Time to worry about the social care squeeze

Care workers are the largest workforce in England’s health and social care system, but there is a high vacancy rate alongside unwelcome levels of turnover and instability. With a record increase in the National Living Wage just announced, Mark Dayan looks at what has happened to social care pay over the past decade and assesses what impact the living wage rise might have on the sector.

Blog post

Published: 21/12/2023

Filling 860,000 roles across the country, the workforce of rank and file care workers is by far the largest in England’s health and social care system. But with nearly one in eight roles vacant, many people going without the care they need and a rapidly growing waiting list, it is not big enough – and sees undesirable levels of turnover and instability. Scotland, Wales and Northern Ireland too have struggled with problems around recruitment, pay and attractiveness.

The last few weeks have seen two important announcements for this group of workers and those who might join them in future. The first was a record increase in the National Living Wage, of almost 10% – a boost for the over four in 10 care workers paid less than this in 2023.

A close look at what has happened to social care pay across the UK over the past decade, using the recently updated ONS Annual Survey of Hours and Earnings (ASHE), suggests that while it will be welcome for existing workers, this rise in legal minimum pay is unlikely to change some of the key trends behind the current difficulties. ASHE’s category for care workers includes a range of roles working with children. It is not a perfect match for some other definitions used in social care, as it includes a handful of roles supporting mental health care, but it does primarily capture the wide range of roles in residential social care, and in the many different forms of support in people’s own homes.

That may mean there is little to counterbalance any effect of the second announcement – a ban on migrant workers bringing their partners and children if they choose this job.


It is not the case that care worker pay has been uniquely trodden down over the last decade. In fact, with an 8% increase in average real-terms hourly pay since 2011, they have fared considerably better than the average worker, whose average hourly pay has actually fallen by nearly 3% over a grim period for the British economy. Qualified health professionals, whose NHS rates have fallen far behind inflation and who may now be more junior on average than they used to be, have seen an average fall of over 17% during the same period.

But this is part of a wider pattern of workers in lower paid positions like care work gaining much higher wage increases than their already more highly paid counterparts. This is a good thing in and of itself, not least for social care workers who often face poverty. It has likely contributed to UK income inequality flatlining at a high level even as wealth disparities have grown. 

A recategorisation in the classification of job titles used in the ASHE between 2020 and 2021 means that there is some discontinuity in the data as shown in the chart. For example, people working as “care supervisors” were moved from being care workers to senior care workers. However, the trend exists clearly on either side.

However, it makes the choice to be a care worker in 2023 a different prospect from 2011. The Migration Advisory Committee noted in a warning to the government last year that: “Historically social care workers were paid a premium over occupations against which the sector competes today. However, this premium has narrowed in the past decade. This has been driven, in part, by the 2016 introduction of the National Living Wage.”

We can see this dynamic clearly when comparing care work to the other largest categories of service worker in the ONS’s more specific categories: retail assistants, cleaners, miscellaneous administrative staff. The gap in median hourly wage has shrunk from around £2 to around £1.

In these private sector professions, this trend seems to be related very closely to the starting position, not to anything unique about social care. Administrative workers have similarly seen a premium eroded. Chefs, who had a very similar initial wage in 2011 on average, have also seen their relative position fall.

This may be a difficult position for social care, for three reasons. Caring for people can be more rewarding than other jobs, but it also means strenuous physical work at times and the stress of situations where people’s health or safety can be at risk. These are the sort of traits in a job which might be associated with relatively higher pay. 

Where supermarkets or cafés offer non-pay benefits such as discounts on food, a chronically underfunded social care sector long overdue reform can be a tough setting in which to work. Shortages of colleagues and unpaid travel on the clock force unpredictable extra responsibilities on workers and eat into the time they can spend working with the people they care for. The sector is often seen as poorly valued. One in three care workers is on a zero-hours contract, often meaning no occupational sick pay. Across all workers, that is only about one in 30

Lastly, because it is vital caring work with direct implications for the wellbeing and safety of clients, simply lowering requirements or standards for people hired into social care is not an appealing option.

Why stick around?

As the Nuffield Trust and others have pointed out before, this pattern exists not just when comparing care workers to other types of worker, but inside the adult social care workforce itself. The median care worker in 2011 earned nearly a third more than one of the lowest paid tenth: they now earn less than a sixth more.

Again, the pattern of more being given to those who have least is certainly no bad thing. It is rewarding people who deserve more and could be making entry-level positions more desirable. However, it probably also reflects more experienced staff being paid little more than those new entrants. The surveys of employers carried out by Skills for Care find that care workers with five or more years’ experience are paid just 6p more per hour than those with less than one year in the job. 

This reduces the rewards to sticking with a job, and probably contributes to the findings from interviews of care workers that social care offers limited opportunities to progress compared to other sectors.

What next?

It seems probable that the next increase in the National Living Wage will continue these patterns. Its £11.44 rate will be higher than the pay of 40% of care workers this year, which may continue to compress the gaps between more and less experienced workers. However, the new requirement will be higher than the pay of 60% of sales and retail assistants or cleaners, further reducing the premium paid for choosing care over the UK’s other largest service sectors.

With less than no money available to local authorities to increase pay, the compression trend is likely to continue. We have argued that without enough pay to reward people and stop them seeing their futures elsewhere, investing in better training and recognition for social care staff may only equip them to leave. There needs to be a carefully thought-through strategy to increase pay, not simply blindly, but in a way that brings back rewards for choosing social care as a career and sticking to it. My colleagues are working with the Health Foundation appraising options to achieve this, with research to be published next year.

Pay increases will also go further if training, terms and conditions improve and make social care a more intrinsically appealing place to work, with more of the feeling of a committed career. 

Until then, people who face going without the support they need, and going without the dignity and independence this can help to build, face another difficult year as we wait to see the impact of new migration restrictions on the one part of the care workforce that has grown healthily. The timing of any effect may be particularly hard for leaders trying to run and plan a functioning system even as local authorities and trusts responsible for funding care across the UK teeter on the brink of financial ruin. This is a bleak prospect – even if allayed by the bright spot that the lowest paid people they employ, at least, are likely to find their paychecks stretch a little further.


Suggested citation

Dayan M (2023) “Time to worry about the social care squeeze”, Nuffield Trust blog