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Care Work

Current understandings and future directions in Europe

National Report, United Kingdom


Mapping of Care Services and the Care Workforce

Claire Cameron

Peter Moss

January 2001

Thomas Coram Research Unit, Institute of Education University of London



Contents ............................................................................................................................................................................ 2

Tables................................................................................................................................................................................ 3

Chapter 1 The Co ncept of Care .................................................................................................................................... 4

Chapter 1 The Concept of Care .................................................................................................................................... 4

1.1 Legislative care: children...........................................................................................4

1.2 Legislative care: adults ...............................................................................................5

1.3 Research literature: care.............................................................................................6

1.3.1 Care as in providing care or care work in the literature......................................6

1.4 Summary....................................................................................................................9

Chapter 2 Defining the Domain .................................................................................................................................10

2.1 Care work: children's day care/childcare/early childhood services .........................10

2.2 Care work: residential care for children and young people .....................................11

2.3 Care work: care for adults and older people ............................................................12

2. 4 Summary.................................................................................................................13

Chapter 3 Structures of care work..............................................................................................................................15

3.1 Role of the state........................................................................................................15

3.1.2 National government.........................................................................................15

3.1.3 Local government .............................................................................................16

3.2 Role of the voluntary sector .....................................................................................17

3.3 Role of the private, for profit sector .........................................................................17

3.4 Role of local communities .......................................................................................17

3.5 Providers of care services - the private, voluntary and public sectors .....................18

3.6 The legislative framework for care work and care services .....................................19

3.6.1 Legislation governing care work with children ................................................19

Chapter 4 Overview of Services.................................................................................................................................22

4.1. Childcare Services...................................................................................................22

4.1.2 Childcare services in the private and voluntary sectors ....................................22

4.1.3. Childcare services in the public sector .............................................................24

4.1.4 Unregulated childcare .......................................................................................26

4.1.5 Childcare services for disabled children...........................................................27

4.2 Residential services for children and young people ................................................27

4.3 Day and residential care services for adults and older people .................................30

4.3.1 Domiciliary care................................................................................................30

4.3.2 Day centres........................................................................................................30

4.3.3 Residential care .................................................................................................31

4.4. Summary.................................................................................................................32

Chapter 5 Overview of Occupations.........................................................................................................................34

5.1 Care Occupations that belong in care domain because of the major role in three

care fields .......................................................................................................................34

5.1.1 Using the LFS ...................................................................................................34

5.2 A profile of childcare workers .................................................................................36

5.2.1 Training and career structure in childcare.........................................................36

5.3 A profile of youth and residential care workers.......................................................38

5.3.1 Training and career structure in youth and residential care..............................39

5.4 A profile of workers in adult and elderly care occupations .....................................40

5.4.1 Training and career structure in adult and elder care........................................40


5.5 Summary..................................................................................................................41

Chapter 6 The Costs of Care .......................................................................................................................................42

6. 1 Total public expenditure, i.e. by all levels of government ......................................42

6.2 Public and private expenditure in different care fields ............................................42

6.2.1 Expenditure in care field 1: childcare ..............................................................42

6.1.2 Expenditure in care field 2: residential and youth services ..............................44

6.1.3 Expenditure in care work area 3: adult and elderly day and residential services


6.3 Finance .....................................................................................................................45

6.4 Proportion of working population employed in care work......................................46

Chapter 7 Collective bargaining and the role of social partners ............................................................................47

7.1 Union membership in the UK ..............................................................................47

7.2 Main trade unions and employers organisations..................................................47

7.3 Employment Conditions in care work .................................................................50

Chapter 8 Current debates and future directions ......................................................................................................52

8.1 Current debates and policy trends ............................................................................52

8.1.1 Private markets - staying power?......................................................................52

8.1.2 Quality Issues - regulation and training ............................................................53

8.1.3 Services to support families and the workforce ................................................53

8.1.4 Blurred Boundaries ...........................................................................................53

8.1.5 The workforce? .................................................................................................53

References ......................................................................................................................................................................55

Appendix One................................................................................................................................................................56

Appendix Two ...............................................................................................................................................................59

Appendix Three.............................................................................................................................................................65

Appendix Four...............................................................................................................................................................68


Table 4. 1 Children and young people looked after by placement, 2001 ..........................30

Table 4.2. Classification of services ..................................................................................32

Table 5.1: Job titles and SOC codes, with Care Work field and the services occupations

are employed in ..........................................................................................................35

Table 6.1. Net public expenditure on childcare and early education: 1998/99: England ..43

Table 6.2 Parental expenditure on childcare, term time and holidays, by age group, mean,


Table 6.4 Net public expenditure on selected services for adults and elderly people: 1999-

2000: England ............................................................................................................45

Table 7.1 Employment conditions of care workers, education workers, those in high

percent female jobs and all women workers, percent, 1997 – 1999, UK ..................51


Chapter 1 The Concept of Care

The concept of care in the English language and UK context is wide ranging in both its

content and application. Moreover, changes have occurred over time in our understanding

of the term 'care'. The etymological roots of the term 'care' in Old English referred to

anxiety, burden and concern. In Middle English, the idea of care as protection, or

responsibility was incorporated and later the sense of care as having regard or liking for

someone was introduced (Petrie, forthcoming). In addition, the Old Saxon meaning of

care was 'sorrow' (Skeat, 1958). Today we talk of 'taking care of' as taking responsibility

for another, of 'caring about' as having regard for or liking another, 'care giving' as

providing for another's needs, and 'care receiving' as recognising that responding to care

involves a dynamic relationship (Tronto, 1993).

A second source for the concept of care, that is related to the first source but is closer to

the meaning of care as work and as applied in this project, is the way the term care is

deployed in English law. This is where divisions according to age group begin, and the

meaning of care as arrangements for dependent or vulnerable people become more

specific. It is also where the tension between care and other concepts (such as protection

and/or surveillance), and other principles (such as the privacy of the family) become

more clearly articulated. So far as care for or of children is concerned the term care in law

is bound up with the term 'welfare'.

1.1 Legislative care: children

From the early 19th Century onwards, many Acts of Parliament were passed with

relevance for children. During the early period, these mostly concerned regulating the

conditions in which children were employed, the conditions in which they were

imprisoned, and access to education and other services. However, in 1872, the first Act

designed to regulate the conditions of children's lives inside domestic premises was

passed, followed by Acts in 1889 and 1908 that developed the idea of the protection of

children from harm by parents or parent figures. However, the term 'care' remains

undeveloped: it only appears in the sense of an adult taking responsibility for a child (as

in 'under the care of').

By the time of the 1948 Children Act, which was far-reaching and set the tone for

subsequent children's legislation, the meaning of the term care had become twinned with

'welfare', as in 'an act to make further provision for the care or welfare' [for children

where the parents are absent or unfit]. The sense of care as responsibility is also present,

as in the duty incumbent upon local authorities to 'receive the child into their care', but

the legislation also details care or welfare as referring to 'providing for his proper

accommodation, maintenance or upbringing', including any intervention thought

necessary 'in the interests of the welfare of the child'. So by the mid 20th century, care in

children's legislation referred to responsibility held for a child, commitment to meeting

their needs, or welfare, and even acting as a 'reasonable parent' would.


The 1948 Act was updated in the Children Act 1989. This Act reinforces the idea of a

child's welfare or their best interests as the primary principle in decisions taken by courts

about children, and elaborates on ways of supporting families where children are 'in need'

of services to assist them. It also minimises the extent to which the state can take care of

or responsibility for children and young people by introducing the concept of 'parental

responsibility' and the principle of working in partnership. In theory, the protection and

support services are then to be available at the request of parents. The meaning of 'care' is

thus changed again: the state is seen as complementary, rather than as an alternative to

parenting. Rarely can the state take total responsibility for a child and his or her

upbringing, but the ways in which the state can support a child's best interests by the

provision of care services are expanded.

1.2 Legislative care: adults

The meaning of the term 'care' in legislation for older people's care is around

arrangements for supporting and housing people when they become dependent on others

for everyday living tasks. However, the main responsibility for everyday care work with

older people has lain with family members, despite a post second world war expansion of

services for older people such as personal care, assistance with household tasks, leisure

activities and health care. The sense of care as protection or responsibility has remained

in some cases, such as care of frail mentally ill people and the option for social services

and health authorities to require an older person to attend hospital if they are endangering

themselves or others. But in general the sense in which care is deployed for this group is

around care giving, or providing for another's needs whether through marital or

neighbourly loyalty, a sense of family duty or paid work, combined with, but not

necessarily, a certain amount of caring for, or having regard for another. The concept of

empowerment, mostly through providing the conditions for independence has also

become an important part of care in recent years.

The current example of care in elder care is 'community care' legislation, with its

emphasis on both care through the market, and family care. This was introduced in the

1980s (and then entrenched in the Community Care Act 1991) as a way of reducing costs

borne by statutory sector services and of distancing the relationship between the public

sector and actual care work by encouraging the contracting out of care work to private

companies of care providers. Social services departments were given responsibility to

arrange the provision of residential care, day and domiciliary care services, including

respite care and to assess the need for such services (SSI, 2001).

The legislation also encouraged care by family members, usually women. The position

currently is care within the law for elderly people is merely regulation on health and

safety to ensure minimum conditions in services provided by private contractors - it is

responsibility at a remove, with the family entrusted with the task of ensuring quality of

care for its members.

In summary, legislation provides only a partial definition of the concept of care, as

providing a minimum safety net for vulnerable citizens, rather than articulating the full

capacity of the concept.


1.3 Research literature: care

A third source on the concept of care is the research literature. As care is found in a wide

range of situations, from family life to incarceration, involving paid and unpaid

relationships, and vertical and horizontal hierarchies, so there is a vast literature on the

subject. We are not going to consider care between parents and children here, as that is

clearly outside our remit but it is useful to remind ourselves that care is the engine of

family life (Brannen et al., 2000). But in our study we are moving beyond family life to

examine care outside families, supplementing, complementing, and replacing family care.

However, care as unpaid work attending to older people provided by spouses, daughters

or other relatives is a major source in the literature and the elaboration of the concept of

care in this domain will help make clear the extent to which it is similar to or different

from care as paid work. The following section will tease out the uses to which the term

care has been put in unpaid and paid care work literature.

1.3.1 Care as in providing care or care work in the literature.

Land (1991:11) describes care as a 'multidimensional concept and very difficult to

define'. It is a set of tasks, but also a relationship. She describes the tasks as 'servicing' the

needs of others. Balbo (1987:52, quoted in Land, 1991) elaborates: 'being there to wait, to

listen, to respond, to attend to the needs and desires of others; to worry when difficulties

are anticipated, to deal with one's own sense of guilt when problems are not successfully

resolved: this is servicing'. The implications of this care work, Land argues, are not only

time intensive work, but also fragmented time for the carer. This is equally applicable to

the mother who cares for young children and fits work (or life) around children's hours,

as it is for the carer for an elderly relative.

Abel and Nelson (1990) summarised the development of feminist theorising of care work

to that point. They noted that the concept developed with recognition of the gender of

carers: caregiving was overwhelmingly associated with women, whether for children,

elders or as paid care workers. They argued that feminist work on caregiving challenged

established dichotomies such as autonomy/nurturance; reason/emotion; public/private.

For example, Gilligan (1982) argued that caregiving is essentially relational, requires

self-integrity, and fosters independence in others. These qualities of caring or nurturing

another promote maturity, decision making and autonomy in the carer. On the second

dichotomy, Waerness (1983) argued that reasoning and emotion are combined in the

caregiver to produce a 'rationality of caring': they 'apply knowledge gained through the

intimate understanding of a particular individual' (Abel and Nelson, 1990:5). Care work

also transcends the public/private dichotomy as it applies across both the public arena and

the domestic domain, each shaping the other. Indeed, community care, where families

buy in services from each other or private companies, funded by the state, show a whole

mix of public/private relationships.

Abel and Nelson argued that care work has to be understood in the context in which it

occurs. There are similarities between paid and unpaid care work in that 'most caregivers

are members of subordinate groups who provide care from compulsion and obligation as

well as warmth and concern' (Abel and Nelson, 1990:7). So far as care work within

formal organizations is concerned, Abel and Nelson point to an absence of research on


the meaning of care work for the workers, but an acknowledgement that for many the

'emotional labour' involved is the main source of satisfaction in the work. The authors

also point to a potential source of tension between the time efficient demands of

bureaucracies and the time engaging, interpersonal, unpredictable demands of care work

(ibid.,1990: 12-13).

Fisher and Tronto (1990) defined care as 'a species activity that includes everything we

do to maintain, continue and repair our "world" so that we can live in it as well as

possible. That world includes our bodies our selves and our environment all of which we

seek to interweave in a complex life sustaining web' (Fisher and Tronto, 1990:40). For

them, caring has four intertwining element: caring about (or maintenance, knowledge),

taking care of (assuming responsibility), caregiving (commitment, adaptability) and carereceiving

(responsiveness). Caring is also a practice involving certain ability factors:

time, material resources, knowledge and skill.

Care has also been understood to have an ethical dimension. Waerness (1997), for

example, proposes that good care can be understood as a moral issue, where neither the

clinet nor the care worker can be treated as objects. Fisher and Tronto (1990) suggest that

each of their four elements of care has an ethical dimension, with value attached to

responsibility, competence, responsiveness and integrity. Tronto (1993) has further

developed the concept of an ethics of care, in which care is regarded as “a practice rather

than a set of rules or principles…It involves particular acts of caring and a ‘general habit

of mind’ to care that should inform all aspects of moral life” (127).

Another conceptualisation of care that has emerged in recent years in the academic

literature is ‘social care’. Daly and Lewis (1997) foreground three dimensions of this

‘multi-dimensional concept’: care as labour; care taking place within a normative

framework of obligations and responsibilities; and care as an activity with costs. In sum,

social care can be defined as the activities involved in meeting the physical and emotional

requirements of dependent adults and children, and the normative, cost and social

frameworks within which this work is assigned and carried out” (6). It is also argued that

this concept of social care overcomes the fragmented way in which the concept of care is

often used, with dichotomies often assumed between, for example, formal and informal

care and the care of children and adults (Daly and Lewis, 1997; Kroger, 2001).

From a perspective informed by health research, Hugman, Peelo and Soothill, (1997)

argued that care and caring work is a marker of civilised life. It is also an embedded

common sense term and a key element in the construction and reconstruction of

contemporary identities. The welfare state in western societies has been defined and

expanded on the basis of care services. In addition, the recent restructuring of welfare

states has recognised the plurality of stakeholders in the definition and practice of caring.

Turning to care work itself, the authors point to some possible distinctions between paid

and unpaid care work. Those who are employed to do caring work do not necessarily

have an emotional or intellectual commitment to the person cared for: the distinction

between caring for (responsibility) and caring about (warmth or affection) is evident here.


A definition of the caring professions is proffered: 'someone who through their skilled

and knowledgeable practice demonstrates commitment to the person and to the goal of

helping' (Hugman et al., 1997:10). This combination is expected to transcend work

conditions and duty and is a vocation, which cannot be bought as goodwill expresses

caring. There is also the notion of a 'duty of care' for agencies: statutory duties to fulfil

and procedural correctness, which delineate areas of responsibility for professionals and

assume client groups to be without responsibility (ibid., 1997:11).

In an interesting study of giving and receiving the personal care of bathing, Julia Twigg

(2000) argued that there are clear differences between paid care work and care by kin in

terms of the kind of social relations developed, the kind of work that is permissible and

the kinds of boundaries that exist. More specifically, home care workers can develop a

warm friendship with a client, with clear arrangements for access to and privacy from

certain parts of the clients' lives. Seeing carework as work helps to see it in terms of other

forms of employment in human services: there are close parallels between home care and

nursing, for example.

