struggle to meet safety standards. Hence narratives which obscure the identity of care home workers as ‘workers’ serve as useful allegories for an industry in which care home businesses want to suspend their commercial identities as efficient, independent, and profit hungry.
An apparent confusion in the minds of leading politicians about the rights bearing status of social care workers suggests that setting aside notions of commerce and employment in matters of social care is not such a hard sell. For example, the Scottish Cabinet Secretary for Health made a statement to Holyrood on 28th April in which care within families and the activities of the care home industry were presented as synonymous: both needed the protection of the state:
As well as those working in care homes to protect our most vulnerable people, I know there are many carers – both paid and unpaid – who are supporting people to stay in their own homes and they, too, must be protected.
Unpaid carers provide care to family members, friends or neighbours. Unpaid carers have a legal status that carries with it access to social security payments, to assessments of support needs and duties of the state to meeting eligible support needs. Being an unpaid carer is often a full-time job, but it is not an occupation. In contrast, a social care worker is a skilled professional with rights of employment in an occupation that is regulated in law. The melding together of paid and unpaid care is easily done because the occupation is culturally aligned with highly gendered understandings of ‘women’s work’ in domestic settings. In portraying care work as a quasi-domestic role akin to caring for one’s own family, the difficult and sometimes deadly working conditions that care workers navigate are naturalised. However, and crucially, social care workers have employers. Yet for political purposes, the existence of the myriad of employers in the social care industry and their political and economic function is being hidden from view.
Exploitation and political popularity
We are living through a time of perpetual televised briefings and these provide regular opportunities for the state to hone its narratives about social care. Like 1940s families gathering around the wireless for an update on the war effort, these briefings provide a shared lens through which citizens can gain information on the current status of the virus and the action is being taken. Every briefing brings new facts and figures, but the information shared is select, it represents value judgments by the UK, Welsh and Scottish governments about what each has decided is important for the public to know. A doctor or nurse employed by the NHS will regularly see their skills reflected, acknowledged and praised in these briefings. Care home workers are far less frequently mentioned. Indeed, it is a striking feature of the UK daily news conferences that care home workers are so rarely mentioned, and that homecare workers, personal assistants and learning disability support workers have never been. A stark exception was 15th April, the day that UK Secretary of State for Health and Social Care introduced a CARE badge as a ‘badge of honour’ to be worn by all those working on the frontline of adult social care in recognition of their ‘courage in this battle’. The idea was to create a branding that would, somehow, afford care workers the same recognition as NHS staff. The Secretary of State was roundly criticised in the press for introducing a gimmick and for failing to address massive staff shortages due to chronically low pay and poor conditions of work across the social care sector.
However, a couple of weeks later, the Department of Health and Social Care launched a further initiative under the CARE branding, an application for social care workers to download to their mobile telephones. It was claimed that the ‘CARE App’ would ‘support staff on-the-go through the coronavirus pandemic’. This initiative adds to the catalogue of pretence that the state has a social care workforce. The Secretary of State personally urged that every social care worker should download the app so they could ‘see’ for themselves the latest updates from his Department, benefit from shopping discounts and boost their mental health with handy links to self-help websites such as Sleepio and Silvercloud to improve sleep, reduce stress and build resilience.
The app indicates the state is working hard to create the appearance of direct support for a social care workforce that it abandoned long ago. Although designed in part to respond to mental health concerns, the app champions individual responsibility and serves to disguise the structural underpinnings of work-related mental health problems such as in-work poverty, inadequate training and massive staff shortages. Some of the information available via the app is indeed important, but none of it is written with the genuine intention of training care workers. Instead, policy information from Public Health England and the Department of Health and Social Care is dumped into the app. The implication is that care workers, despite their low-paid and precarious employment, have a personal, individual responsibility to keep up to date while ‘on-the-go’ and caring for the dying in their thousands. Yet in law, it is employers that are obliged to ensure that staff are trained sufficiently to provide safe care. Once again, the function of social care employers is erased.
