Care Workers vs. Covid

The government has failed frontline workers from the beginning of the pandemic – but in the North West, thousands of care workers organised to fight back, join a union and win liveable sick pay.

Over the past year, care workers have been at the forefront of the struggle against Covid-19. Despite inadequate personal protective equipment (PPE), broken promises around testing, and an absence of occupational sick pay, they have put themselves at risk every day to care for those who need it.

According to the Office for National Statistics, care workers are twice as likely to die from Covid-19 as NHS staff. The rates of infection, meanwhile, are demonstrably higher in workplaces where care workers do not receive occupational sick pay. In these cases staff are often forced to attend work while ill because they cannot afford to live off statutory sick pay of just £95.85 per week.

Trade unions have long called for that situation to change. It was clear even before this pandemic that care workers couldn’t live on such paltry sick pay. But even as Covid-19 hit — and the country ‘clapped for carers’ each week — there was no substantial shift in government policy. For all of their bravery and dedication, the most the government was prepared to offer care workers was a badge.

The truth of the modern economy is that you only get what you organise for. But this is made particularly difficult in the care sector — which, despite being essential to our society, has been allowed to fall into a state of chaos by the government.

The Challenge of Organising

According to Skills for Care, over 1.5 million people are employed within adult social care in the UK—82 percent of them female—and over 200,000 of these are based in the North West. The challenges of organising social care workers, however, are significant, largely down to decades of neoliberal governance and the associated fragmentation of the sector.

Workers are divided across different providers, different workplaces, and different local authorities. Although approximately 20 percent of care workers in the North West are UNISON members, our density—the percentage of workers in trade union membership—varies greatly across different types of care. For instance, density is higher within residential care and supported living where there are common workplaces to organise, and it is easier to get workers together to agitate around collective issues.

In contrast, density and organisation within domiciliary care—which involves care workers providing personal care in individuals’ homes—is much weaker because there are far fewer opportunities for workers to meet and unions to organise. Density and trade union organisation is also higher in services which were more recently delivered by the public sector. Many in these workplaces remain on superior terms and conditions, retaining a trade union culture. Without a constant union presence, however, this muscle memory fades as contracts change hands, staff leave, and terms are steadily eroded.

The precarious nature of employment within the sector also creates significant barriers to trade union activity. Around a quarter of the workforce (24 percent) are on zero-hour contracts, rising to almost half (42 percent) of the domiciliary care workforce. The lack of job security means that many staff are fearful of engaging in union activity while the nature of traditional trade union democracy has excluded the overwhelmingly female workforce, many of whom have additional domestic caring responsibilities.

The fragmented model of social care commissioning also acts to undermine trade union organisation where care is funded by individuals, public bodies, or direct payments from personal budget holders. Even publicly commissioned social care can be funded through local authorities themselves or joint commissioning with NHS partners. The result is a pattern of provision that is frankly chaotic — not to mention removed from democratic oversight and accountability. This means it can be difficult to identify and influence decision-makers.

As a consequence of this fragmentation, it is incredibly difficult to build and maintain collective worker power. To develop deep organising, large scale and long-term resources are required that mirror the financial might of providers across the sector. In the absence of this, our strategy has increasingly focused on mobilising and developing militant minorities to challenge employers and influence decision-makers.

Organising Care Workers

For a number of years, our industrial organising within social care was targeted at unscrupulous private and voluntary sector providers that were cutting pay and conditions to maximise private profits. Although it resulted in a number of major victories—including significant membership growth, recognition agreements, and commitments from a number of councils across the North West to our Ethical Care Charter and to pay the Real Living Wage—the reality was that victories either became temporary or proved impossible to monitor under the commissioning model of outsourced social care.

Workplace leaders were recruited, issue-based campaigns were run, membership was built, and recognition agreements were won — but then care providers gave up their contracts with the local authority and, due to weak employment law, recognition agreements were sometimes lost when services transferred to a new provider.

We launched political campaigns, lobbied councillors, passed motions, and authorities provided additional funding to providers so they could pay staff the Real Living Wage — but many providers simply pocketed the money and refused to pass it on to frontline staff. While local providers—often off-shoots from councils themselves—generally complied with increased commissioning standards, many larger multinational companies were resistant to pressure because they were not so dependent on contracts from individual local authorities. Furthermore, following years of austerity and cuts, many councils did not have the capacity or resource to monitor or sanction the flaunting of commissioning requirements.