So far as care within residential care for children is concerned, much more research

attention has been paid to organisational dimensions and the outcomes for residents than

to analysis of the social relations dimension of 'care' within the staff's role (eg., Brown,

Bullock, Hobson and Little, 1998; Sinclair and Gibbs, 1996; Frost, Mills and Stein,

1998). Where analysis of the role of care workers has taken place, the residential care

task is seen as in the same domain as social work, rather than other kinds of childcare.

Millham, Bullock and Hosie (1980) outlined three roles for the care worker in residential

care: instrumental roles; expressive roles; and organisational roles. Instrumental roles are

about building skills with clients, and organisational roles are about the maintenance of

the service. In relation to expressive roles, the authors say that 'relationships pursued by

residential workers … are expected to be far less affectively neutral [than those with

social workers] and premium is given to emotional warmth and pastoral oversight'

(Millham et al., 1980:24). Davies (1995) argued that care work within residential care

follows similar principles and holds similar values to social work, including respect for

the young person, fostering independence, promoting individual uniqueness, nonpaternalism,

and self-actualisation and freedom. Thus in residential care literature, the

'care' is seen in the context of the kinds of (problem) backgrounds the 'clients' bring to the

care setting, rather than their age, or filial relationship.

Recently, the UK government has issued a consultation document about national

minimum standards in residential care for children and young people (SSI, 2001). In the

chapter on the Quality of Care, there are standards for children's participation, respect for

privacy, children's involvement in preparing nutritious meals, children's personal

appearance, health care, treatment of medicines, education, and leisure activities. There is

no elaboration on the kind of kinds of caring relationships children and young people can

expect with members of staff in residential care, suggesting that for policy, 'care' is used

in a limited sense as an instrumental term, describing how an administration is to fulfil a



Finally, the concept of care for people who work with people with disabilities has in

recent years become much less paternalistic and much more about empowerment than in

previous eras. Again in tandem with developments in social work, care work with this

group is about encouraging independence and individuality.

1.4 Summary

Care as a concept is holistic in that it is concerned with the whole person, and it is

relational, as it depends on two parties. It refers to responsibility adopted for another, and

commitment to their well-being. Providing good quality care usually involves 'emotional

labour' - that is, giving of the self within social relations. We have found the four distinct

elements of care identified by Fisher and Tronto (1990) to be particularly helpful, and

will return to these in later sections: caring about, taking care of, caregiving and carereceiving.

One of the reasons that defining the concept of care, and using care as an

overall term of reference is difficult is that attempts to understand care have been very

tied to the context in which it takes place, which encourages a perception of 'care' within

various care services, and care by kin, as being very different.

But it is also true to say that care is context-dependent, as care within families,

neighbours, care services in the private ma rket, or in public bureaucracies do all differ.

Location, status, legislative support, and individual approach will all affect the way care

is delivered and received. Understanding paid care work requires an understanding of

family care work and informal care work on the one hand and the services on the

boundaries of care on the other: health, education, play, social work. In some cases, as in

residential care for children, there is a merge of social work and care work. Care work is

shaped by the gender of the care workers and women dominate every care work

occupation in the UK as we shall see in later chapters. Models of care that derive from

the gendered division of labour in families can be seen in many care work occupations.

Using definitions explored above, care is found everywhere, and it is a basic tenet of

human relations in our society. Furthermore, care work, the effort, rewards and labour of

care whether as a parent, child, friend, neighbour, relation, volunteer or worker is

normatively rewarding. The organisation of care work into paid care work covers

children, young people, older and disabled people in a range of community and

institutional settings, attending to everyday needs, for a range of reasons: childcare, out of

school care, foster care, residential care, home care for those with disabilities or who are

frail and elderly. However, as we will see, there has been a growing trend in UK policy to

see care work as instrumental, a series of technical services that can be measured and

accounted for, packaged and parcelled out. Whether there is any tension between this

kind of policy and care practice will be a subject for our study.


Chapter 2 Defining the Domain

We can think of the care domain as those occupations and services that exist to service

everyday needs for maintenance and wellbeing of individuals and groups. Care typically

uses the relationship between carer and cared as a key vehicle for care work -

conversation helps establish the trust necessary to use this relationship to help another

achieve their goals, whether it is a child trying to manoeuvre a truck through sand or an

elderly person trying to put on their support stockings.

However, in the UK the care domain is largely obscured by other domains that border

and overlap with care. Care is seen as existing alongside education for preschool aged

and to a lesser extent school aged children, and alongside health in services for older

people. Care is a part of play work, but not the sum of play work in out of school

services. Within social work, care exists alongside measures to control the actions of

families who neglect children, for example, and to protect the lives of children from

significant harm from some parents. Social work also identifies care services such as

foster care for its clients, but these services may have additional responsibilities that go

beyond maintenance and may be specific therapeutic interventions such as family work.

As a result few occupations are solely 'care work' but many occupations and services

have an element of care within them. In addition, the realm of care work is not set in

stone but shifts with policy changes, so some occupations may be considered care work

in one era become health care in another era.

Nevertheless we can identify areas of work and services to which the term 'care' is

applicable. For example, 'childcare' (one word) services cover services for care and

education both before and around the school day, and 'child care' (two words) services

include residential services for children and young people such as foster care and

residential care. There are also day and residential care services for disabled and elderly

adults. Many job titles include the term 'carer' both within and beyond these areas of

work. It is also important to note that in terms of policy, there are two explicit care areas:

social care and childcare. Childcare broadly matches the 'childcare' services mentioned

above while 'social care' covers a whole range of non-education, non-health, nonchildcare

services for children and for adults. Each care work area has neighbouring

fields or related services that border onto it, but care work is not so central to it. At the

same time, the relationship between the care domain and other domains is provisional,

with the policy gaze continually examining the borders and overlaps of policy areas.

2.1 Care work: children's day care/childcare/early childhood services

In the UK, we can discern childcare services for children up to the age of 14 as the first

care work area. These are services mainly for children while their parents work or study,

which may take place in the parents’ own home, in the carer’s own home or in

institutions1. They embrace care, education and play as the main purposes of the services.

A commonly used phrase to refer to these services was 'early childhood services', to

1 See Chapter 7, for full list of services/occupations.


avoid a specific focus on one of the three purposes, but indicate inclusivity. But the

definition of 'early childhood' has had to be stretched perhaps untenably with the advent

of the Nationa l Childcare Strategy, which identifies 14 years as the upper age limit for

this policy initiative on childcare services. In addition, the title has an uncomfortable

relationship with 'early education' services2.

There is a clear overlap between childcare and the place of schools in this care work

domain. There are two main ways in which schools have done care work. First, they have

pastoral care responsibilities for their children, which is a generalised responsibility for

wellbeing and to identify any major problems for children. Second, many schools employ

non-teaching staff who traditionally had a childcare training, to work alongside teachers

in classes for younger children, or in classes where some children had particular needs.

Recently, policy attention is increasingly shifting to view schools as potential sites for

care services, such as nurseries, after school services and breakfast clubs (as well as for

other services including social work and health). New concepts of the school are

emerging, labe lled ‘new community schools’ in Scotland and 'extended schools' in


But the overlap is not just schools doing care work. Care settings are also asked to deliver

an 'educational' curriculum. ‘Childcare services’ in the private sector meeting certain

requirements may receive a ‘nursery education grant’ to provide early education to 3 and

4 year olds. A national curriculum for children aged 3 - 5 (the Foundation Stage in

England, linked to specific early learning goals) is applicable across these childcare

settings, as well as in schools. Care workers, therefore, are asked to consider themselves

educators as well as carers.

There are also overlaps between childcare and play services. Play work offers a distinct

form of service that focuses on childrens' self expression through play. This can be found

in a range of services such as before and after school clubs, holiday play schemes,

adventure playgrounds and similar leisure schemes. There can be a tension between care

and play: many services exist in order to support parents' working and so take full

responsibility for children attending; others are free access schemes that by definition do

not supervise children's attendance (they cannot stop a child leaving). The National

Childcare Strategy endorses the first kind of scheme but leaves the second in a more

ambiguous position. In addition, the emphasis in play on self-expression and freedom to

choose can come into conflict with the tendency within care to anticipate and meet

perceived children's needs. However, play is still an embryonic profession, with

relatively few trained workers, so actual practice varies enormously and many people in

play work will have childcare qualifications, thus further blurring the boundaries in


2.2 Care work: residential care for children and young people

The second main area of care work is residential services for children and young people.

These are services and occupations that exist to provide alternative accommodation for

2 The National Childcare Strategy was designed to improve services that support parental employment,

rather than examine the whole range of care and education services that children might access.


children and young people when their own parents cannot provide an adequate home or

when a break from parental care is necessary on a temporary basis. The main form is

foster care with individuals or families on a temporary or long-term basis. This is a clear

example of care work - of maintenance, continuance and repair of wellbeing. But, as

indicated above, some foster carers may undertake additional training or be asked to

complete specific intervention tasks such as compiling a life history book with a child, or

talking to them about their possibly unhappy childhood experiences. Similarly there are

adoptive families who plan to adopt a child on a permanent basis and who are paid in the

initial phases prior to the adoption order being made.

Other care services in this area are residential institutions where children or young people

can stay for shorter or longer periods for respite or as a preparation for foster care or

adoption. Some children may stay for several years in residential care, but policy and

practice is directed away from this. Also in this care work area are care workers attached

to supported housing for young people either leaving care or otherwise requiring

additional support before being able to cope on their own. Finally, there are hospices for

children who are terminally ill and institutions for children who are disabled.

The workers in these kinds of institutions can be residential social workers, teachers,

nurses, counsellors, care assistants and support workers. Some residential social workers

and support workers will have a social work or similar training; nurses, teachers and

counsellors will usually be qualified. But many workers will not have an appropriate


2.3 Care work: care for adults and older people

A third care work area is day care for elderly and/or disabled people. Services in this

care work area take place in people's homes and in institutions, with the emphasis being

very much on supporting people to live independently and empowerment through a

policy of 'community care'. The purpose of the Community Care Reforms of 1993 was to

enable more people to continue to live in their own homes as independently as possible

(DH, 2001c). Community care largely means encouraging and sometimes paying for

family members and volunteers (usually women) to provide care for people who would

otherwise require care in an institution. The main arena of paid care work is home helps,

now known as home carers, who provide personal assistance such as bathing as well as

household tasks and to a lesser extent shopping. Home care is an area of shifting tasks

and an overlap with health care - home carers are now more likely to perform health

related tasks that were traditionally the remit of district nurses. There are also day centres,

for social and leisure activities, and which provide a location for more specific services

such as occupational therapy.

There are areas of overlap here with informal care, paid volunteering and personal

assistants. Informal care accounts for the majority of care work for elderly and/or

disabled people (as well as most care for preschool aged children). This is care provided

by family members, often daughters or daughters-in-law, to maintain relatives in their

own homes. As such it is unpaid, derives from models of family caring and is subject to


the social relations of families rather than of paid work. Paid volunteering schemes are

designed to financially reward people who volunteer to help an older or disabled person

with daily living tasks, and/or develop a relationship which may be rewarding for them

both. The extent of pay is very varied but usually not high.

Recently, 'cash for care' schemes have been developed which are a hybrid between paid

care work and family care. In essence, the disabled or older person is given a grant by the

state to pay a carer – a personal assistant - to provide for their care needs. Personal

assistants are paid by disabled people to be their 'arms and legs' or 'ears and eyes' in order

that they can live in their own homes. The person they pay can be a family member, or

neighbour, or someone previously unknown to them and recruited to do this work. The

idea is that this empowers the cared for person to make choices that suit them, rather than

having experts decide on appropriate care. But concerns have been voiced that the

arrangement can become a form of domestic service, in which the personal assistant is

vulnerable to poor conditions and exploitation - an inversion of the classic power

dynamic in care work. The boundaries around kin care and care work are thrown into

sharp relief with this practice 3.

Finally, there are residential services for elderly and/or disabled people. Again the

emphasis is on promoting independent functioning wherever the older or disabled person

is resident. There are general ‘residential homes’ for older people in need of fairly

constant assistance with daily living and more specific ‘nursing homes’ for people with

chronic medical conditions. A serious problem in the UK is the use of hospital beds to

care for older people who, from a medical point of view, could be discharged but who

need such a level of care that they are not able to go home. A recent joint health and

social care initiative - 'intermediate and rehabilitation for older people' – seeks to develop

'holding' situations for such older people until permanent plans are made for them, rather

than staying in hospital.

The work of these homes is about maintenance and enhancing the quality of life for

residents, and the main means of achieving this is through encouraging independent

functioning, and so improving self-esteem. As such these institutions are clear sites of

care work: they employ care assistants. More specific institutions bordering on care work

are hospices, which offer both respite and longer term care for people who are dying, and

employ nurses and counsellors as well as care staff, and nursing homes.

Nursing homes, as the name implies, employ nursing staff and nursing auxiliaries, and

cater for people with severe long-term medical conditions. The roles of care assistants,

working in residential homes, and nursing auxiliaries probably do not differ greatly.

2. 4 Summary

The care domain in the UK is broadly defined and diffuse: many professional disciplines

overlap with or border on care work. Care work has mainly developed in the post war era

to address evolving expectations of the realm of care work: no longer sufficient to

3 The social relations that result from this arrangement are the subject of an ongoing cross-national research

study in the UK by Clare Ungerson and Sue Yeandle.


protect, remove or institutionalise, care work is now about maintaining and improving the

quality of life an individual can expect, whatever their particular condition. Alongside the

intention to maintain and improve there is also an emphasis on citizen's rights and

accountability: a patronising 'caring for' or 'taking care of' is no longer acceptable. The

social ideal is of prolonging, regaining or working towards 'independent living'. This is

pursued through the concept of 'empowerment', and promotes the idea of being able to

make choices about one's care rather than expecting 'experts' to deliver appropriate care.

In this respect it is possible to see care work as absorbing contemporary ideas about the

primacy of the 'autonomous individual' in advanced liberal societies, willing and able to

assume responsibility for managing his or her own life and risks.

The care domain in the UK is also characterised by diverse arrangements for the funding

and provision of care, and it is to this that we turn next.


Chapter 3 Structures of care work

This chapter will examine how responsibility for care work services and occupations is

divided between different layers of central, regional and local government, and between

the public and private sectors.

3.1 Role of the state

The UK is made up of four countries: England, Scotland, Wales and Northern Ireland.

Although there is national legislation that applies across all four countries, each country

has varying levels of devolved powers for social policy. England, Scotland and Northern

Ireland have the power to enact legislation in all service areas such as health, social care

and education. For example, the Scottish Executive has, since its inception in 1998,

developed a distinct social policy compared to England, with different policies on such

matters as higher education, funding for long term care for the elderly and pay and

conditions of teachers. In addition each country is divided into local authorities, which

have responsibility to implement legislation and some discretion to interpret legislation.

3.1.2 National government

Two main trends are discernible in the role of national government. First to withdraw the

public sector from direct provision, and to rely on the market and private organisations to

provide new services. In the case of childcare, identified by the Treasury as a critical area

of service development for economic success, the government will intervene when there

is 'market failure'. This could be either through subsidising the cost of childcare to parents

(the Working Families Tax Credit), or through supporting the development of provision

in certain economically deprived areas (the Neighbourhood Nurseries Initiative). All the

other areas of care work are heading in a similar direction, with pressure on local

authorities to use privately run services rather than develop their own services. Having

said this, most local authorities retain a number of their own services. For example, two

thirds of places in residential care homes for children and young people are in the public

sector (EO/IDeA, 1999).