The CARE App encouraged users to share stories and experiences in chat threads, on grounds that peer-to-peer support would help care workers learn from one another. The GMB union however took to the national press to urge care workers not to use the app because it provided ample opportunity for the state, and employers, to ‘spy’ and ‘snoop’ on individuals. Without data protection warnings, care workers had been required to provide the app with their name, job role and information about the identity of their employer. Anyone who used the chat function could be personally identified by anyone else. Unsurprisingly, care workers wanted to chat about lack of PPE in particular workplaces, and some responded with advice on how to make your own PPE from stationary cupboard items, others shared fears about being tested for the virus because they could not afford to self-isolate and there were complaints about service users’ engaged in apparently reckless behaviour. As the GMB union pointed out, these revelations could lead to care workers being dismissed from their employment or referred to regulatory agencies. There is mounting evidence that the government does not even understand the basics of the difficulties care workers face in their working lives. The CARE App feigns the appearance of a meaningful connection between the state and the social care workforce. Its design provides further evidence of the state exploiting social care workers for political purposes.
It would be wrong however to neglect the publicly visible role that employers in the social care industry have been playing in this crisis, as expert commentators. They too have narrated accounts of care home workers in ways that obscure their political role as employers within a privatised industry. A particularly revealing example is a blog post recently written by Donald Macaskill, the Chief Executive of employers’ association Scottish Care. In it he shares excerpts from a letter written to him by a care home worker ‘Mary’ about her deep sense of grief at the death of residents for whom she has cared for years. Macaskill introduces Mary to his readers by using emotive and feminised metaphors of ‘rhythms’ and ‘seasons’ and ‘nature’ to emphasise the naturalisation of her feminine caring role. He conjures images of her emotional toil through ‘pain’ ‘comfort’ and ‘solace’. Yet Macaskill exploits Mary as he extols her virtues, initially by prefacing her account with a disclaimer that coronavirus infection is no-one’s fault (and thus no-one’s responsibility):
‘despite very stringent efforts, with adequate PPE and a well-trained staff the virus got into [Mary’s] care home. No-one knows how, but it did’.
To suggest that the transmission of the virus is a total mystery or trick of fate is a tactic serving to individualise issues as random or isolated, rather than plugged into a matrix of political, economic, historical and social injustice. In his blog post Macaskill draws on Mary’s story about the heartbreak of care work during the coronavirus pandemic and he urges readers to look beyond statistics. He concludes:
I hope that in the coming days and weeks the increasing words of harsh criticism, of finger-pointing and blaming, will be quickly worked through. I accept that they are often an understandable response to grief and trauma and that they are sometimes necessary to assure and to hold accountable all of us for what we have done and not done. But they ill-serve us if we want to move forward as a nation, as a community and as individuals.
It is inconvenient indeed that the statistics tell us that care home deaths are at staggeringly high levels and that they point to systemic errors. It is a discursive sleight of hand to suggest that stories about the traumas of care workers and residents should permit the corporations at the heart of the care home industry to evade criticism and avoid blame. Donald Macaskill represents ‘the voice of the independent care sector’ and yet he uses the voice of a care home worker to effectively call for a rapid resumption of business as usual. It is pertinent to ask, to whom is he speaking? Who is the ‘us’ to whom he refers as potentially accountable? Who is the ‘us’ that would be ill-served by criticism and blame? It is politicians, Government and the state.
Across the U.K., government leadership of the pandemic response has been widely recognised as confusing and slow off the mark. In this article we have provided examples in which political messaging about the social care industry is designed to confuse. The exploitation of care workers is central to the existence of a social care industry sustained by state finance and light touch regulation. At a time of crisis, there is surely the possibility that the systemic failures of the UK’s social care industry will be exposed and that the public will not tolerate its continuation. Consequently, the admiration of the public for care home workers is being manipulated by a narrative in which politicians pretend that the social care workforce is part of the NHS family and that paid care work is much like the work of women in everyday families. Political discourse is exploiting home care workers during the pandemic and attempting to hide the basic facts about the political and economic functions of privatisation.
Lydia Hayes is Professor of Law at Kent Law School.
Hannah Walters is a researcher for University of Kent on the Regulating Social Care at Work project.