Sex discrimination at the heart of social care in Scotland

Overheard whilst visiting friends: young 5 year old boy says to mum who is struggling to get the DVD player to work, “We will need to get dad. It’s men’s work!” The stony glare from his mother highlighted for me the way in which our children’s view of the world and the roles we play in it can be so greatly influenced by gender attitudes. Brought up 5 decades ago on one level society seemed to be giving me a clear message, namely that men did the hard physical work and women did jobs such as nursing and care. Despite advances on so many fronts I’m less and less convinced that things have changed in terms of our stereotyping of roles or that we have undertaken the serious and hard work needed to address gender segregation in society. So its not surprising a 5 year old in 2017 is still demonstrating attitudes of 50 years before.

At the end of last week the media reported the result of a historic equal pay case that could potentially cost Glasgow City Council hundreds of millions of pounds. For 12 years lawyers representing more than 6000 mainly female workers fought against the city administration which had graded jobs dominated by men, such as gravediggers and refuse collectors, above those largely done by women, such as home carers and cleaners. Last week three judges at the Court of Session quashed an earlier employment tribunal ruling that the grading system met equal pay laws.

Dependent upon a settlement the ruling has huge fiscal implications for Glasgow City Council but what it also displays is the insidious acceptable face of sex discrimination that has infected the treatment of care staff over the years.

Is it acceptable in Glasgow or elsewhere that predominantly male roles, such as gravediggers or refuse collectors, however valued a role they play, are rewarded so much more than mainly female care staff?

Why is it that we value the work of those who care so little? The fact that we are paying ‘only’ the Scottish Living Wage and struggling to even achieve that – communicates its own message of limited value and respect, as does the term ‘un-skilled.’ Yet the reality couldn’t be further from the truth. Today our care staff are engaged in multi-skilled, complex, clinical care and support – and still we reward them less than those who dispose of our detritus. It’s not surprising then that staff say they are made to feel ‘worthless.’

It seems to me that the whole of society continues to demean and devalue care. Our local authorities and Integrated Joint Boards are no doubt somewhere in Scotland as I write this issuing a tender or contract whose poor restrictive terms will make it inevitable that a care provider will have no alternative but to offer staff low terms and conditions. And probably the same authority will hypocritically laud itself as a Living Wage Employer – that is to its own staff!

Added to that when you eventually do get a contract the chances are that electronic contract monitoring will make staff feel as if Big Brother is watching them every step of their day! There is a simple truth that fair contracts and commissioning lead to fair work practice.

The Tribunal ruling against Glasgow City has helped to shine a light on discriminatory practice. With a workforce which is predominantly comprised of women at some 86% I am absolutely certain that the unequal treatment, poor terms and remuneration, intrusive work monitoring and lack of trust, are in part the result of systemic sex discrimination in social care in Scotland. Would any sector or profession dominated by men have to endure such unequal treatment and abuse?

Care is a female role so clearly not as important or worthy of reward as manual masculine labour is. That’s the message we are communicating and not just to 5 year old boys. It’s time to start challenging the status of care and stop having to scrimp and robustly negotiate for financial crumbs to provide quality services and offer decent conditions for workers.

It’s just a pity that in Scotland’s social care system expensive legal cases have become the route to achieving equality and dignity for our female workforce and by extension for the thousands they care for.

Donald Macaskill (Dr)

@DrDMacaskill

Every week there seems to be yet another report highlighting the crisis state in which the health and social care workforce finds itself. We have had dire warnings about the shortage of doctors and their levels of fatigue. We’ve had the RCN stating the pressures resulting from nursing vacancies in the NHS. Scottish Care in the spring stated that 9 out of 10 care at home organisations are struggling to fill vacancies and two weeks ago we reported again on nurse vacancies running at over 1 in 4 posts lying empty and over 2/3 of care home providers struggling to fill positions. With the added pressure of Brexit, the rising Scottish Living Wage and pressure from retail and hospitality it is an operational nightmare to try to fill posts and establish an adequate workforce.

We need a fundamental review of the workforce in social care and that cannot be undertaken in isolation from a root and branch review of the whole sector. At the moment it feels as if we are lurching from one reaction to another without a coordinated and thorough review.

Policy makers declare that we need to develop a workforce to fit the needs of the future. We keep hearing about ‘new models of care’ as if there is a utopian reality where quality person centred rights based care is just waiting to be discovered offering a cheap alternative to current models. That is a naive wishful thinking that ignores that the basics of care are inherently consistent – the heart remains the same whatever the outward form of delivery. That heart requires people, namely a well-equipped, resourced, valued and skilled workforce.

We have to accept that we will never address workforce shortage by under-resourcing the care sector. How can we build stability, career pathways and a future for staff to commit to when we have organisations with no sense of sustainability due in part to one year contracts and a lack of investment in a sector which is a major player in the Scottish economy?

There are new and innovative approaches to the care workforce with the work of Highland Homecarers and the Local Cornerstone model to name but two.  Whatever the specific model for a workforce fit for the future they have some intrinsic and consistent elements:

• Autonomous frontline workers able to make decisions and supported to take action
• Self managed teams where the emphasis is on collegiality and outcomes – a sense of making a contribution that matters
• Professional respect with colleagues in other teams
• Being part of a multi-disciplinary team with clear escalation routes and an emphasis on locality and flexibility
•  Light touch oversight through proportionate regulation and appropriate levels of information recording
• An emphasis on staff physical and emotional wellbeing as critical to a healthy team
• Excellent learning and development for staff who are enabled through rota planning to learn and to develop their skills for whatever career pathway they choose
• Appropriate and rewarding terms and conditions as well as a good level of basic pay.

These are some of the ingredients which we know when they are present staff are made to feel valued and are therefore more likely to remain in their posts. Yet what we have today is light years away. What we have at present are reports which like one from Christie & Co tell us that care homes say they are “increasingly competing with supermarkets like Aldi and Lidl who are actively recruiting and offering attractive pay rates”.

Getting it right for our workforce means getting it right for those who are supported and cared for in our communities and care homes. This should be a set of jobs valued and recognised for their benefit to the whole of Scottish society.

 @DrDMacaskill