The second government trend is to control the way services develop, both through

managing local authorities and regulating the private market. For example, there are

'targets' at all levels of central and local government about all aspects of the development

of services, from the spending of government departments to the kinds of staff to be

recruited to the achievements of young children in primary schools. Another example is

the introduction of prescriptive curricula for children in the Foundation Stage and

throughout primary school. Streams of funding have multiplied, again as a control

mechanism: it has been estimated, for example, that there are over 40 streams of funding

for childcare services. There are inspectorates for services: in England for example there

is the Office for Standards in Education (OFSTED) for schools and childcare services,

and the Social Services Inspectorate (SSI) for social care services. The government also

publishes league tables of schools, hospitals and social services departments in order to

measure the progress of institutions and authorities against one another and to introduce

corrective measures to those that are said to have weaknesses.


Another example of governmental control is the introduction of a new 'infrastructure for

quality' in social care that involves four bodies: the Social Services Inspectorate, which

inspects and reviews performance of local authorities; the National Standards Care

Commission, which will regulate provision in the independent sector and ensure services

work to common standards across the country; the General Social Care Council, which

will regulate the workforce and their training; and the Social Care Institute for

Excellence, which will aim to create a knowledge base about what works in social care

(SSI, 2001)4.

Within this market/control dual approach, the roles of national government also include:

issuing detailed guidance on the implementation of legislation 5 that steers local

authorities and providers in a desired direction and on issues arising with existing

legislation sometimes as a result of court cases (for example, a case on smacking a child

resulted in guidance from the government); identifying, supporting and disseminating

what it considers to be relevant research; establishing and funding local area early years

development and childcare partnerships (EYDCPs); and establishing national training

organisations to develop training in various care work sectors.

Responsibility for care services at national level is divided. Childcare services, for

children from 0 to 14 years, are the responsibility of the Education Departments in

England and Scotland, responsibility having been transferred from welfare in 1998. Child

care services (e.g. residential care for children and young people) together with care of

elderly people and people with disabilities resides with the Department of Health in

England. In Scotland, child care services are now located within the Scottish Executive

Education Department, along with other social work services for children and families,

but care services for adults are located within the Department for Health.

3.1.3 Local government

The main unit of local government across all regions is local authorities. There are 150

local authorities in England, 22 in Wales, 36 in Scotland and 26 in Northern Ireland.

The role of local authorities is to implement national legislation, interpreting it according

to local needs. So far as care and related services are concerned, local authorities are

responsible for education (local education authorities or LEAs are responsible for central

services supplied to schools, most schools now being more or less self-governing) and

social services (social workers, some day care and residential care institutions, some

domicilary care (home carers), supporting foster carers and adoptive families and so on).

Local authorities are also responsible for housing (some supported housing schemes,

although mostly these are situated within the voluntary sector) and leisure facilities (some

play schemes, services for the elderly).

4 In Scotland similar plans are being made under the Regulation of Care (Scotland) Act 2001. The Scottish

Care Commission will undertake the regulation of care services for young children (rather than OFSTED).

5 Guidance and regulations are issued by the government to provide a statement of the requirements placed

on local authorities by the legislation.


The emphasis on privatisation outlined above means the trend is towards the local

authority acting as an planner and/or regulator rather than providing care services itself.

Local authorities have a strategic and co-ordinating role in many areas of care work, such

as encouraging the development of childcare through the EYDCPs and the joint heath

and social care approaches to residential care for older people.

3.2 Role of the voluntary sector

The voluntary (private not for profit) sector has always had a significant role in the

provision of care and we lfare services in the UK. This is particularly the case in housing,

but also in family and children's care services where large national organisations such as

the National Society for the Prvention of Cruelty to Children, Barnado's, the Children’s

Society, NCH Action for Children, Save the Children and Home Start play an important

role. These are all voluntary societies with a long history of both running services and

developing innovative ways of working. There are also many voluntary organisations

operating on a smaller scale, providing a wide range of services often within a particular


In the last two decades voluntary sector services have been seen as preferable providers

of care to the public sector with possibly adverse implications for their continued ability

to innovate and 'lead the field' in ways of working with children and families. The

voluntary sector is also responsible for many advice, leisure and residential care services

for older people and for people with disabilities of many kinds.

3.3 Role of the private, for profit sector

The role of the private for profit sector in providing care services has grown considerably

in the last ten years. Made up primarily of small employers, this sector now provides the

majority of home care services and residential care places for the elderly, and about a

third of residential care places for young people. There is also a trend for private

companies to recruit train and support foster carers. The private for profit sector runs

around three quarters of nurseries for preschool age children and a proportion of after

school clubs and holiday play schemes. The sector is represented by national

organisations such as the National Day Nurseries Association, which has local branches.

Employers training interests are represented on government-initiated sectoral training

organisations. Private providers are also represented on local EYDCPs, organisations

charged with the development of early education and childcare services.

3.4 Role of local communities

Local communities have also had an historic role in shaping the direction of local

services. This occurs through the democratic process of voting party political councillors

onto local councils which then take strategic decisions in relation to the development or

not of local services. Sometimes local councils use the planning system to permit or deny

proposed developments or insert conditions into developments: one example of this

might be an insistence on childcare places alongside the development of a supermarket.


It also occurs through community action groups of various kinds that can form in relation

to a specific initiative that is wanted or not wanted and lobby councillors or other

political representatives such as Members of Parliament. This kind of lobbying is

historically most likely to happen in relation to the development of childcare services, as

addressing the poor availability of childcare was not really a national policy issue until

the Labour government came to power in 1997. In some cases, community action led to

the formation of services, such as the Children's Centre in Sheffield, which is now

praised as a centre of excellence in childcare - an Early Excellence Centre. However,

there have also been instances of local communities objecting to the siting of some care

and welfare services in residential neighbourhoods, so local communities are not always

supportive of the practical development of services even when they applaud the existence

of services to support their own needs.

3.5 Providers of care services - the private, voluntary and public sectors

As will be apparent from the above discussion, providers of formal care services are

situated in the private, voluntary and public sectors. Even this three-way division does

not capture all providers. For example, within the voluntary sector there are self -help

groups who develop and run provision such as playgroups; workers' co-operatives who

develop and run services such as day nurseries; and large scale voluntary agencies who

have a developed infrastructure and run numerous services, such as family centres,

residential care, foster care support services and so on. The division is further

complicated by the fact that there is no neat division of the care work sector by type of

provider: within each care work area there are providers from all three types, albeit with

varying proportions of care services within one type or another. The table below

summarises the proportionate use of different kinds of providers in the care work domain.

Table 1. Approximate total and percentage of services by provider type, England

Total n Public sector Voluntary


Private sector total

Day nurseries 7,800 6 94 100

Family centres 430 75 25 100

Playgroups 14,000 100 100

Schools 2 58 37 95

Nannies N/a 100 100

Childminders 72,300 3 100 100

After school clubs 4,900





Residential homes

and schools

1,46 59 19 22 100

Bail hostels and

supported accom

Hospices 21 100 100


care for


and young


Foster care 100 100

Day centres Information



Day and


care for



Home care 44 56 100


Residential and

nursing homes

30,700 8 92 100






Homes for disabled






Hospices 200 25 75 100

1 Voluntary and private providers are also known as 'independent', which combines the two types of


2 Schools refers to school based provision for three and four year olds in nursery schools and classes, and

infant classes in primary schools. Also to private and voluntary providers, and places in independent

schools. These figures refer to percentage of age group placed in the service(s).

3 Some childminders are employed by local authorities: in 2001 310 children had places with such

childminders. In addition to the information presented, local authorities also 'placed and paid for' 13,300

places in voluntary day nurseries and 11,500 places in playgroups and preschools.

Sources: DH, 2001; DfES, 2001a; DfES b; DH, 2001c; DH 2001d

This table shows that the majority of care services, whether for adults or children, are

located in the private and voluntary sector. The public sector has retained a major ity

interest in care work that clearly lies in the realm of 'welfare' (family centres, residential

care), and that overlaps with 'education' (nursery schools and classes). All other services

are either being developed in the private and voluntary sector or have been transferred to

it by deliberate policy effort.

3.6 The legislative framework for care work and care services

The first chapter set out an historical perspective on how legislation defines 'care'. Here

we will set out the main principles of the main Acts of Parliament that govern care work

and the provision of care services as defined in this project.

3.6.1 Legislation governing care work with children

The Children Act 1989 is an overarching piece of legislation that governs legal

provisions and services for children including private (family) law and public law (the

exception is adoption services). This means that options open to the court in divorce

cases are equally available in public law cases. The legislation covers England and

Wales: separate legislation for Scotland was passed in 1995.

The aims of the Act were to:

·  strengthen parenthood with reference to rights and responsibilities;

·  support parents with provision of certain services;

·  limit the use of courts to those cases where means of obtaining collaboration or

partnership have failed; and

·  provide a legal framework with overarching principles and a menu of court orders

available across all jurisdictions (DH, 1989, 1.4; 1.7; 1.6; 1.1, quoted from Cameron,



Specifically, the 'we lfare principle' is important: where a child comes before a court, their

welfare or best interests are the paramount consideration of the court when reaching a

decision. In other words the overriding purpose of the Act is to promote and safeguard

the welfare of children (DH, 1989:1.20).

However, although a child's welfare is paramount in some cases, the Children Act 1989

does not guarantee access to services for all children. The provision of children's

services, such as childcare, is governed by a section of the Act (s.17) that limits public

responsibility to children defined as 'in need' due to actual or likely impairment of health

or development. This includes disabled children. Studies of the implementation of the Act

showed that most local authorities interpreted ‘in need’ to mean those children who have

been, or at clear risk of being abused or neglected, rather than adopting a broader

perspective that included parental employment or study, or children as citizens with

rights to access services (Cameron, 1997).

Responsibility for providing childcare services for other children therefore remains with

their parents, mainly through using the private market in such services. The Act, in Part

X, does however confirm the State’s responsibility to regulate this market, through

applying standards and an inspection regime. The legislation led to the implementation of

an updated regulatory regime (recently, a new regulatory regime has been introduced

which transfers responsibility for regulating childcare services in England and Wales to

the body that inspects schools – OFSTED).

The Children Act also provides a regulatory framework for private foster care, registered

children's homes for three or more children, voluntary homes, foster care and some

aspects of independent schools.

In sum the Act covers: legal principles governing all cases brought before courts; a menu

of court orders available to the courts, with implications for practice in social work

agencies; criteria for access to publicly funded services; regulations for the provision of

care services for children and young people situated in the private and voluntary sector.

Amendments to the Children Act 1989 have been enacted. Recent changes include: the

Care Standards Act 2000, which introduced cha nges to the scope and methods of

regulation of residential and day care services; the Children (Leaving Care) Act 2000,

which imposed new duties on local authorities in respect of young people who have left

the care of the local authority; the Carers and Disabled Children Act 2000, which

introduced a system of direct payments to enable those with parental responsibility for a

disabled child to arrange for care services; and the Criminal Justice and Courts Services

Act 2000, which changed arrangements for the representation of children in court

procedures and established the Children and Family Care Advisory Service.

For adults and elderly people the legislative framework is set by the Community Care Act

1991. As stated above (p5) this Act gave responsibility for residential care to local

authority social services departments (it had previously been divided between health

authorities and local authorities). Local authorities have a duty to assess a person's need


for care services and arrange for that care to be provided (often known as a 'care


The Care Standards Act 2000 also requires all domiciliary agencies providing home care

to be inspected by the National Care Standards Commission to 'ensure that the services

these people experience are of a proper standard' (Health Minister Jacqui Smith, 2001,

Community Care 6 November).


Chapter 4 Overview of Services

4.1. Childcare Services

There are two main purposes of childcare services: care of children to facilitate parental

employment and education of children through the curriculum. Most childcare services

are situated in the private and voluntary sectors: those in the public sector are either

designed for children whose health and development would be impaired without such

services, or are for short spells of school based education.

4.1.2 Childcare services in the private and voluntary sectors

Childcare services in this sector have expanded rapidly in the last decade or so and the

profile of services has changed. Most importantly, the volume of day nurseries in the

private and voluntary sector has increased markedly (7,800 nurseries in England in 2001,

DfES, 2001a). Most (73 percent) day nurseries are privately owned and managed, either

by a single owner or by a chain of nurseries. The remaining nurseries were run by a

voluntary management committee (7 percent); a college of further education (6 percent);

a workplace nursery (4 percent); or were jointly managed, which might be a partnership

agreement between two bodies (not including a local authority, 5 percent, including a

local authority, 2 percent) (Cameron, Moss and Owen, 2001).

These nurseries cater on average for 44 children, who are most likely to be aged two and

three. Fewer nurseries cater for the younger age group, and many four year olds are in

school (see below). Approaching half of nurseries also provide additional services such

as out of school services and nearly all offer places to children with special needs (ibid.).

Most nurseries are open from 8 am to 6pm. Approximately 62,400 managers and

childcare and education staff work in day nurseries and they cater for approximately

343,200 children6.

In 2001 there were 72,300 childminders (DfES, 2001a), who offer full or part-time family

day care in their own home. Childminders have a long history in the UK, they were first

developed in areas of high female employment during the 19th Century as places where

mothers could leave their children to be 'minded'. Legislation to regulate the homes and

the individuals was first introduced in 1872, and subsequently in 1908, 1948, amended in

1968 and in the Children Act 1989. The basic tenet of the legislation, that of 'suitable

premises and persons' has remained throughout. The local authority has a duty to register

and inspect childminder's homes, although until the 1989 Act, the coverage and

effectiveness of regulation was much disputed.

6 No statistics on total staff numbers are kept but the average day nursery has eight staff. Total calculated

by multiplying the number of nurseries (7,800) by 8. Figures for the number of children were calculated by

multiplying the average number of children attending (44) by the number of nurseries.


The vast majority of childminders care for children whose parents pay fees directly to

them, but a few local authorities have employed childminders directly (catering for only

310 children in 2001). Most local authorities pay, where appropriate, for children in need

to be cared for by childminders, under an arrangement known as 'placed and paid for'

(3,400 children in 2001). In recent years there has been a decrease in the number of

childminders (30 percent fewer between 1996 and 2001). There also tends to be a high

turnover of childminders. The most common pattern is for childminders to begin their

work when their own children are young and they are themselves not employed in the

labour market, and they tend to leave the work when their youngest child begins school.

It is seen as a job that fits around the needs of family and one that offers the opportunity

to be at home and earn an income (Mooney, Knight, Moss and Owen, 2001).

Childminders each cater for an average of 3.5 children, making a total of 253,050 places

in family day care.

Playgroups/preschools provide sessional care and education for children aged 2 ½ to 4

years. They were developed in the 1960s as a response to the lack of nursery education

in the state sector initially as part of the self-help voluntary sector. Parent management

committees manage most playgroups or preschools as they are often now known,

although in recent years there seems to be an increase in privately run provision. The

volume of sessional playgroups is decreasing. There are now 14,000 playgroups, 22

percent fewer groups than at the peak in 1990 (DfES, 2001a). Playgroups provide a total

of 330,200 places, although more children a ttend as many children attend for only two or

three sessions a week (Brophy, Statham and Moss, 1992). Therecent decline in numbers

of playgroups may be a result of an increase in state funded nursery education, and

parents tend to prefer the latter service (HMSO, 1994). Playgroups also cater for children

in need, and in 2001 cared for 11,500 such children.

