I was recently in a meeting about how to support care workers better. The meeting, which (unusually) included senior local authority staff and local care workers, was focused on developing practical ideas to better train, develop and support the care workforce. The low status of these workers was highlighted: workers reported how other professionals like GPs and district nurses can treat them with disdain, failing to recognise the detailed knowledge that they have about the person being cared for, who they may well see several times a day, much more than anyone else. This local authority is really working hard to build connections with local care workers, which is all too rare now that most care work is outsourced to the private sector.
One suggestion from the local authority was that care workers need to be recognised as a profession, albeit not a registered profession like social work, but with the status that comes from being viewed and treated as ‘a professional’. To underline this professionalism it was suggested that the care workers no longer undertake ‘domestic’ tasks (i.e. cleaning) and that a different worker be brought it to do this work. Care workers would then be free to do the care work.
This to me is pulling in exactly the wrong direction. We already have an over-specification of the tasks that certain professionals will do, leading to a succession of people coming into the home of frail people to look after a specific aspect of their support but neglecting the whole person. We also have too many hierarchies: social workers say they feel looked down on by GPs; care workers feel looked down on by social workers and district nurses. Is it really helpful to address the marginalisation of one tier of this hierarchy by adding another (the no-skill cleaner) for them to look down on?
The 21st Century Public Servant project highlighted the advantages of genericism over hyper-specialisation, because of the way that it enables more sustained and holistic support based on ongoing relationships and mutual respect. The much-heralded Buurtzorg model in the Netherlands is based on well-trained nurses doing the full gamut of home-care tasks: the medical aspects, but also putting out the washing and making connections to neighbours. It gets great outcomes for patients, evaluates well on cost-effectiveness and staff love it.
The home care workers that I spoke to at the event were themselves dubious about the suggestion that they give up doing the cleaning. They don’t want to do ‘blitz cleans’, but said they were happy to keep on top of the day to day domestic work. They didn’t feel their clients would want another person coming into their home. They also didn’t want to have work taken off them and given to someone else, probably on an even lower salary.
Hopefully that message will be heard and we won’t be solving the very real issues of the low status of care workers by creating a new strata of even more marginalised workers.