As the coronavirus crisis approached, it was becoming increasingly obvious that, as a trade union at regional level, we could not achieve long-term material wins for care workers by solely targeting multinational providers that are organised on a global scale and have almost limitless resources. Instead, to achieve lasting change across the sector in the North West, we needed to organise workers to target decision-makers we could realistically influence—in this case, local authorities that commission social care—by exposing bad practice within the private and voluntary sector and working with councils to strengthen commissioning, contract monitoring, and develop in-house alternatives.

Back in February, official government advice was that there was no risk of coronavirus outbreaks in care homes. Fast-forward ten months and there have been tens of thousands of excess deaths. The scale of the crisis is unprecedented, but the causes of the current emergency predate the pandemic. The extent of the current crisis is a result of the inherent contradictions and weaknesses within our outsourced and fragmented social care system. After all, a privatised model of social care will always place the need for profit above the welfare of service-users and workers.

Pandemic Realities

On 23 March 2020, the day the UK first went into lockdown, UNISON North West launched our ‘Care Workers vs Covid-19’ campaign. The first phase of the campaign involved a major worker survey aimed to identify key issues and concerns, generate organising leads, gather worker testimony, and provide information and data to inform our political and media strategy. In just over a week, the online survey was completed by nearly 2,800 care workers in over 1,000 care settings. Each contact generated was followed up with a detailed one-on-one phone conversation with an organiser within days of completing the survey.

The survey findings demonstrated the gulf between government rhetoric and the reality on the ground. From terrifying tales about PPE—including staff being instructed by management to make masks out of sheets of paper—to clinically vulnerable workers being forced to attend their jobs despite receiving letters from the NHS advising them to shield because they could not afford to live on statutory sick pay (SSP). The results were also analysed by academics at the Wellcome Trust who called on the government to make arrangements for the provision of normal income for care workers who were absent due to Covid. As one care worker in Wigan said,

I started experiencing symptoms of coronavirus. I had a temperature while at work. I came home feeling really bad, and was struggling with my breathing so I had to self-isolate … I had a big deduction to my wages. Knowing the huge financial hardship this was going to cause me, I did wonder if I should just try to work even though I was unwell.

In total, eight out of ten care workers said they would not be paid their full normal wages if they became ill, needed to shield, or self-isolate because of Covid-19.

The findings of our survey were shocking, but it’s important to place them in the context of privatised and outsourced social care which has systematically undermined pay and conditions within the sector.

Most care workers do not receive occupational sick pay and—even before the current crisis—were routinely and regularly forced to attend work when they were ill, increasing the risk of spreading infection to vulnerable service-users. Proper sick pay for care workers, therefore, isn’t just the moral thing to do, it’s necessary to guarantee the health of workers and service-users. The privatised model of social care has demonstrated itself unable—or unwilling—to deliver this basic need.

The evident public health risk posed by the absence of occupational sick pay created a clear campaign demand that could unite workers and members of the public. It also spoke to the idea of bargaining for the common good—issues which extend beyond immediate worker interest within the workplace to common class interests—which is an essential strategy for public service unions such as UNISON to win lasting material change.

The Campaign

In response to our survey, we launched our Care Workers vs Covid-19 campaign demands specifically and deliberately aimed at the twenty-three local authorities in the North West that commission social care. These included guaranteeing testing, PPE, protection from dismissal, and support with childcare. But the most ambitious call was for councils to provide additional funds to protect normal pay for all care workers that were absent due to Covid-19.

Through outsourcing social care, councils had also outsourced their ability to directly determine the terms and conditions of the social care workforce. It was therefore going to take a fundamental change for workers to receive Covid sick pay. Throughout the campaign we utilised our ‘traditional’ bargaining machinery, including lobbying through our branches and writing to council leaders and senior officers, but we knew this would not be effective without significant worker mobilisation and wider public pressure.

At the beginning, up to a dozen full-time UNISON organisers were deployed phone-banking care workers. Detailed conversations were held using the ‘anger–hope–action’ organising conversation framework. This involves identifying issues that matter to workers, agitating around them, and discussing how collective action through the union can build power and improve things at work. In total, over 5,000 phone conversations were held with care workers — each of which included specific asks of workers.

Workers were engaged and mobilised to support a range of campaign activity: from signing and sharing petitions and open letters to meeting politicians to provide personal testimony; from organising online workplace meetings to speaking to the media; from social media posts to making viral videos; from recruiting their colleagues to lobbying local councillors. Thousands of care workers took action during the pandemic and over 4,000 new social care members joined the union.