Playgroups/preschools attach particular importance to parental involvement, and typically

require parents to help with sessions on a rota basis. This, and the fact that sessions are

usually only 2 - 3 hours long, makes this service generally unsuited to families where

parents are employed outside the home, unless extra help is employed. The future of

playgroups seems to be at a crossroads. Recent changes to the requirements of childcare

services may lead to playgroups developing longer hours or otherwise developing more

flexible services. However, other changes leading to a formalisation of the curriculum for

young children (the 'early learning goals') and environment (inspection through

OFSTED), may mean that the numbers of playgroups continues to fall: it is increasingly

difficult to find playgroup workers who will accept very low wages and increasingly

formal demands on top of the time with children.

These three services are legally required to be registered and inspected, with

responsibility for this task passing in 2001 from local authorities to national bodies (e.g.

OFSTED in England). Together, they provide the bulk of childcare places for preschool

aged children – which in the UK means below compulsory school age of 5 years. Figure1

illustrates the changes in volume of the three main services over the period 1993 – 2001.


Source: DfES (2001) Children's Day Care facilities at 31 M arch 2001, analysis by Charlie Owen, TCRU

Figure 1: Changes in the number of playgroups, childminders and day nurseries, 1993 -


So far as school aged childcare is concerned there is a fast developing network of out of

school services (4,900 after school clubs and 12,900 holiday play schemes in 2001,

DfES, 2001a) (see figure below). These can take various forms such as breakfast, after

school and homework clubs and holiday schemes. They can also be run in various ways,

such as voluntary or private sector free standing clubs, or as services attached to nurseries

or schools. At present nearly all the services are run independently of each other and of

schools, so although together these services form the basis of 'wraparound' care, they do

not yet necessarily function in a coherent way.

Day nurseries, childminders, playgroups and out of school services form the bulk of

childcare services in the private and voluntary sectors. In addition, there are many family

support services run by voluntary organisat ions, such as family centres, which cater for a

range of needs, but usually focus on children defined as 'in need' and their families

(Smith, 1996). Other examples of services might be toddler groups, toy libraries,

HomeStart (a counselling and practical Support service largely staffed by volunteers),

and many others aimed at addressing specific needs of communities.

4.1.3. Childcare services in the public sector

The main publicly funded service for children prior to compulsory schooling at the age of

five is nursery education in schools or in classes attached to primary schools. In

addition, except in Scotland, there are many four-year-old children in reception classes in

primary schools. The current government is committed to universal provision of part-time

education for three and four year olds by 2004, and although the target for four year olds

has been achieved it is not through a substantial increase in the volume of services in the


1993 1994 1995 1996 1997 1998 1999 2000 2001








Playgroup Childminder Day nursery


last four years (see above graphs). Nursery classes are for 2 ½ hours a day, five days a

week during term time only, while reception classes are generally full-time after the

initial half term induction period.

Nursery classes and reception classes are staffed by a qualified primary school teacher

(whose training may ha ve included work with 3 and 4 year olds). Nursery classes and

many reception classes also have a childcare worker (nursery nurse), and often have other

adults such as volunteers and students working in them. There is a maximum of 26

children in nursery classes and 30 children in reception classes. Both these types of early

education follow the Foundation Stage curriculum, which aims to 'help practitioners

provide learning and teaching experiences of the highest quality throughout the

foundation stage, while allowing them to respond flexibly to the particular needs of the

children, families and community with whom they work' (Foreword, QCA, 2000).

There is some concern that despite the clear educational benefits of nursery education,

part-time hours do not greatly help parents to combine employment and parenting

without the involvement of another service (childminder, nanny, nursery, or relative) and

policy steps are being taken to improve 'wraparound' care for this service (DfES, 2001d).

The figure below shows trends in the provision of early education services since 1993.

Unfortunately, data was not collected on the provision of nursery places within primary

schools in 2001. However the trend is one stabilisation in the provision of full-time

equivalent places, rather than rapid expansion. In January 2001, 58 percent or 709,500

children aged 3 and 4 attended maintained nursery schools or classes.

Source: DfES, 2001a, Children's Day Care Facilities at 31 March 2001, analysis by Charlie Owen, TCRU

Figure 2. Full-time equivalent places in playgroup, primary and nursery education

Education Places

Education shown as full-time equivalent

1993 1994 1995 1996 1997 1998 1999 2000 2001








Playgroup Primary Nursery


As well as providing early education and care to three and four year old children, schools

have a pastoral care role for all children and there is recognition of the importance of a

supportive environment for learning: schools can employ non teaching staff whose

primary role is to assist individual children or whole classes (these staff have many job

titles such as nursery nurse, learning support assistants, special needs assistants, one-toone

assistants). Schools take up the option to employ 'care' staff to greater and lesser

extents: there is now policy support for this, particularly in economically and socially

deprived areas.

Local authority centres play a much lesser public sector role. Where these exist, they are

in various forms such as day nurseries, family centres, combined centres and early

excellence centres. Historically, although there has been a long-standing local authority

power to provide day nurseries, only a few, mainly metropolitan local authorities

developed this service. Publicly funded nurseries are disappearing: the number of local

authority day nurseries decreased by 35 percent between 1990 and 2001 (DfES, 2001a),

so that in 2001, only six percent of day nursery places were provided by the public sector,

but the figure for the number of children attending is not given. Some local authorities

run family centres (see above). These tend to focus on family support, and may or may

not include childcare as such. Of the 430 family centres in operation, two thirds are for

children of all ages, and nearly a quarter are for children under five (DfES, 2001a).

Some local authorities run, jointly run or support the running of combined centres, which

are centres that combine early education and care in one place. Some of these have

become Early Excellence Centres, an initiative designed to identify and financially

support the work of innovative services that combine education, childcare and often other

services, with a view to actively promoting good practice in the vicinity. A further

publicly supported initiative is the Neighbourhood Nursery Initiative. The aim is to

provide money for building nurseries where they do not currently exist, in areas of social

deprivation where the provision of childcare may encourage mothers to enter paid

employment. Most of these nurseries, however, are likely to be run by the private sector.

There is also the Sure Start initiative, which aims to offer multi-agency (health, social

care, childcare, education) services to families in deprived areas of the country, with the

ultimate aim of lifting young children out of poverty. These initiatives are indicative of

considerable policy attention and public finance given to early years care and education

since 1997, driven by public policy concerns to raise educational standards, promote

employment especially among women, and reduce high levels of child poverty.

In 2000, there were 2,800 full-time equivalent staff working in public sector nurseries

and playgroups, and 3,900 staff full-time equivalent staff working in public sector family

centres. Counted within the latter figure are some social workers rather than care staff

(DH, 2001e).

4.1.4 Unregulated childcare

Turning to the private, unregulated childcare sector, nannies are employed by either one

or two sets of parents to care for children in one or both parental home(s). There is no


requirement for nannies to register with local authorities (although there has been some

policy discussion about this and it may change). It is not known how many nannies there

are, nor how many children they care for.

Nannies are traditionally female and have a childcare qualification, although there is no

requirement about either gender or qualifications. They can live in or out of an

employer's home. A study of childcare students showed that 23 percent of students

wanted to become a nanny, the third most popular form of childcare work (after school

nursery nurse and working in a private nursery) (Cameron, Moss and Owen, 2001).

Analysis of the Family Resources Survey (1993 - 1996) showed that of parents in social

classes I/II who were both employed and might be the social class group most likely to

pay for childcare, around 10 percent used 'other' as a childcare arrangement (a category

which should include nannies). Twenty five percent of these parents used a relative, 27

percent a childminder and 23 percent used a nursery, creche or playgroup (Owen, p.c).

These figures give some indication of the place of nannies in the childcare field: a

significant minority, but a largely invisible player.

Other unregulated childcare services would include: au pairs, who traditionally live with

a family for a year to assist with childcare and household duties in return for board and

lodging and a small wage; mother's helps; maternity nurses; housekeepers; and other

household assistants who are privately recruited, paid and managed. No further

information is available about their quantity or characteristics.

4.1.5 Childcare services for disabled children

Children with disabilities often attend mainstream care and education services,

sometimes with additional support through non teaching staff such as a classroom

assistant. In addition, there are special schools, and opportunity playgroups, which cater

for children with specific needs.

4.2 Residential services for children and young people

Foster care is the largest supplier of accommodation to children and young people (from

the age of 0 to 18 and sometimes 21) who cannot live with their own families. Two thirds

of ‘looked after children’7 are in foster care: a total of 37,900 children were counted in

one week in 2000 (DH, 2001a). This is care provided by an individual, couple or family,

for children who require alternative accommodation because of neglect, abuse or other

reason. Foster carers provide everyday care and receive a fee from the local authority for

doing so. Foster placements can be for varying purposes: emergency placements, a series

of short breaks, or a long-term placement.

7 Looked after children (LAC) is the term used to describe children and young people who are looked after,

or cared for, by the local authority. They may be looked after by request of parents, or by virtue of a court

order. Being looked after does not negate parental responsibility, although its operation may be limited

according to circumstances (DH, 1989).


Foster carers can also be involved in more specialist tasks, for example, preparation of a

child for moving to another type of care, or in supporting older young people with

particular problems, or in supporting children with disabilities. Traditionally foster carers

were recruited and supported by local authority social services departments, but the

involvement of private firms in doing this is increasing. Training for foster carers is also

becoming formalized, with the introduction of accreditation awards, such as National

Vocational Qualifications, for foster carers. There is an acute shortage of foster carers; a

recruitment campaign in 2000 did not achieve its target of 7,000 new carers (DH, 2001b).

It is not known how many foster carers there are, although each one on average cares for

approximately 1.5 children. This would suggest that there are around 25,300 foster carers

in England.

In addition to foster carers recruited by social services departments and other agencies

there are private fostering arrangements between parents and a carer with no mediation

by public or private welfare agencies. Under the Children Act 1989 someone proposing

to leave their child with someone other than a (close) relative should inf orm the local

Social Services Department and anyone looking after such a child should inform social

services, who should visit and inspect. However, there are serious doubts as to whether

this happens. There is no registration process (as happens with childminders), only a

requirement to notify, and no figures are collected. The government estimates there are

10,000 such arrangements but there is no way of knowing how accurate this is (Owen,

p.c; Philpot, 2001). Such information as does exist about private fostering indicates that

most arrangements are made by London parents from West Africa (often students)

placing their children with white families in order for the children to benefit from

additional opportunities that their parents believe foster carers can give their children.

Residential care is institutionally based care for children and young people who cannot

live at home or with other relatives and is an alternative to foster care for about ten

percent of looked after children, or 6,300 children and young people (DH, 2001a). There

are various kinds of residential care: the majority are community homes which can be

maintained, controlled or assisted by local authorities: in the latter two cases, a voluntary

organisation runs the home with variable levels of financial and/or managerial input from

local authorities8. There are also secure units, which in 2000 provided places for 3

percent of looked after children (DH, 2001a).

Whatever the managerial arrangements, most homes run for similar purposes: to offer

emergency, short-term, respite and longer term care to children and young people. Nine

percent are under the age of ten, but by far the majority are aged thirteen and up (ibid.).

Workers in homes not only provide day to day care, they also work with young people

8 There are also: voluntary children's homes, which are run by non-profit making voluntary organisations

and are subject to inspection by the local authority; private children's homes, which are run by individuals,

companies or organisations for profit, and similarly have to be registered; dual registered schools, which

are homes defined as boarding schools and are registered under both education and local authority

systems8; registered residential care homes, which normally provide care for children with health care

needs; and small unregistrable homes which accommodate fewer than four children and are run by private

organisations for profit.


towards the next stage in their lives, along with social workers and other welfare


Surveys have concluded that there are over 18,000 members of staff in local authority

children's homes in England, Scotland and Wales, and 9,240 members of staff in private

and voluntary sector homes in the UK (i.e., also including Northern Ireland) (IDeA,

1999), making a total of around 27,240. Not all of these are care staff: around a quarter of

staff working in community homes are support staff of various kinds such as cleaners,

cook, administrative staff and so on. However, the Department of Health figures for 2000

show that there were only 8,700 full-time equivalent staff working in public sector

community homes for children looked after. It is difficult to reconcile these two figures.

For looked after young people other placements are also possible, such as being placed in

a boarding school (no information on how many), or being placed with parents (11

percent of looked after children), and other relatives or friends (17 percent of all those in

foster care) (percent figures from DH, 2001a). There are also forms of supported

accommodation, such as supported lodgings, hostels, semi-independent living units of

various kinds which may or may not be attached to or managed from a community home.

For children with severe disabilities respite care, or regular breaks with specially trained

families or in institutions can be arranged. Around six percent of children looked after are

placed for adoption in England. This is expected to be a permanent placement where

specifically recruited and assessed adoptive parents are eventually granted an adoption

order by a court, which includes parental responsibility for a child. The adoptive parents

can be financially supported by the state and in the early stages are similar to foster

parents although the expectation from the outset is usually one of permanency. Some

adoptive parents, however, are working with children who may return to live with their

own parents, a scheme called 'concurrent planning'.

Finally, for children who are terminally ill there are 21 children's hospices. Hospices

offer 'a way of caring' and 'seek to help people to live life to the full' when they are facing

a terminal illness, usually cancer. Hospice care takes place in specific buildings

(hospices), as well as in domestic homes, day centres and on specialist hospital wards

(Help the Hospices, 2001). It is not known how many staff there are or how many

children and young people they care for.


Table 4. 1 Children and young people looked after by placement, 2001

Number Percent

Foster care 38,400 65

Residential care 6,200 10

Hostels and other supportive placements 510 1

Placed for adoption 3,400 6

Placed with parents 6,900 12

Lodgings, residential employment or living


1,100 2

Residential schools and other placements 1,100 2

All children looked after 58,900 100

Source: DoH, Children looked after in England: 2000/2001

4.3 Day and residential care services for adults and older people

The main policy is to provide services to enable people to remain in their own homes.

This section will describe domiciliary, day and residential services for adults and older

people with varying needs.

4.3.1 Domiciliary care

In 2000 398,000 households (415,000 clients) received home care/home help that was

purchased or provided by local authorities (2.8 million contact hours, DH, 2001c). On

average, care was provided for seven hours a week. The trend is for fewer households to

be provided with more intensive support. Of the total number of hours, 22 percent of

households had only a single visit of less than two hours per week, while 18 percent of

households had more than ten hours and 6 or more visits per week. Home help/home care

is defined as services that assist the client to function as independently as possible and/or

continue to live in their own home. Services may involve routine household tasks within

or outside the home, personal care of the client or respite care in support of the client’s

regular carers (DH, 2001c).

A dramatic shift has taken place in the last ten years. Whereas in the early 1990s most

home care was provided directly by the local authority, now over half is provided by the

private and voluntary sector. There are around 204,000 staff working in home care, of

which 187,000 are care workers. About 37 percent of these workers are located in the

public sector, the remainder in the private and voluntary sector (Comas-Herrera,

Matosevic and Kendall, 2001, Appendix 1 in Henwood, 2001).

4.3.2 Day centres

Day centres offer social activities, occupational therapy, and practical assistance for

people under 65 with physical disabilities, people with learning disabilities, people with

mental health problems, and older people, who may have mental infirmity or disabilities

of some kind. There are about 30,694 local authority day centre staff of whom 19,353 (63

percent) are either day centre officers or care staff (i.e., not managerial or social work or


support posts). These staff divided between the different types of centre as follows:

13,500 full-time equivalent staff work in public sector centres for adults with learning

disabilities; 2,300 staff (fte) work in centres for adult with physical disabilities; and 2,000

staff (fte) in centres for adults with mental health problems. In addition, 3,300 staff (fte)

work with the elderly and elderly mentally infirm in day centres, and 3,000 staff (fte)

work in mixed client group centres (DH, 2001e). It is not know what proportion of day

centres is run in the independent sector and what in the public sector.

