A Critique Of The Caring Profession In Northern Ireland

William Ennis looks at the North's caring profession. William Ennis is a Progressive Unionist activist in East Belfast. The piece is featured on Long Kesh Inside Out.
  • The following essay was part of an assignment I submitted toward my Open University studies. I believe the provision of care for those in society, old and young alike, as well as the treatment of those who provide that care, are issues in which Loyalist communities, along with others, have a huge stake. 

Why are low wages a feature of the caring profession, and what are the implications of low wages for the provision of care in a modern society?

To undertake this essay I shall create two sub-headings to deal with the two main questions within the title.  In both sub-headings of this essay I have identified more avenues for potential explanation than can be explored given the mandatory word limit.  The few selected are the ones I consider most prominent.

Why are low wages a feature of the caring profession?

Females have consistently been over-represented in the caring profession.  It is also the case that females are paid lower wages than men.  With the above two factors considered it is clear that the combined effect will be a poor wages in the caring profession.

“The main differences are a gender wage differential of about 20% in favour of male employees, a wage premium of around 30% for full time over part time workers, and a wide variation in wage rates between employees according to their level of qualifications (an analysis of data by the UK Labour force survey, Slater, 2011).”

It has been argued that the nature of the work undertaken by the caring profession is that which is more natural to women than men.

“Thus a study of UK nurses claimed that many of their skills derived ‘not from the qualities of being a good nurse but from the qualities of being a woman’ but omitted to consider what they should be paid for these skills (O’Brien, 1994, cited in DD309 by the Open University).”

This is compounded by the fact that many care workers lack formal qualifications which many would argue justify improved remuneration.

“It is one of the lowest paid sectors in the economy, reliant on an overwhelmingly female workforce, many of whom lack formal qualifications…  (Pennycock, 2013).”

The reasons suggested as to why men are remunerated greater than women have included their less being less likely to have attended university, especially in poorer countries and their role in the family unit as mothers with the family gaining greater utility through the introduction of children to the household than through having the woman undertaking paid employment.  This is arguably a root cause of the aforementioned association of hands-on caring with being a woman.

The caring profession is labour intensive as opposed to capital intensive.
This means as companies suffer increased costs these costs cannot be met by deploying a different technique which utilises capital assets to a greater extent, or replace workers with technology, and so a company providing care services to a client or recipient must utilise its labour assets extremely cost effectively.

“The answer lies in care provision being a hands-on personal service:  it involves providing physical help while relating for the person being cared for.  This can not be done at a distance, and provides little scope for raising productivity by technological change because the number of people for whom one carer can care simultaneously is limited.” (Himmelweit, 2011).

In a state such as the United Kingdom, where care is a funded largely by a socialised budget, namely the NHS, increased costs could not be off-set by raising prices as would be the case in the for-profit private sector.  The care delivered at regional level is managed by delegation to local government which is therefore responsible for balancing its own budgets.  As costs must be restricted in aid of balancing the budgets, raising or sustaining the wages of workers in the caring profession, it could be argued, suffers considerably as ways and means are found to hold down those wages, which are the most significant factor.

“The national minimum wage (NMW) is a right, not a privilege.  And yet estimats suggest that between 160,000 and 220,000 direct care workers are likely to be being paid less than the legal minimum.  This is nothing less than a national scandal…” (Pennycock, 2013).

When budgetary constraints are to be factored in a sector as labour intensive as the care profession, workers remuneration is the most likely, if not the obvious cut.
Some would argue the case for a system of healthcare finance in place in other countries whereby the organisations providing care are free to set their own prices with government involvement being limited to a set financial contribution to the recipient of the care, thus creating greater marketisation of the care profession. 

Those who champion this theory would argue that the producer surplus which may become prominent would facilitate fairer remuneration of care workers and/or greater consumer welfare.  Those opposed to such an idea would argue that the opportunity for profitability would, in practice, do nothing more than create an incentive to withhold such a pay-rise.

Care workers are less likely to avail of collective bargaining.

Collective bargaining, such as that of the trade’s union movement would improve the bargaining position of workers and provide a forum of communication between employers and employees.  The workers of the care profession don’t do this to the extent of others and this could be one of the reasons for their poor remuneration. 

Suggested reasons for this include one theory that due to the geographically scattered nature of the case load of a care worker everyday communication and liason with other care workers is not commonplace.  In addition to that, immigrant labour is disproportionately over-represented in the profession adding isolation and language barriers to the reasons collective bargaining is not happening to the degree it might.