Initially, our resources were targeted in local authority areas where our power-mapping showed councils would be sympathetic to the aims of the campaign. The ‘Salford Offer’ was reached early on, which guaranteed full normal wages for all Covid-related absence, carer’s leave, as well as support with travel and temporary accommodation. The agreement extended across all social care providers, not just those commissioned by Salford Council and the CCG. It was delivered in Salford without any contractual variation — providers were simply told, in no uncertain terms, that access to additional funding would be contingent on making these commitments.

At a similar time, Liverpool City Council committed to a £6.2 million financial resilience package that included commitments to maintaining normal wages for care workers who were absent due to Covid-19. Unlike in Salford, Liverpool City Council made these changes via contractual variations with existing providers.

The agreements reached in Salford and Liverpool were crucial. Firstly, they made organising conversations more effective as it was much easier to give workers hope by referring to concrete examples. Secondly, it illustrated to other councils how they could deliver campaign commitments — either through contractual variations or through setting strict expectations with close monitoring.

Worker Victories

The very nature of in lockdown is such that there are fewer opportunities to take collective and escalating action. However, where councils were resistant to supporting the campaign, we supported members in more targeted ways. One of the most effective tools involved care workers writing directly to their councillors. We rejected a 38-Degrees style bulk email—which politicians soon become immune to—and instead concentrated on personal experience from the frontline.

We particularly used this technique in local authorities where the leading group was resistant to the campaign — such as Stockport and Bolton Councils. Through this we were able to secure sufficient cross-party support to pass motions at council meetings. In other areas, we mobilised media campaigns—targeted at either the local authority or employers—which showcased worker testimony and first-hand experience of trying to survive on the measly statutory sick pay.

Slowly but surely, thanks to amplified worker pressure, more local authorities began to support the campaign. The announcement of the government’s Infection Control Fund—initially worth £600 million from May to September—gave us further opportunity. The fund is administered and monitored through local authorities and is available to all residential care providers within the area, not just those commissioned by the council.

One of the key stipulations of the fund is to maintain normal wages for Covid-19 absence in order to prevent workers coming to work ill and spreading infection. While the fund is primarily aimed at residential care, 25 percent of it can be used according to ‘need’ — and we used this to push for an expanded commitment that covered domiciliary and supported living care.

Through building worker power, voice, and pressure, we were able to use the fund to reach agreement that full normal wages should be maintained for care workers across all care settings. In total, seventeen of the twenty-three commissioning councils have formally signed up to the Care Workers vs Covid-19 campaign to date — or are delivering in line with the campaign demands. As a result, in contrast to most other places in the country, thousands of care workers have had their normal wages maintained for Covid-related absence.

Beyond the Pandemic

The pandemic shows that the inherent weaknesses within our social care system cannot be resolved until we recognise that conditions of employment are intrinsically linked to the quality of care, and until we remove the profit-motive from the sector. To achieve this, we need a broad-based coalition of support including workers, service-users, carers’ groups, family organisations, and politicians.

Although we find ourselves in the midst of a second wave, and care workers remain on the frontline, the extension of the Infection Control Fund until March 2021 gives us the space and opportunity to look at our demands beyond the pandemic.

There appears to be general consensus that adult social care needs major investment, but this cannot come unless there is structural reform within the sector. Under the current model, any increase in funding would simply represent an increased public subsidy to private profit. There is little doubt that the sector would benefit from collective bargaining — in some cases this has been developed into the idea of a National Care Service, however the prospects of this are limited while the Tories have a majority.

Care workers, care-users, and our communities cannot wait for change — we need to start building for lasting change at a local authority level now. Our experience of working with councils to improve employment standards in social care demonstrates that there is no lack of political will to see improvements, but many councillors believe it is too costly and  ask to see an example of where social care has been proactively brought inhouse, rather than as a result of company collapse. Our aim is to work together with political allies to deliver those concrete examples.

We recently gave support to a Liverpool City Council scrutiny panel on the potential for insourcing social care. The outcome of this work was the report Who Cares? Re-inventing Adult Social Care which recognises the reality of funding restrictions but demonstrates, even within the contemporary financial envelope, that the city’s current homecare contract—with a highly profitable multinational company top-slicing 28 percent of its funding for ‘admin’ costs and voluntary sector providers diverting significant funds to excessive director-level pay and inflated case reserves—could fund an inhouse alternative.

At the centre of the next phase of our campaign is therefore a Stand Up for Social Care Councillors Network that will bring together sympathetic councillors, workers, trade unions, and supportive organisations to organise collectively to improve social care standards and develop alternative models that will be delivered inhouse and put workers and service-users before private profit.

The current crisis has proved the value of our workers and exposed the weakness of private social care. We now need action after the applause to deliver the fundamental change our social care sector needs.