In addition, a small number (570) of local authority staff work in specialist teams in

alcohol, HIV/AIDS and drug centres, of which the majority almost half (46 percent) are

social workers, and a quarter (26 percent) are care managers or support workers.

Care staff (often called wardens) also work in sheltered accommodation, which provides

accommodation for people who need a limited amount of help with daily living. Comas-

Herrera et al. (2001) identified 19,100 care staff employed in the voluntary sector but

there was no data on the public sector.

We have been unable to find information on the number of users or the total number of

day centres, specialist teams or sheltered accommodation.

4.3.3 Residential care

Residential care homes provide long-term and respite care for frail elderly people who

may or may not have disabilities and who cannot manage their own homes and/or daily

living. There are various types: residential care homes, nursing care homes, and private

hospitals and clinics offering accommodation. There are 30,700 care homes, a level that

has remained virtually unchanged in recent years, and nearly all of them are in the private

and voluntary sector. Around eighty percent of residents are over the age of 65 years

(DH, 2001d). Anecdotal evidence suggests that the remaining 20 percent of residents are

people who have learning or physical disabilities that require longer term care and for

whom specialist services are not available. Around 557,000 staff work in residential care

and nursing homes , of which 13 percent work in the public sector. In local authority

homes for elderly people with a mental infirmity, there are 43,842 staff, of which about

58 percent are care staff. Of the 487,000 staff in private and voluntary sector residential

and nursing homes, 359,300 (74 percent) are care and/or nursing staff (Comas-Herrera et

al., 2001).

There are residential care homes for adults with disabilities. These are mostly run by

voluntary organisations, and provide care and accommodation on a long-term or respite

basis for adults with severe or specific disabilities and who cannot manage in their

families or on their own. In local authority homes for adults with a mental health

problems and learning disabilities there are 17,291 staff, of which 65 percent are care

staff. (Comas Herrera et al., 2001). The number of services and users of them are


As with children's services, there are also hospices (200 in 2001), which offer palliative

care in a variety of settings: voluntary or independent hospice buildings, National Health


Service Palliative Care Units or in people's own homes (Help the Hospices, 2001). This is

an area of care that overlaps with health care as most of the wor kers are trained nurses,

although the kinds of relationships that occur between workers and clients are probably

similar to other kinds of care work in high dependency situations. The number of services

and users of them are unknown.

Table 4.2. Classification of services




Local care and welfare Educational Residential





Foster carers

Hospice care

Day nurseries/ neighbourhood



Toddler groups

Family centres

Combined centres/early

excellence centres

Nursery schools and



Opportunity playgroups



(4/5 – 18/22)



including respite

care for youg people

with disabilties

Hospice care

Out of school clubs

Holiday playschemes

Family centres

Reception classes

Special schools

Residential care (mostly for

children aged 10+), including long

term, short term, respite care, and

planned series of short breaks

Boarding schools, including those

for children with disabilities

Supported lodgings (15+)



(18/22 –


Home care/personal

assistants for people

with disabilities

Hospice care

Day centres for people with

disabilities/mental health


Residential care for people with


Sheltered accommodation



(60/65 <)

Home help/home


Hospice care

Day centres Residential care, long term and


Sheltered accommodation


4.4. Summary

Table 4.2 summarises the main services within the care domain that we have defined for

this project, organised according to the age group for whom the service is provided and

type of setting in which the service is provided.

Provision of care services in the UK have witnessed a dramatic shift in the last decade,

with considerably more services being provided by private and voluntary sector providers

than previously. A high proportion of childcare for children has always been in the

private and voluntary sector (childminders, playgroups), and this sector has emerged as a

major provider of residential care and domiciliary care for older people in the 1980s and

1990s. The private sector is also now a major player in residential care for children and

young people and in agencies for foster care. Public sector provision is mainly seen in


education for three and four year olds, and in providing for children where there is

'market failure', although the public sector plays an active role in regulating the market.


Chapter 5 Overview of Occupations

This chapter will examine the characteristics of those who work in care services, and the

characteristics of the work. It will focus on those jobs that belong in the care domain

because of their major role in the care fields already identified in this report: childcare for

children up to the age of 14; residential care for children and young people; and day and

residential care for adults and older people. A list of other care work occupations, that

involve some care work but do not belong in the care domain for the purposes of this

project, can be found in Appendix 1. In the UK, care work is rarely at a professional

level, in terms of extensive qualifications and training in order to practice. There are

some people with professional qualifications (e.g., in teaching, social work or nursing)

working in care work, but it is not a single profession-led field as such. Most training and

qualifications are competency based, with varying degrees of theoretical knowledge

included. This is in contrast to other well established human professions, such as

education, and health.

5.1 Care Occupations that belong in care domain because of the major role

in three care fields

5.1.1 Using the LFS

Secondary analysis of the Labour Force Survey, combining data for three years (1997 to

1999) was commissioned for this report using SOC codes to delineate childcare workers,

youth work and residential care workers and adult and elder care workers. The

occupational codes used are given in Appendix 3. The main job titles used in the care

services described in Chapter Four are listed in the table below, along with the Standard

Occupational Classification (SOC) code used in the Labour Force Survey9.

There are some problems with using the SOC system. In particular the codes do not

correspond with commonly used job titles. A particular code may, for example, include

several types of job: analyses therefore provide information on occupational codes, not

on individual jobs Assumptions sometimes have to be made about which job titles are

included in a code, and these assumptions may not be accurate. Overall, therefore,

analysis of the LFS does not produce very refined occupational information. It does,

however, provide a good overall starting point for assessing the workforce profiles of the

care workforce, and other sources will be used to complement this data.

9 SOC codes are applied to groups of occupations, and provide the main classification for analysis of largescale

data sets such as the Labour Force Survey (LFS). The LFS is a regular household survey, and collects

data from approximately 60,000 household per quarter.


Table 5.1: Job titles and SOC codes, with Care Work field and the services occupations

are employed in

Care field (see

Chapter 5)

Services employed in SOC


Occupations included within SOC codes

1. Care assistant 3 Day centres, res homes 644 Care assistants/attendants

2. Care worker 3 Day centres, res homes 644 Care assistants/attendants

3. Childminder 1 Childminding 659 Other childcare occupations

4. Family centre worker 1 Family centres 659 Other childcare occupations

5. Foster carer 2 N/a 370 Matrons/ houseparents

6. Health care assistant 3 Day hopsitals, centres 640 Assistant nurses/auxiliaries

7. Home help/home carer 3 Home care 644 Care assistants/attendants

8. Houseparent 2 Residential care 370 Matrons/ houseparents

9. Learning support assistant 1 Schools 652 Educational assistants

10. Nursery nurse 1 Nurseries, schools 650 Nursery nurses

11. Nursery assistant 1 Nurseries 650 Nursery nurses

12. Nursery supervisor 1 Nurseries 650 Nursery nurses

13. Nursing auxiliary 3 Residential care homes 640 Assistant nurses/auxiliaries

14. Nanny 1 N/a 659 Other childcare occupations

15. One to One assistant 1 Schools 652 Educational assistants

16. Playgroup/preschool leader 1 Playgroups/preschools 651 Playgroup leaders

17. Playgroup/preschool assistant 1 Playgroups/preschools 659 Other childcare occupations

18. Playworker 1 Out of school services 659 Other childcare occupations

19. Residential social worker 2 Residential care 370 Matrons/ houseparents


5.2 A profile of childcare workers

As we have seen, there are many kinds of childcare services in the UK, with a clear

overlap with early education services and some overlap with welfare services. Moreover,

many childcare workers do not work in a childcare service (for example, they work in

schools (see Chapter Four) or in apparently unrelated sectors such as tourism, see Simon

et al. (2001) for a fuller discussion). We have also seen that the location of the workforce

is spread across the public, private and voluntary sectors, with most services and hence

most workers employed in the last two sectors. While there is not much variation in the

characteristics of the workforce, there are some differences in the conditions of the work

across these services and loca tions.

As Table 5.1 shows there are a wide range of job titles for childcare workers – 11

altogether. The LFS however has only three occupational codes: 'nursery nurses',

'playgroup leaders' and ‘other childcare occupations'. The LFS category 'other childcare

occupations' includes a wide range of job titles, including childminders, nannies, out of

school workers, family centre workers and possibly many other job titles not coded

elsewhere. The detailed figures are given in tables in Appendix 3.

In brief, childcare workers are most likely to be aged 35 - 49 years (47 percent of

childcare workers were in this age group); ethnically white (96 percent); and female (97

percent). Seven percent had a work limiting disability. Seventy three percent of childcare

workers are either living together or married, while 11 percent are single. Forty percent of

childcare workers had co-resident children. For nearly one third (32 percent) of childcare

workers, their highest educational qualification was the basic school leaving qualification

at age 16 or 17 ('O' Levels or GCSEs). A further third had (33 percent) had either A

Levels or 'above A levels' as their highest qualification. Only four percent had a

university degree.

Many childcare workers are not qualified for the childcare job they do: in day nurseries

just over a half have a Level 3 qualification (meaning they can work unsupervised);

nearly eighty percent of childminders do not hold a work related qualification; and

among playgroup leaders it is a similar picture. This means it is very difficult to structure

discussion of the occupations around the training and career structure: this will be

discussed next.

In sum, analysis of the LFS shows that childcare workers are generally female and white

and have a comparatively low level of general education. While increasing numbers of

people in the population as a whole are gaining A Levels and degrees, this is not reflected

in the profile of childcare workers (Cameron, Owen and Moss, 2001).

5.2.1 Training and career structure in childcare

There are many training courses available in childcare, and a very fragmented training

field is currently being rationalised through the introduction of a framework for

nationally accredited qualifications for early years education, childcare and playwork

(QCA, 1999). The framework is both reducing the number of available qualifications and


reorganising them into groups according to their level and their category. There are six

levels ('entry' to Level 5), and the categories relate to whether they are general (eg.,

school leaving), vocational (a general orientation towards an occupational field), or

occupational or professional (i.e., they assess competence in a job or a field of work).

The main childcare qualification is a Diploma in Childcare and Education (previously

known as a diploma in nursery nursing) and this is judged a Level 3 qualification. This

typically takes two years of full-time study at a college of further education, including

periods of practice placement. Entry requirements are around five GCSEs including

English, so an entrant beginning straight after leaving school (which is when most do

start) can qualify by the age of eighteen or nineteen. This qualification is seen by the

Qualifications and Curriculum Authority (QCA, 1999) as adequate preparation for

working in a relatively unsupervised capacity, as a nursery nurse in a day nursery or in

nursery schools and classes, or as a nanny, preschool leader, playgroup leader,

childminder, playworker and so on, although many people in these posts do not have such

a qualification. Cameron et al. (2001) found that 52 percent of day nursery staff working

in the private and voluntary sector had a diploma level childcare qualification, while

Mooney et al's (2001) survey of childminders found that only 21 percent had a childcare

qualification, of which the most commonly found was the diploma.

In addition to the diploma there are other Level 3 qualifications in the framework: a

Certificate in Childminding Practice; a Certificate of Professional Development in Work

with Children and Young People, and a Diploma in Preschool Practice. There are also

Level 2 qualifications which qualify someone to work when supervised in a childcare or

playwork setting, and a Level 4 qualification in Ear ly Years, Childcare and Playwork,

which is designed for managerial posts.

This system of diploma and certificate courses provides the basic structure of training in

childcare. However, there are also a growing number of Early Childhood Studies and

Playwork studies degree and HND (Higher National Diploma) courses run in universities

and colleges of further or higher education. These offer a general academic and practice

based education, but it is not known how many graduates then go into work in the

childcare, early education or playwork field. In a focus group study of playwork students

on an HND course, there was considerable discontent with the career possibilities in

playwork in relation to their level of education (Cameron et al., 2001) although whether

this view is typical of HND/degree level students is not known.

In addition to college based training, many flexible opportunities for gaining

accreditation for sessional training have been developed in recent years. For example, a

popular route to gaining a playwork qualification is a course called Take Ten for Play,

which is based on ten hours of training and can take place in a workplace or other

community facility, and can be run by an independent trainer or a playwork development

officer employed in a local authority to develop playwork services. In general the field of

training in childcare and playwork is a fast developing one, with a recent policy emphasis

on improving the qualifications base in the field in order to achieve an expansion of

services. As the former Minister, Margaret Hodge, said 'delivering the Government's


Strategies for childcare, early education and Sure Start depends on the skills and

competence of the people who work with children' (Hodge, quoted in QCA, 1999).

In terms of career structure in childcare and playwork, traditionally there has been very

little relationship between qualifications and advancement, in part because there have

been relatively few options for those trained in childcare and related areas. Private and

voluntary nurseries were traditionally small-scale enterprises, with few managerial

positions, although there has been a recent influx of larger-scale nursery chains, which

may in time offer more opportunities. There is a high turnover in childcare and related

work, but most occupational movement is within the sector rather than outside it

(Cameron, Mooney, Moss and Owen, 2001). Most people in the work are satisfied with

the work, and the main source of satisfaction is working with children: this may act as a

disincentive to seeking work that involves less direct contact with children (Cameron et

al., 2001).

5.3 A profile of youth and residential care workers

This area of care work comprises residential and foster care workers for children of all

ages, including those working in supported accommodation such as bail hostels and in

services for children with disabilities: Table 3 shows three job titles but these cannot be

clearly distinguished in the LFS analysis. Foster care is included within SOC code 370,

matrons and houseparents; while some workers may be included under ‘other childcare

occupations’, which mainly includes childcare workers, or as ‘social workers’. Another

difficulty is that residential social work has usually been seen as either part of resid ential

work for adults and children, or has been seen as part of social work, whereas here we

want to present the data just for children and young people's residential work. In addition,

as with the first area of work, residential and youth services are located in private,

voluntary and public sectors, with varying degrees of attention paid to data collection

across these sectors.

However, analysis of the LFS focusing on SOC code 370, again for the UK and for the

years 1997-1999, shows the following characteristics of this workforce. Approaching half

of this group (43 percent) are aged 35 to 49 years; nearly all of them are ethnically white

(95 percent) and most are female (85 percent). Three-quarters of this group are either

married or living together as a couple and over a third (39 percent) have co-resident

children. This group is the best qualified of the three care work groups: 25 percent have

'above A Levels' as their highest qualification and 8 percent have a degree. As with the

childcare group, a significant minority (21 percent) cited 'other qualifications' while 20

percent had A Levels, and 18 percent had O levels. Nine percent had no qualifications.

Survey data by provider sector shows that across both public sector and private and

voluntary sect or homes, nearly two thirds (64 percent in public sector, 63 percent in

private and voluntary) of care and teaching staff are female, and 37 percent are male

(DH, 2001e; IDeA, 1999). In public sector homes, data on the ethnic origin of the staff

shows that between two thirds and three-quarters of the staff in community homes and

homes for children with learning disabilities are ethnically white. The next largest

category is 'black' (6 to 9 percent of staff) with much smaller percentages of staff from


Asian, mixed or other origins. However, the ethnicity data on approaching one quarter of

the staff is unknown (DH, 2001e).

