New horizons: What can England learn from the professionalisation of care workers in other countries?

There is growing public recognition that care workers have long faced a formidable number of challenges. These include low pay, poor terms and conditions, hugely variable access to training, and limited opportunities for career development. These have been exacerbated in recent years by increased rates of sickness and burnout during the pandemic and changes to immigration rules following Brexit, which have led to intensified recruitment and retention challenges.

Perceptions of care work as ‘low skilled’ continue to persist, despite the pandemic highlighting just how vital care workers are. Their dedication and capability has also been recognised in Baroness Cavendish’s report. In recent years there has been increased debate around the ‘professionalisation’ of this staff group. This generally refers to the creation of a statutory register of staff and their professional regulation, and can involve improvements to pay, training and career development, and terms and conditions.

Our report reviews what the evidence shows about the professionalisation of care workers in other countries. It draws on the experiences of those other countries to inform policy reforms that England may wish to consider as part of a longer-term strategy for the adult social care workforce in this country.

Key messages

Our review found that:

• Evidence from the other UK countries shows that registration and professional regulation can reduce risk to the public, improve outcomes for people drawing on social care services, improve confidence in the workforce, and can drive up workforce standards through mandatory minimum training. England is the only country in the UK that has not introduced registration and professional regulation of care workers. But the experience in Scotland and Wales also warns that it could introduce unnecessary barriers to recruitment and retention, and such a system could be costly.
• Care workers who receive relevant, high-quality training are more likely to stay in their role and be equipped with the skills and confidence to deliver better care. Mandatory minimum training, or the right to receive training, are approaches used internationally to good effect. Benefits to these approaches include improved outcomes for people drawing on services, improved confidence and status among workers, improved person-centred care, and reduced turnover. Programmes tend to be most effective when training is relevant to the role, equitable in terms of access, and sits alongside alternative routes for workers to demonstrate their skills.
• Evidence demonstrates that increasing pay to competitive wages would reduce staff turnover, particularly for staff paid at lower wage levels. Countries around the world have used a number of different routes to improve pay: Scotland and Wales are taking steps to standardise pay and increase it beyond the National Living Wage, and pay bonuses have been awarded in all three devolved countries. Germany has introduced a sector minimum wage and policymakers are seeking to implement collective wage agreements to increase and standardise wages across the country. The national pay and progression framework introduced in New Zealand has helped improve retention, and this more attractive pay scale has also attracted new starters who are male, younger, or with graduate degrees.
• The day-to-day working terms and conditions of care workers in England need urgent attention. Countries around the world have sought to address precarious employment and improve conditions in a variety of ways. New Zealand funds home care workers’ travel time and travel costs, while Germany has introduced childcare grants and additional days of annual leave. Scotland is distinct in the UK for requiring providers to take staff wellbeing into account in their staffing decisions. Other countries such as Norway and Germany offer much more generous sick pay provision.
• International experiences suggest that measures must be designed and implemented together rather than introduced in isolation. Unless reforms are designed in tandem, they are likely to have limited effectiveness, and could even risk exacerbating workforce recruitment and retention challenges. The evidence base on the impact of the different measures is still emerging, and should be closely followed. While there are many examples of positive impact, there have been a number of notable unintended consequences which can be learned from. For example, mandatory training may introduce unnecessary rigidity, making it more difficult to retain specific groups of staff. Pay increases may further minimise the difference in pay for more senior staff, and attempts to introduce guaranteed hours at a national level may not benefit all staff consistently.
• Care workers are a diverse staff group. One in four are from Black, Asian or minority ethnic backgrounds and these groups are less well represented in senior positions. Professionalising the workforce and providing consistent opportunities to access training and development opportunities could help to address inequalities in progression and earnings, and could also help attract underrepresented groups into the workforce.

Care workers are first on the front line, delivering care in precarious conditions, but last to see meaningful acknowledgement of their perseverance. Protecting the health and safety of these staff should be a longstanding priority for employers and the DHSC, and not just during a pandemic. Ensuring that pay, training, and terms and conditions better reflect the value of care work to wider society is in the public interest. A number of workforce initiatives have recently been introduced, however, and there is now an opportunity for policy-makers to go further to reverse the deepening workforce recruitment and retention crisis in England. As governments across the world are taking increasingly bold and creative action to embed workforce reforms, there is much for England to learn as it pushes forward with planned reforms while considering further action as part of a longer-term adult social care workforce strategy.