“…  One that has a limited bargaining power and a particularly weak collective voice.  This is exacerbated by the frequent physical separation from colleagues that is a distinct feature of the irregular and fragmented service they provide.  Union membership among domiciliary care workers and the support workers stands at 24 per cent, far lower than that of care managers (58 per cent) and qualified social workers (88 per cent), according to the social care workforce research unit at King’s college London. (Pennycock, 2013)

The mean gross hourly earnings in the UK (£) in 2005 for an employee who has entered into an agreement of collective bargaining was 11.72 compared with 10.65 which is the mean gross hourly wage of the employee who has not entered into an agreement of collective bargaining (Forth., 2006, as citedin DD309 by the Open University).

Conclusions to part 1 of this essay

  • Gender inequality means that women are remunerated more poorly than men and as a profession in which female workers are disproportionately overrepresented this will have an impact upon the wages of the caring profession
  • This profession is a labour intensive one where technology or alternative techniques can not be deployed to increase production as production can not be increased due to the hands-on nature of this profession
  • Collective bargaining is under-deployed by the workers of this industry.

What are the implications of low wages for the provision of care in a modern society?

Emotional labour is a concept theorised by the sociologist Arlie Hochschild.  It refers to the manner in which workers in certain line of work must use deployment of their emotions to aid the successful execution of their tasks.  One example might be the warmth and friendship radiated by a worker of the care profession toward their patient/person under their care.  For clarity, another might be a debt collector whose ‘nastiness’ as it where, would have to be deployed in a way which is hardly natural in the carrying out of his work.

The care profession is a clear example of one where emotional labour is a significant factor.  One of the reasons care-work can be so emotionally difficult and draining is that the caring relationship required between carer and patient is very often subject to a time restraint which greatly inhibits the delivery of a good standard of service.  The short periods of time which the carer gets to spend with his/her patient also adds to the emotional cost placed upon the carer as this short time period often prevents the mutuality of such a friendly relationship as well as reducing the effectiveness of the care.

High turnover rates are often high in low paying care work.

“In much of the emotional labour discussed in the literature, the interaction with any particular person is limited in time.  Indeed, one of the reasons why such work is often considered emotionally wearing is because it is so one-sided and temporary, so that no meaningful relationship can develop- though jobs vary in the extent to which performing emotional labour is a cost or a benefit to workers (Wharton, 1993, as cited in DD309, The Open University).

The nature of care work is so personal that the ability for one person to receive care may even be dependent upon the right care worker.  Relationships can bring about this important level of care.  The low wages to which care workers are more often than not subjected makes such beneficial standards less likely.

One might argue however, that the emotional labour model suggests manipulation of ones emotions.  This implies on some level that care for the well-being of the patient is not present in the carer.  Many I’m quite sure would object to such scope for misunderstanding.

Social investment is a concept which must be kept central to any discussion concerning the provision of care.

Social investment is the provision of goods whose future returns to society are higher than their private benefits and thus market provision is less than would be pareto optimal (Himmelweit, 2011).

Low wages in the care sector affects the delivery of that care due to the decreasing opportunity for mutually beneficial relationships between carer and patient.  This is caused by high turnover in the sector and would ultimately re-align the provision of care to non-paid care workers, ie family.  Not all of those in need of care are in so lucky a position.  This will deteriorate the confidence many have in society that when their time comes they will have their needs met.  Care of children is the most direct investment our society can make and the poor remuneration of care workers deteriorates our society.

Conclusions to part 2 of this essay

  • Poor wages leads to short periods of time between carer and care recipient, which leads to poor standards of care
  • Poor standards of care leads to poor social investment

Works Cited

Forth., B., 2006. UK Labour Force Survey, Autumn 2005, London: National Institute of Economic and Social Research.
Himmelweit, S., 2011. The economics of care. In: R. e. a. Simonetti, ed. DD309: Doing economics, markets, people and policy. Milton Keynes: The Open Universiy, p. 268.
O’Brien, M., 1994. The managed heart revisited: Health and social control. Sociological Review, 42(3), pp. 393-413.
Open University, 2013. Econometrics. [Online]
Available at: https://learn2.open.ac.uk/mod/oucontent/view.php?id=423653&section=8.4.1
[Accessed 16 06 2013].
Pennycock, M., 2013. Does it pay to care, s.l.: Resolution Foundation.
Slater, G., 2011. Wage determination, discrimination and segmentation in labour markets. In: R. e. a. Simonetti, ed. Doing Economics: People, markets and policy. Milton Keynes: The Open University, p. 197.
Wharton, A., 1993. The effective consequences of service work: managing emotions on the job. Work and Occupations, 20(2), pp. 205-32.

1 comment:

  1. In any functioning society we all ought to have an interest in the care provided to those that require it as well as the treatment of those who provide it.

    Indeed the work is often emotionally difficult because of the time constraints relative to the needs of the service users. Regrettably the emotional labour aspects are rarely addressed even where training is provided. This of course leads to early burn-out for carers, high staff turnover often resulting in fractured service provision and increased costs. Very brief and simple training interventions can minimise such outcomes.