5.3.1 Training and career structure in youth and residential care

In this area there is a lack of specific qualifications. Traditionally, the sector has been

seen as allied to social work rather than other work with children (Cameron, in

preparation), but only 5 percent of care staff and 31 percent of independent sector care

home managers have a social work qualification. In public sector homes, 76 percent of

managers and 7 percent of childcare staff have a social work qualification, (IDeA, 1999).

Surveys identify a range of qualifications and forms of training, including nursing,

national vocational qualifications (NVQs, a form of accreditation for experience and

competence in work), In-service Course in Social Care (ISCS), as well as 'other' courses

and qualifications such as general childcare qualifications, youth and community work,

counselling courses and so on. 'Other' qualifications account for 23 percent of the

qualifications held by residential care staff (IDeA, 1999).

When all the social work and non-social work qualifications are added together, and the

data for independent and public sector homes are combined, a quarter (25 perce nt) of care

staff hold 'relevant' qualifications for their work (IDeA, 1999). If managers and

supervisors are included, the proportion qualified rises to 34 percent.

The poor qualification base in residential care has been causing some policy concern

(DH, 1999), although Brown et al., (1998) found that lack of training by itself does not

correlate to poor quality of care in residential homes for children and young people.

Historically, as entry to residential care did not require a qualification, employment was

seen as a means of gaining the necessary practice experience for social work courses.

Training for foster carers was traditionally a short evening course as part of assessment

procedures. However, “the approval and induction of foster carers, as well as their

subsequent training, have been identified as major gaps in existing arrangements for

looked after children” (Kozak, Petrie and Webb, 2001:15). Training for foster carers has

recently been extended, so that now a foster carer can complete a Level 3 NVQ award (a

competency and assignment based award, accrediting practice). National occupational

standards have also been developed for foster care. Overall, there seems to be divergent

trends in foster care. On the one hand there is a growing professionalism of foster carers,

with training, specialisation who can command higher fees and sometimes employment.

In a study of support for foster carers, around three quarters of carers agreed that

fostering was a professional job and should be better rewarded than it was (Baker, Gibbs,

Sinclair and Wilson, 2000). On the other hand, there are foster carers who see the work as

a vocation, or little more than voluntary work.


5.4 A profile of workers in adult and elderly care occupations

Workers in these occupa tions account for another 5 job titles in Table 3. For our analysis

of the LFS, however, these are reduced to two SOC codes: 640 (assistant nurses and

auxiliaries) and 644 (care assistants and attendants, including residential workers).

This analysis found that the workers in this care work area are more evenly spread across

age bands: just over a third (36 percent) are aged 35 - 49 years; while around a fifth are

aged 50 or over (26 percent) or aged 25 - 34 years (21 percent). Seventeen percent are

aged under 25 years. As with the other care work groups, nearly all are ethnically white

(95 percent), and female (91 percent). Two thirds of this group are either married or

living together as a couple and 41 percent have co-resident children. Nine percent of this

group have a work limiting disability, a bigger proportion than in the other groups. This

group is not well qualified. A fifth (21 percent) have no qualifications; 21 percent have O

Levels as the highest qualification; and 26 percent have 'other' qualifications. Only 23

percent have A Levels (a higher qualification taken at 18 in school or further education

college) as their highest qualification, 8 percent have above A Levels and 2 percent have

a degree

5.4.1 Training and career structure in adult and elder care

According to the Department of Health, about 80 percent of the social care workforce do

not have a relevant qualification for the job that they do and secondary analysis of the

LFS has shown that levels of qualification within the social care occupations vary

considerably. Thus while 43 percent of social workers and probation officers hold a

university degree, this is the case for just three percent of care assistants (Simon et al,


A national training strategy (Modernising the Social Care Workforce) for social care is

now in place to address serious skills shortfalls in social care occupations arising in part

from this lack of a qualifications base. A part of this strategy is the development of a

'national occupational standards framework' (by the Training Organisation for Personal

Social Services or TOPSS). These standards set out what is expected of each job role and

provide benchmarks for qualifications (TOPSS, 2001).

As noted earlier (p.16) the career structure of social care is also being re-invigorated

through three new bodies aimed at improving and controlling the quality of work and

services: the General Social Care Council, which registers certain social care workers

(social workers and managers of social care establishments) to ensure their competence;

the National Care Standards Commissions, which will, regulate residential settings; and

the Social Care Institute for Excellence which carries out research in social care. These

bodies aim to professionalise the training, entry to and practice in social care, with an

overall aim of improving the quality of social care.

However, none of these bodies have yet mapped out a new career structure for social

care. The traditional career progression through local authority employment to

managerial positions is under challenge in three ways. First, the volume of local authority


employment is decreasing in favour of private and voluntary sector service providers,

who may or may not offer a career structure. Second, the need to retain direct care

workers may place a higher premium in pay negotiations on client work, and less on

managerial work, which would reverse the traditional system of rewards for management.

A third point about social care careers is that policy is increasingly directing a division

between management and planning of care on the one hand, and providing care on the

other. Social workers are increasingly appointed to 'care manager' posts, whose job is to

organise the delivery of care services, by care staff. The future for social work, for

example, may lie in managing and developing care staff (Higham, 1998).

A last point concerns the implications for the care workforce of a growing trend for

paying informal providers to care (‘direct payments’ or ‘cash for care’). If this method of

obtaining a care service comes to involve substantive numbers of people, this may add to

the care ‘workforce’, and potentially open up opportunities for the carers to be employed

elsewhere in more formal settings. However, the conditions of work of such

‘employment’ are minimal – there is no job security and no sense of belonging to an

organisation that will provide a level of protection. In addition, the highly personalised

social relations involved in paying a neighbour or relative or recruiting a worker

individually rely on trust and may become uncomfortable for those concerned (there are

parallels with the social relations of childminders and parents, cf. Mooney et al., 2001).

The extent to which staff starting at the 'bottom' of social care as a care provider could

progress to care management and/or beyond is not yet established and will rely on the

flexibility and foresight of the initiatives in training.

5.5 Summary

Diversity of care services is matched by diversity of occupations. There are however

some common features across the care workforce. First, nearly all occupations are highly

gendered, with highest levels in childcare, followed by eldercare. Residential care work is

least gendered, but the workforce is still 85 percent female. Second, occupations are

generally specific to each of the three care fields we have mentioned – in other words,

each care field has developed its own group of occupations specific to that field. There

are, for example, no general care professions practiced across two or three fields. Indeed,

as a third point, not only is the field largely unprofessionalised, but levels of training are

low. In all three fields, government policy is grappling with how to improve training

levels, mainly through competency-based qualifications rather than major upgrading of

basic or initial training.


Chapter 6 The Costs of Care

Estimating the cost of care services is difficult because so many of the services are in the

private and voluntary sector. There is also the hidden costs of parental fees paid for care

services (for example, by parents for childcare) as well as of informal care by families

and kin that is unpaid and therefore also difficult to calculate. Paying for most care, such

as childcare or eldercare, is borne by families: even care by the state such as residential

care for children and young people attracts a parental liability to pay, although it is rarely

exercised. These private costs are often not included in calculations.

6. 1 Total public expenditure, i.e. by all levels of government

There are various sources on expenditure, such as government statistics, OECD reports,

and research studies. None of them take 'care services' overall as a category, all are

focused on particular services or groups of services according to departmental

responsibility and so on. The available figures will be presented.

According to Social Trends 31, a total of £221billion was spent in the UK on social

protection benefits in 1998-99. This total, expressed as spending per head of the

population in 'purchasing power standards', was the same as the EU average at £3.7

thousand. Expressed as a proportion of GDP, spending was 27 percent (Social Trends 31,

2001:tables 8.1, 8.2).

Nearly half of the total social protection expenditure in the UK was for elderly people

and survivors (widows and widowers) (just over £80bn). The next greatest level of

spending was on sickness, health care and disability (around £70bn). Spending on

families and children was less than a third of this (£19bn), with housing (about £15bn)

and unemployment (£15bn) and other (about £2bn) being the remaining items included

(Social Trends 31). Social Trends comments that 'a large proportion of social protection

expenditure is taken up by spending on the social security programme and the National

Health Service' (Social Trends 31, 2001: 145). Much of the expenditure itemised

therefore gives a general picture and does not describe the spending on care services as


6.2 Public and private expenditure in different care fields

6.2.1 Expenditure in care field 1: childcare

Table 6.1 gives an idea of government expenditure in childcare. The three categories

(early years education, children in need and other childcare services) include many

services provided under tha t heading. For example, the total spending on early years

education includes school-based services (nursery and reception classes), as well as

private and voluntary sector provision receiving public funding for delivering education

to 3 and 4 year olds. Likewise the category children in need includes the total spending

by central and local government on services for younger children in need (i.e. under 8


years), such as family centres, family support. However, it is not clear from government

sources how much public money is spent on after school clubs, holiday playschemes, and

other play services for older children, including disabled children, up to the age of 14. In

addition to the nursery education grant for early education and paying the costs of

children in need, the main form of government funding takes the form of a subsidy, paid

through the tax system, for the childcare costs of low and medium income families – the

Childcare Tax Credit. Introduced in 1999, by August 2001 it was being claimed by

154500 families, who received on average £37 per week, a relatively low sum in relation

to the costs of childcare services. There is no information on the take up rate of this

benefit among eligible families. Most beneficiaries (89%), however, are lone parents

(Inland Revenue, 2001).

Table 6.1. Net public expenditure on childcare and early education: 1998/99: England

Cost per FT place (£) Total govt



Nursery schools and


1,960 p.a 1,914m 1,914m

Children in need (local

authority day nursery)

40 p.d 270m 270m

Other childcare services N/a N/a

Total 2,184m

Source: DfES, Statistics of Schools, 2001; Netten, 2000; DH 2001;

Most parents pay some or all of childcare costs. Calculating this parental cost is very

difficult. The average cost of a full-time childcare place for a two year old in a nursery is

£110 per week, making an annual total of £5,720 (Day Care Trust, 2001). The average

cost for a childminder place is slightly less, at about £95 per week or £4,940 per year.

Just taking these two services, and assuming that places for all ages of child cost the same

amount, the total spent on care for children by parents is £3,135,496,000.

However, analysis of the Family Resources Survey shows that parents on average pay

less per week than the previous figures suggest. This may be due to a number of reasons,

in particular extensive part-time working and childcare use (see Table 6.2: note that these

figures are for 1993-96, so preceding the introduction of Childcare Tax Credit). However

they also show that ‘informal’ care by friends, neighbours and relatives, which remains

more common than formal childcare, involved costs for parents. Parents in the 'other'

category pay the most for children of all ages, probably because this category includes

nannies, as they are not specifically included elsewhere. Unsurprisingly, expenditure on

children under the age of five years outstrips that for older, school age children.


Table 6.2 Parental expenditure on childcare, term time and holidays, by age gr oup, mean,


£ per week

0 – 4 5 – 10 11 – 14 Total

Term Hol Term Hol Term Hol

Friend/neighbour only 21.47 22.85 12.38 22.62 13.01 21.97

Childminder only 45.63 47.71 17.43 36.83 18.36 34.90



54.87 55.95 17.92 36.59 14.20 24.65

Relative only 24.17 24.58 14.69 19.59 13.79 16.16

Other only 73.34 75.61 30.93 46.85 25.00 35.03


Source: Family Resources Survey, 1993 - 1996, analysis by Charlie Owen, TCRU

6.1.2 Expenditure in care field 2: residential and youth services

Calculating the public expenditure on this group of services is slightly simpler because all

the services are the responsibility of one government department (the Department of

Health), and the same department is also responsible for the vast majority of the young

people who use the service (children in need). Therefore there are fewer sources of

finance. However, the available statistics do not tell us whether the spend given is just for

the direct care services or whether they include costs for support staff such as social


Table 6. 3 Net public expenditure on selected residential and youth services:1999-2000:



Community homes 520

Special education 70

Children in secure accommodation 30

Foster placements 420

Other (including admin, youth justice, adoptions)* 1310

Total 2350

Source: Personal Social Services Current Expenditure in England: 1999 - 2000, DH 2001)

* may also include spending on registration and inspection of children's day care

Netten and Curtis (2000) estimate that the unit costs of foster care are £538 per week, and

for children in a community home, the estimated cost is £1,837 per week (see Appendix 1

for details).

6.1.3 Expenditure in care work area 3: adult and elderly day and residential


Overall public spending on this care work area is itemised in Table 6.4 below.


Table 6.4 Net public expenditure on selected services for adults and elderly people: 1999-

2000: England


Local authority residential provision 550

Commissioned placements in residential care 700

Nursing residential placements 710

Residential placements: physical disability 180

Residential placements: learning disabilities 690

Residential placements: mental health needs 170

Day centres 170

Home care/help 950

Day services: physical disability 430

Day services: learning disabilities 570

Day services: mental health needs 210

Other (including admin) 610

Total 5940

Source: Personal Social Services Current Expenditure in England: 1999 - 2000, DH 2001

Analysis of the trends in spending on these items shows that in the ten years to 1999-

2000, spending on personal social services doubled from £5,300m to £10,100m (DH,


Estimates of the unit costs of a range of adult and elder care services are given in

Appendix 1. For example, home care per hour is estimated to cost £10.10 per hour,

attendance at a local authority run day centre costs £19 per half day session while the cost

of local authority residential care on a long stay basis is estimated to be £440 per week.

As with the first care field, childcare, the invisible area of spending is the contributions of

families and older people themselves to the cost of their care, although the fee element of

residential care in private homes is assumed to be the actual cost borne by families (see

Appendix 1). There is no up to date information on such private expenditure. According

to an OECD report, the estimated total spending on long-term care10 (1992 - 1995) as a

percentage of GDP in the UK was 1.30; and estimated public spending was 1.00. This

suggests that private expenditure, in the early 1990s, accounted for a quarter of long-term

care costs (Jacobzone, 1999: Table 4).

6.3 Finance

Overall, users pay the greater part of costs for childcare services, while government pays

most of the costs of eldercare services and virtually all the costs of early years education

10 Included within the definition of long-term care is “the care needed to help older persons leading an

independent life, at home or in an institution. It excludes informal help. For home care, it should include all

home care services, including district nurses services, excluding medical visits. For institutions, it includes

all the costs related to care and lodging, including help for all self-care activities but excluding medical



and residential care for children and young people. What is missing from this picture is

the costs incurred by informal care, i.e. by unpaid carers, both directly and in terms of

foregone earnings.

6.4 Proportion of working population employed in care work

Using the Labour Force Survey and the occupational categories with the closest

approximation to care work as defined in this project (SOC codes 370, matrons,

houseparents; 644, care assistants, care attendants; 650, nursery nurses; 651, playgroup

leaders; 659, other childcare occupations, and 652, educational assistants), Simon

calculated that 4 per cent of the working population are employed in care work (Simon,



Chapter 7 Collective bargaining and the role of social partners

This chapter will consider the main social agents or non-governmental organisations

involved in promoting and protecting the care workforce. It will identify how trade

unions perceive care work occupations, the extent to which any collective agreements

exist, and it will give a profile of the current employment conditions in the three care

work areas.

7.1 Union membership in the UK

Union membership in the UK is not high. According to the Office for National Statistics,

the proportion of the working population who is a member of any trade union (including

those not affiliated to the TUC) was 30 percent in 1999. The Trades Union Congress

(TUC) represent around 70 trade unions and professional organisations which together

have nearly seven million members (

7.2 Main trade unions and employers organisations

It should be noted at the outset that trade unions are not major players in the care work

field, and as a result information is limited. Trade union membership is higher in the

public than the private sector, so that the shift to private sector provision has reduced

union membership rates as services have increased. Consequently, for example, only ten

percent of childcare workers are members of trade unions or professional organisations

(Cameron et al., 2001).

Moreover, there is no single trade union that represents care workers. The main public

sector union, UNISON, represents local government workers, which includes a minority

of childcare workers, residential social workers, home care workers, and care assistants.

Another big trade union, the Transport and General, represents workers in a wide range

of industries and is actively recruiting childcare workers, although data on how many

care workers are member was not available. Similarly, the GMB represents workers in

diverse industries and claims to have some care workers as members.

There are no employers’ organisations representing the care sector, although there are

some membership organisations for employers in particular sectors, for example the

National Day Nurseries Association for employers in the private childcare sector. These

bodies however represent a minority of employers, and have no involvement in collective


·  In 1998, the Government set up national training organisations (NTOs) across the

whole economy, which represented employer interests with respect to training. These

NTOs were given responsibility for developing workforce training in their sector.

NTOs were relevant to care work: the Early Years NTO (covering mainly childcare

services for children under 8); SPRITO (covering out of school services and play);

PAULO (covering youth work, community education and community work; and


TOPSS England (covering the social care workforce, including residential care

workers, foster carers and others working within personal social services such as care

assistants and managers in home care, and residential care for adults and older


After only a few years of existence, these NTOs are being abolished in March 2002. They

will be replaced by Sector Skills Councils which will aim to lead ‘the skills and

productivity drive in industry or business sectors recognised by employers… they will

bring together employers, trade unions and professional bodies working with government

to develop the skills that UK business needs’ (Sector Skills Development Agency, 2002)

There are also many non-governmental organisations interested in care services and care

work, from the point of the view of users or providers. These organisations have a

number of roles, which are taken up to a lesser or greater extent according to internal

priorities. These may include: campaigning on behalf of services/professionals /clients;

providing services directly; research, development and training, and so on. Below are

listed some of the main organisations.

Organisations representing children and families

NCVCCO is the umbrella organisation for voluntary child care

organisations in England. Membership includes over 100 charitable organisations ranging

from large national groups to small family centres, investing between them over £400

million each year to improve the quality of life for children and their communities.

The National Children's Bureau (NCB) is a registered

charity that promotes the interests and well-being of all children and young people across

every aspect of their lives. It advocates participation by children and young people in all

matters affecting them and challenges disadvantage in childhood. It has a number of

specialist units addressing particular concerns. These are: Children's Play Council which

works to raise awareness of the importance of play in children's lives; Children and

Violence Forum which addresses issues concerning children and violence in society;

Council for Disabled Children an independently elected council which works to empower

children with special needs and their families; Drug Education Forum which provides an

independent and authoritative role for drug education; Sex Education Forum, a

nationwide group which promotes effective sex education; The Forum for Rural Children

and Young People, a strategic body helping the voice of rural children and young people

to be clearly heard. The NCB also has regional projects across England and one in

Northern Ireland and works in partnership with Children in Scotland and Children in


The Day Care Trust was established in 1980 and is the

national childcare charity. It promotes high quality affordable childcare for all.

The National Childminding Association , which promotes quality registered childminding

for children, families and communities


The National Day Nurseries Association is a national childcare charity that promotes

quality childcare and education for all children in the early years

The Pre-school Learning Alliance ( is a

national educational charity and umbrella body, linking 17,000 community-based preschools.

The charity aims to support the active involvement of parents in their children's

early education and to provide opportunities for those same parents to participate in

further education and tra ining.

The National Association of Early Years Professionals ( is a

‘professional association for all who work with young children, whether in the private

sector, for a Local Authority in Education, Social Services, a Health Trust or in any of the

many other spheres of employment covering the care and education of young children.’

Kids' Clubs Network is the national organisation for out of

school childcare.

National Children's homes (NCH) provides and campaigns for

family support services such as family centres and residential care.

The National Society for the Prevention of Cruelty to Children (NSPCC) is the UK's leading charity specialising in child protection and

the prevention of cruelty to children. It has been protecting children from abuse for over

100 years. The NSPCC is the only children's charity in the UK with statutory powers

enabling it to act to safeguard children at risk.

Who Cares Trust ( promotes the

interests of children in public care and work with ‘all those interested in their

well-being in England, Scotland, Wales, Northern Ireland and around the world’.

First Key ( ‘exists to significantly improve the life chances of

young people in and leaving care, through influencing and providing quality services to

those with particular responsibility for this potentially vulnerable group’.

Organisations representing elderly people, disabled people and their families

Age Concern England is the major non-statutory provider of services

and support for older people. It operates both at the national and local level. It works to

(a) Promote positive attitudes to older people and ageing (b) Influence and develop public

policies that affect older people (c) Promote effective care for older people (d) Encourage

choice and opportunity for older people.

Help the Aged provides a range of services including

information, a national telephone alarm system, and a Care Advisory Service, free advice

for long-term care advice on care provision.


There are many organisations designed to assist those with disabilities. These are mostly

specialist organisations concerned with specific disabilities. Two more general ones are

British Council of Disabled People

Disabled Living Foundation

A more complete list is included in Appendix Four.

7.3 Employment Conditions in care work

Because there are a large number of occupations (see Table 4.1) and information on

employment conditions is not available for each in sufficient detail, data on employment

conditions will be presented for each care field, using data from the LFS. Table 7.1 gives

details of the sector the care workers located in, their working hours, contractual status,

benefits, such as whether they were enrolled on an educational course, or had been on

work related training in the previous three months, and finally the hourly pay as given in

the LFS. Table 7.1 also includes the same details for workers in education (secondary

school teachers, primary/nursery teachers, special education teachers), those working in

job which have a high concentration of female workers and might therefore be similar to

childcare, and all women workers, as points of comparison.


Table 7.1 Employment conditions of care workers, education workers, those in high

percent female jobs and all women workers, percent, 1997 – 1999, UK

Job title/ occupational



Pu P+V



Mean FT





Pay (£ per


Childcare 1 57 43 23 35 80 17 29 4.41

Youth and residential care 38 62 41 72 93 12 34 6.32

Adult and elder care 48 52 30 46 93 12 33 4.70

Education workers 86 14 40 75 83 12 55 9.94

High percent female jobs 14 86 28 50 93 18 25 5.18

All women workers 30 70 31 55 92 14 29 6.29

1 childcare includes nursery nurses, playgroup leaders, educational assistants, other childcare occupations

Pu = Public; P+V = private and voluntary sector; FT = full-time; EnC = enrolled on a course; WRT = work

related training

Source: secondary analysis of the LFS, 1997 - 1999, analysis by Antonia Simon, TCRU; Simon et al., 2001

Table 7.1 shows that

·  Education and childcare workers are most likely to work in the public sector. Just

over half the childcare workers included in the LFS analysis were working in the

public sector, mostly in local government. Fewer adult and elder care workers, and

youth and residential care workers did so. The relatively high proportion of childcare

workers in the public sector is because many nursery nurses are working in local

authority schools but categorised as working in a childcare occupation, and because

of the large number of educational assistants working in schools.

·  In terms of working hours, youth and residential care workers worked the longest

hours per week, followed by education workers. Childcare workers worked the fewest

hours: they were also the least likely to work full-time, twenty percentage points less

likely than all women workers were. Overall, rather more than half care workers had

part-time jobs.

·  Childcare workers were least likely of all groups to have permanent contracts: 1 in 5

did not. This reflects the high proportion of educational assistants included within the

childcare category – educational assistants are more likely to be on yearly or termly

contracts that are nursery workers.

·  Childcare workers were more likely than those in other care work areas to be enrolled

on an educational course, but education workers were the most likely of al the groups

to have been on work related training in the previous three months.

·  The highest wages are earned by those working in education, while the lowest are

earned by those working in childcare and eldercare who earn about three-quarters of

the average for all women workers.


Chapter 8 Current debates and future directions

8.1 Current debates and policy trends

The main trend in current social policy for care work services is what could be called a

market-controlled approach. This, as outlined in Chapter Three, emphasises the private

market as a source of care provision, and at the same time seeks to control the way in

which the market develops. The private market and the voluntary sector have been

steadily adopting many of the provider roles that were once the province of local

government. Examples are home help services, residential care for older people, and

more recently for children and young people, where private and voluntary sector run

services and establishments now numerous if not in the majority. Some services have

always been in the private and regulated sector, such as childminding and foster care. For

all services the policy emphasis has been on improving the quality of care services by

setting occupational standards, creatin g professional barriers to entry to the profession

and tying resources to the fulfilment of government set targets.

The current government also has a clear agenda on alleviating and then eliminating child

poverty through economic success of parents and households: it seeks to encourage

employment as a method of increasing resources to children. To this end the government

will intervene in the private market and provide services such as childcare or the

infrastructure for services where there is 'market failure'. This might be an area of

economic deprivation where the private market requires input in order to flourish.

8.1.1 Private markets - staying power?

The main debates are about whether the private market has the interest in care and

welfare services, the capacity to sustain that interest over time and the human cost in

terms of terminated care arrangements if care services in the private sector are not

sustained. The privatisation trend in social care began in the 1980s and 1990s when an

organisational split between purchasing and providing social care services was introduced

through the Community Care Act 1991. Although this division has been subsequently

weakened within the organisation, the split in terms of who actually provides the care has


There is evidence that despite an ageing population, the number of places in residential or

nursing homes is declining. At the same time the number of households receiving home

care services is also declining (Social Trends 31, 2001). It is possible this is due to

increased levels of health, wellbeing and independence among the elderly population, or

it may indicate an increased reliance upon neighbours and family members due to the

unavailability of care services.


8.1.2 Quality Issues - regulation and training

·  Modernisation of training and social care profession through new regulations, targets

for recruitment, qualifications and mapping occupational standards. These bodies are

the Social Services Inspectorate, which inspects and reviews performanc e of local

authorities; the National Standards Care Commission, which will regulate provision

in the independent sector and ensure services work to common standards across the

country; the General Social Care Council, which will regulate the workforce and their

training; and the Social Care Institute for Excellence, which will aim to create a

knowledge base about what works in social care (SSI, 2001).

·  Encouraging employment and training through government initiatives such as the

New Deal (an employment and training initiative for people out of work),

ConneXions and Young People's Personal Advisors (a national network of support to

13 – 19 year olds that brings together many types of advice service including careers

health, welfare and so on), new vocational training for foster carers, and others such

as care assistants, based around on the job training (NVQs, Modern Apprenticeships).

8.1.3 Services to support families and the workforce

·  Supporting families in work: tapered tax credits for working families and for

childcare costs, some improvements to maternity and paternity provisions, but still

limited compared to the best in Europe.

·  Neighbourhood Nurseries Initiative, childcare information services, SureStart, Early

Excellence centres, extending part-time nursery education to all three year olds, and

extending the use of the school as a site for other services. These are all seen as

methods for improving the availability and quality of early years care and education,

and of assisting parents' entry to the la bour market.

8.1.4 Blurred Boundaries

·  Recasting care as 'education' for young children - formalisation of early childhood

experience through curriculum (Foundation Stage) which applies across nearly all

childcare and early education settings

·  Mixing care and health - or rather redefining care as health, care workers doing more

tasks previously ascribed to health workers, joint policies from health and local

authorities re older and disabled people

·  Informal/formal care - Cash for care schemes - giving disabled adults money to pay

for their own care services

8.1.5 The workforce?

What is happening to the worker amidst all this policy change? There is serious concern

about 'initiative overload' in welfare services such as care and education, where each new

minister has to make her or his mark by introducing a new policy, with little time to

embed and evaluate the previous initiatives. There is serious concern about recruitment

and retention rates in all of the care work occupations we have discussed, and beyond in

teaching, social work and nursing. Forty percent of all new teachers are said to have left


the profession within five years. The NISW studies of the social care workforce identified

stress as a major issue for social work staff. Whether these factors are linked or not

remains to be established. Within the childcare sector, while recruitment and turnover

rates are high, most occupational mobility is within the childcare and early years field,

suggesting that the intrinsic rewards of the job remain, but the search for better conditions

of employment continues.

The care worker is a curiously under-examined feature of the policy changes and debates.

Relatively little attention is paid to what the worker actually does while at care work in

the setting of occupational standards: it is more about how to create an environment

where mistakes do not happen and the full range of responsibilities are itemised.



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DH (2001e) Personal Social Services Staff of social services departments at 30

September 2000 England London: DH

Fisher and Tronto (1990) Towards a Feminist Theory of Caring, in Abel, e. and nelson,

M (eds) Circles of Care: Work and Identity in Women's Lives, New York, State

University of New York Press

Higham, P. (1998) The future of social work lies in social care, Professional Social Work,

November 1998, p4

Hugman, Peelo and Soothill, (1997) Boundaries of care - an introduction

Jacobzone, S. (1999) Ageing and Care for Frail Elderly Persons: an Overview of

International Perspectives. Labour Market and Social Policy Occasional Paper

No. 38. Paris: Organisation for Economic Cooperation and Development

Netten, and Curtis (2000) Unit Costs in Health and Social Care, University of Kent,


Philpot, T. (2001) Private Lives, Community Care, 22- 28 November, pp34 - 35

Quality Curriculum Authority (2000) Foundation Stage Curriculum, London, QCA

Simon, A., Owen, C., Moss, P. and Cameron, C. (forthcoming) Mapping the Care

Workforce: Supporting joined-up thinking, Secondary analysis of the Labour

Force Survey for childcare and social care work, London, Institute of Education

Twigg, J. (2000) Bathing - The Body and Community Care, London, Routledge


Appendix One

Unit costs of selected care services, (from Netten and Curtis, Unit Costs of Health and

Social Care (2000)).

Care work areas 1 and 2, 1999/2000

Service Included Type/variation

Per week unless

otherwise stated

Unit cost £

Local authority day nursery for




Session, am, pm 20



Local authority community home 1,612

for children

Care package

costs (2)


Local authority foster care for




support and other

services (3)


(1) establishment costs include buildings, staffing, overheads

(2) care package costs include establishment plus other costs such as living expenses, external services

(3) expenditure on foster care should be treated with caution as it includes expenditure on lodgings,

living independently, residential employment, children placed with parents and children placed for


Care work area 3, applicable for year 1999/2000

Service Included Type/variation

Per week unless

otherwise stated

Unit cost £

Fee Long term 369

Short term 356

Long term 396

Independent (private and

voluntary) nursing homes for

elderly people(4)

Fee plus external

services (5)

Short term 383

Long term 265 Fee

Short term 281

Long term 289

Private residential care for elderly


Fee plus external

services Short term 305

Long term 257 Fee

Short term 272

Long term 282

Voluntary residential care for

elderly people

Fee plus external

services Short term 297

Establishment Long term 419

costs Short term 435

Long term 440

Local authority residential care for

elderly people


costs plus external

services Short term 451


Local authority day care for

elderly people

Revenue costs Per session (am,



Voluntary day care for elderly


Capital and

revenue costs

Per day 24 - 27

Local authority sheltered housing

for elderly people

Capital, revenue

costs and external

services (6)

Per week 148

Housing ass ociation sheltered

housing for elderly people

Capital, revenue

costs and external


Per week 157

Care work area 3 continued, applicable for year 1999/2000

Service Included Type/variation

Per week unless

otherwise stated

Unit cost £

Local authority very sheltered

housing for elderly people

Capital, revenue

costs and external

services (3)


Housing association very

sheltered housing for elderly


Capital, revenue

costs and external

services (3)




Local authority residential care 331

(staffed hostel) for people with

mental health problems Care package





Local authority residential care 73

(group home) for people with

mental health problems Care package





Voluntary sector residential care 295

(staffed hostel) for people with

mental health problems Care package





Voluntary sector residential care 160

(group home) for people with

mental health problems Care package





Private sector residential care 205

(staffed hostel) for people with

mental health problems Care package



Local authority social services

day care for people with mental

health problems

Capital and

revenue costs

Session/day 34

Voluntary/non-profit day care

for people with mental health


Capital and

revenue costs

Session/day 34

Sheltered work schemes Total expenditure Gross per hour 6.40

and income Net per hour 5.00

Voluntary sector residential

rehabilitation for people who

misuse drugs/alcohol

Capital and

revenue costs





Group homes for people with 825

learning disabilities

Care package





Village communities for people 626

with learning disabilities (vol

sector) Care package





Supported living schemes for 933

people with learning disabilities

(independent and public sector) Care package



Local authority day care for

people with learning disabilities

Revenue costs Session/am,pm 23

Voluntary sector activity-based

respite care for people with

learning disabilities

Staffing, capital

and overheads

Per client hour 13

Hour 10.10

Local authority home care


Salary and


Care package 64.80

(4) Source does not include living expenses and is not directly comparable with residential care

(5) Fees in London homes 32 percent higher than national average

(6) External services are community nursing, GP services, other external services, personal living costs


Appendix Two

Glossary of Caring services and Care work occupations in the UK

The four main areas of care work are as follows:

1. Childcare services (National Childcare Strategy 0 - 14 yrs)

2. Residential care services for children and young people

3. Community care services for adults (disabled and elderly)

4. Residential care services for adults (disabled and elderly)

These areas border on a number of related services, which include:

1. Education services (formal schooling aged 5 - 16/18)

2. Health care services (hospital and GP based services)

3. Social work services (organisation and planning for child protection, youth justice,

leaving care, mental health, elder care - but not directly providing care)

4. Community development work services (facilitating work in or using community

centres, playschemes, networks for groups such as mothers, toddlers, return to work etc)

5. Employment support - ConneXions services, personal advisors (new initiative to

provide a personal advisor for every young person leaving school - combining careers

advice, financial, housing and other practical advice, particularly applicable to those

leaving care).

Below are set out the main areas of care services, with a mention for each service type.

Included within each service type are three features of the service:

a = What the service is

b = For whom the service is provided

c = By whom the service is provided. Job titles (not including managers, co-ordinators).

At the end of each main area of care services is a section called neighbouring fields .

These are services which border on the main care services, but do not seem so centrally

involved in providing care.

1. Childcare Services

1.1 Day nurseries

a. Usually all day (10 hour), year round care and education in an institution

b. For children aged 0 - 4

c. Nursery nurses, nursery assistants (trained and untrained)

1.2 Childminders

a. Part time or full-time family day care (hours to suit individual)

b. For children aged 0 - 7

c. Registered and unregistered childminders (mostly without training)

1.3 Nannies

a. Part-time or full-time care provided in the employer's home

b. For children aged 0 - school age, although may continue longer


c. Usually individuals with childcare training, but not necessarily and they are not

regulated or registered. Private arrangement with parents.

1.4 Playgroups/preschools

a. Sessional (2 - 3 hours) care and education

b. For children aged 2 ½ - 4

c. Playgroup/preschool supervisors, playgroup leaders, playgroup assistants

(trained and untrained)

1.5 Combined centres/early excellence centres

a. All day care and education in an institution

b. For children aged 0 - 4 (may also offer after school facility)

c. Teachers, nursery nurses, nursery assistants (trained and untrained)

1.6 Family centres

a. Various models exist from 'drop in' to referral only, address children's needs as

part of a family - may or may not offer separate childcare facility

b. For children of all ages, but predominantly 0 - 4

c. Social workers, family centre workers, day services officers, nursery nurses,

play workers (trained and untrained)

1.7 After school clubs/out of school services

a. Play and care service before and/or after school and/or in the school holidays

b. For children aged 4 - 11

c. Playw orkers, play assistants, volunteers (trained and untrained)

1.8 Nursery class/school

a. Part-time education and care in an institution (usually part of a school)

b. For children aged 3 and 4

c. Teachers, nursery nurses, volunteers

1.9 Reception class

a. Part-time and full-time education and care (first year of school)

b. For children aged 4 and 5

c. Teachers, nursery nurses, classroom assistants

1.10 Schools11

a. Full-time (term time) education

b. For children aged 5+

11 Although the primary role of schools is to deliver the curriculum, there are two ways in which schools

also have a 'care' role. First, virtually all schools recognise they have a pastoral care responsibility, and may

designate certain teachers to coordinate this work. Second, virtually all schools also employ non-teaching

staff who assist teachers, particularly in classes for younger children and children with special needs. These

staff were traditionally 'nursery nurses', although now many people without a childcare training are

employed as learning support assistants etc.


c. Nursery nurses, classroom assistants, learning support assistants, special needs

assistants, one-to-one workers, working alongside teachers

1.11 Special schools12

a. Full-time (term time) education, residential or day

b. For children and young people with specific difficulties, eg., learning,

disability, behavioural

c. Teachers, care assistants, psychologists

1.12 Truancy exclusion units

a. Places where children with difficulties in school can go for sessional education

b. Children who are in danger of or have been excluded from school

c. Teachers, education social workers, psychologists

Neighbouring fields

Family Aides, family workers, family visitors

Employed by local authority social services to visit children and families about specific

problems (eg., behavioural, social, family)

Education social workers

Employed by local education authorities to visit children and families about specific

problems in school (non-attendance, behaviour and/or learning problems, family


2. Residential care services for children and young people

2.1 Foster care

a. Care provided by individuals and/or families to children and young people in

need (including those with disabilities) who cannot live at home or with other


b. For children and young people aged 0 - 17+

c. Foster carers, foster care support workers, social workers

2.2 Residential care

a. Institutional based care for children and young people who cannot live at home

or with other relatives and an alternative to foster care

b. For children and young pe ople, usually aged 10+

c. Residential social workers, houseparents, wardens. Also social workers,

therapists, psychologists, counsellors

2.3 Respite care

a. Family based or institutionally based care at intervals

12 The 'care' role of schools' is even more apparent in schools for children with special needs.


b. For children with disabilities who mainly live at home but whose carers need

regular breaks

c. Families, foster carers, residential social workers, social workers

2.4 Private foster care

a. Usually care provided by a member of the extended family. Can be supported

by the state.

b. For a child/sibling group that cannot live at home, e.g., through displacement,

immigration, family conflict

c. Families

2.5 Adoption

a. Care provided by a family who intend to offer a permanent home, or to work

towards the child returning to their original family. Can be supported by the state.

b. For children and young people for whom a permanent home is required.

c. Adoptive families, adoption workers, social workers

2.6 Hospices for children

a. Care provided in an institution for children who are terminally ill and their


b. Children and young people who are terminally ill

c. Nurses, social workers, counsellors

Neighbouring fields

Supported accommodation

Rooms in shared houses or hostels for young people (aged 16+) who have left public care

with practical and emotional support from a project worker.

Boarding schools

Schools with residential facilities for children (aged 7+, but normally 12+). Usually paid

for by parents, but can be supported by the state in exceptional circumstances.

Houseparents, teachers

3. Community care services for adults (disabled and elderly)

3.1 Home helps/home care

a. Help in the home with personal care, housework, shopping

b. Disabled and/or elderly people

c. Home helps, home carers, home care assistants

3.2 Sheltered accommodation

a. Housing with practical and social support

b. Disabled and/or elderly people in need of support

c. Wardens, care assistants


3.3 Day centres

a. Social activities, occupational therapy, practical assistance

b. Disabled and/or elde rly people in need of social contact

c. Care assistants, occupational therapists

3.4 Voluntary visiting schemes

a. Social activities in own homes or in day centres

b. Elderly and/or disabled people

c. Private arrangements by voluntary organisations

3.5 Sheltered employment schemes

a. Workshops and industries that offer employment with support

b. Disabled adults who need support to earn an income

c. Project workers (?)

Neighbouring fields

Voluntary schemes of various kinds eg., gardening for elderly people, social clubs in

pubs, social activities such as bingo, cards etc. These and many others may or may not

have a degree of support from a care worker of some kind.

4. Residential care services for adults (disabled and elderly)

4.1 Old people's ho mes/residential care/Part III homes

a. Care and accommodation on long term or respite (interval) basis

b. Elderly people who may or may not have disabilities and who cannot manage

their own homes/daily living

c. Care workers, care assistants

4.2 Resid ential care for adults with disabilities

a. Care and accommodation on a long term or respite basis

b. Adults with severe or specific disabilities and who cannot manage in their

families or on their own.

c. Care workers, care assistants

4.3 Nursing homes

a. Health care and accommodation on a long term or respite basis

b. Adults and or elderly people with chronic illnesses or disabilities that no longer

require hospital care but do require attentive nursing care

c. Nurses, nursing auxiliaries, care assistants

4.4 Hospices

a. Care provided in an institution either on a long term or respite basis

b. For adults and/elderly people who are terminally ill and need to be cared for

away from home

c. Nurses, nursing auxiliaries, care assistants


Neighbouring fields

Day hospitals

Institutions primarily designed for health services/interventions, but where social

activities may be available, as well as advice and support on practical matters.

Staffed by occupational therapists, nurses, health care assistants.

The main professional care occupations in UK (there are many variations), excluding

managerial job titles

Adoption worker

Care assistant

Care worker



Family centre worker

Foster carer

Health care assistant

Home care assistant

Home he lp/home carer


Learning support assistant


Nursery nurse

Nursery assistant

Care occupations that involve some care

work, but do not belong in the care

domain for this project.

Adoption worker



Occupational therapist

Play therapist

Project worker


Social Worker




Nursery supervisor

Nursing auxiliary


Occupational therapist

One to One assistant

Playgroup/preschool leader

Playgroup/preschool assistant

Play therapist


Project worker


Residential social worker

Social Worker




Appendix Three

Analysis of the LFS for childcare workers, youth work and residential care workers, and

adult and elder care workers.

Table A3.1 Care workers, SOC codes, population and percentage, 1997 – 1999, UK

Care Group Individual

occupations within

the groups

SOC codes13 Population


Percent of


1. Child Care


Nursery Nurses14

Playgroup leaders15

Educational assistants16

Other childcare


Total in Group










2.1 percent

2. Youth Work and

Residential Care



Total in Group

370 71,249


0.1 percent

3. Adult and Elder


Assistant nurses and


Care assistants and


Total in Group






1.2 percent

4. Other



Total in Group

Rest of SOC



44 percent20

13 SOC codes are taken from the Standard Occupational Classification 1990, ONS publications.

14 This includes assistants and supervisors working within the Nursery setting.

15 This includes assistants and supervisors working within the playgroup/pre -school setting.

16 This includes learning support assistants/one to one assistants.

17 This includes Family center workers, home helps/home carers, nannies and out-of-school service


18 This coding also includes ‘Foster Carers’ and ‘Residential Social Workers’. SOC 2000 provides a more

detailed look at what occupations are coded within each SOC code than does SOC 1990. SOC 2000 allows

one to look at SOC 1990 codes. From this, we were able to determine that Residential Social Workers are

coded with the Matrons and Houseparents (code 370) in SOC 1990 and not with the Social

Workers/Probation Officers (code 293).

19 This includes day center workers (residential homes)

20 54 percent of the population is inactive.


Table A3.2 The age distribution of the care workforce, LFS, 1997 – 1999, UK

Care Groups Age groups








35-49 years 50 plus years

Childcare workers N 99947 108113 259008 90249 557317

percent 17.9 19.4 t 46.5 t 16.2 100

Youth work and

Residential care

N 5403 9314 30583 25949 71249

percent 7.6 13.1 42.9 36.4 100

Adult and Elder care N 116542 138580 244722 175028 674872

percent 17.3 20.5 36.3 25.9 100

Total N 221892 256007 534313 291226 1303438

percent 17.0 19.6 41.0 22.3 100

Table A3.3 Ethnic distribution of the care workforce, LFS, 1997 – 1999, UK

Care Groups Ethnic groups Total

White Black Asian Other

Childcare workers N 534960 8395 8733 5228 557316

percent 96.0 1.5 1.6 .9 100

Youth work and Residential


N 67415 1725 941 1168 71249

percent 94.6 2.4 1.3 1.6 100

Adult and Elder care N 641163 21871 4357 7364 674755

percent 95.0 3.2 .6 1.1 100

Total N 1243538 31991 14031 13760 1303320

percent 95.4 2.5 1.1 1.1 100

Table A3.4 Gender distribution of the care workforce, LFS, 1997 – 1999, UK

Care Groups Sex Total

Male Female

Childcare workers N 15006 542311 557317

percent 2.7 97.3 100

Youth work and Residential care N 10735 60514 71249

percent 15.1 84.9 100

Adult and Elder care N 61089 613782 674871

percent 9.1 90.9 100

Total N 86830 1216607 1303437

percent 6.7 93.3 100


Table A3.5 Marital status distribution of the care workforce, LFS, 1997 – 1999, UK

Care Groups Marital status


Married Living


as couple

Single Widowed Divorced Separated

Childcare workers N369098 35268 102522 8469 29463 12497 557317

percent 66.2 6.3 18.4 1.5 5.3 2.2 100

Youth work and

Residential care

N 48883 4614 7713 2182 5731 2124 71247

percent 68.6 6.5 10.8 3.1 8.0 3.0 100

Adult and Elder care N385445 65259 132226 16058 54412 21472 674872

percent 57.1 9.7 19.6 2.4 8.1 3.2 100

Total N803426 105141 242461 26709 89606 36093 1303436

percent 61.6 8.1 18.6 2.0 6.9 2.8 100

Table A3.6 Highest qualification of care workforce, LFS, 1997 – 1999, UK

Care Groups Highest qualification


Degree Above







Other No


Childcare workers N 22499 72122 110650 174922 98213 76265 554671

percent 4.1 13.0 19.9 31.5 17.7 13.7 100

Youth work and

Residential care

N 5279 17330 14222 12732 15172 6073 70808

percent 7.5 24.5 20.1 18.0 t 21.4 8.6 100

Adult and Elder care N 16059 54038 149994 137166172925 138629 668811

percent 2.4 8.1 22.4 20.5 25.9 20.7 100

Total N 43837 143490 274866 324820286310 220967 1294290

percent 3.4 11.1 21.2 25.1 22.1 17.1 100


Appendix Four

Selected disability organisations

Action for Blind People



Arthritis Care

Article 12


British Council of Disabled People

British Deaf Assocation

British Dyslexia Association

British Epilepsy Association

British Institute for Brain Injured Children

British Institute of Learning Disabilities

British Stammering Association

Brittle Bone Society

Centre for Accessible Environments

Contact a Family

Council for Disabled Children

Cystic Fibrosis Trust


Disabled Living Foundation

Dog AID (Assistance in Disability)

Down’s Syndrome Association

Dyspraxia Foundation

Fragile X Society

Guide Dogs for the Blind Association

Henry Spink Foundation

Hyperactive Children’s Support Group


Muscular Dystrophy Group

National Asthma Campaign

National Autistic Society

National Deaf Children’s Society

National Eczema Society

National Federation of Gateway Clubs

National Library for the Blind

National Portage Association


RADAR - Royal Association for Disability & Rehabilitation

Reach -resource centre for children with reading disabilities


Royal National Institute for Deaf People

Royal Institute for the Blind

SKILL - National Bureau for Students with Disabilities


SENSE - National Deaf/Blind and Rubella Association

Sickle Cell Society

Values into Action

Young Minds