1
Care Work
Current understandings and future directions in Europe
National Report, United Kingdom
WP3
Mapping of Care Services and the Care Workforce
Claire Cameron
Peter Moss
January 2001
Thomas Coram Research Unit, Institute of Education
University of London
2
Contents
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
3
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
...................................................................................................................................44
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
Tables
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,
UK.............................................................................................................................44
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
4
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.
5
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.
6
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
7
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.
8
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
responsibility.
9
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.
10
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.
11
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
England.
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
practice.
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.
12
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
qualification.
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
13
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.
14
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.
15
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.
16
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.
17
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
locality.
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.
18
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
Sector1
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
Childcare
Holiday
playschemes
12,900
Residential homes
and schools
1,46 59 19 22 100
Bail hostels and
supported accom
Hospices 21 100 100
Residential
care for
children
and young
people
Foster care 100 100
Day centres Information
not
available
Day and
residential
care for
adults/
elderly
Home care 44 56 100
19
Residential and
nursing homes
30,700 8 92 100
Extracare/supported
housing
Information
not
available
Homes for disabled
adults
Information
not
available
elderly
Hospices 200 25 75 100
1 Voluntary
and private providers are also known as 'independent', which combines the two
types of
provision.
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,
1999).
20
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
21
for care services and arrange for that care to be
provided (often known as a 'care
package').
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).
22
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.
23
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.
24
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 -
2001
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
Places
1993 1994 1995 1996 1997 1998 1999 2000 2001
0
100
200
300
400
500
Thousands
Playgroup Childminder Day nursery
25
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
0
100
200
300
400
500
Thousands
Playgroup Primary Nursery
26
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
27
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).
28
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.
29
towards the next stage in their lives, along with
social workers and other welfare
professionals.
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.
30
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
independently
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
31
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
unknown.
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
32
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
Setting
Age
Domestic
Local care and welfare Educational Residential
Child
(0-4/5)
Childminders
Nannies
Foster carers
Hospice care
Day nurseries/ neighbourhood
nurseries
Playgroups/preschools
Toddler groups
Family centres
Combined centres/early
excellence centres
Nursery schools and
classes
Playgroups/preschools
Opportunity playgroups
Hospices
Young
(4/5 – 18/22)
Childminders
Fostercarers,
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+)
Hospices
Adult
(18/22 –
60/65)
Home care/personal
assistants for people
with disabilities
Hospice care
Day centres for people with
disabilities/mental health
problems
Residential care for people with
disabilities
Sheltered accommodation
Hospices
Elder
(60/65 <)
Home help/home
care
Hospice care
Day centres Residential care, long term and
respite
Sheltered accommodation
Hospices
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
33
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.
34
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.
35
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
codes
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
36
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
37
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
38
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
39
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.
40
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,
2001).
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
41
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.
42
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
such.
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
43
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
spending
Total
Nursery schools and
classes
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.
44
Table 6.2 Parental expenditure on childcare, term time
and holidays, by age gr oup, mean,
UK
£ 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
Nursery/creche/playgroup
only
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
Total
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
workers.
Table 6. 3 Net public expenditure on selected
residential and youth services:1999-2000:
England
£m
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
services
Overall public spending on this care work area is
itemised in Table 6.4 below.
45
Table 6.4 Net public expenditure on selected services
for adults and elderly people: 1999-
2000: England
£m
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,
2001).
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
costs”.
46
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,
p.c.).
47
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 (www.tuc.org.uk).
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
bargaining.
· 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
48
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
people).
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 http://www.ncvcco.org/
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) http://www.ncb.org.uk/about.htm 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
Wales.
The Day Care Trust http://www.daycaretrust.org.uk
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 http://www.ncma.org.uk/erol.html
49
The National Day Nurseries Association is a national childcare charity that promotes
quality childcare and education for all children in
the early years
http://www.ndna.org.uk/aboutus.html
The Pre-school Learning Alliance (http://www.pre-school.org.uk/Home.htm)
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 (http://www.nann.co.uk/) 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 http://www.kidsclubs.org.uk is
the national organisation for out of
school childcare.
National Children's homes (NCH) http://www.nchafc.org.uk/ 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)
http://www.nspcc.org.uk/ 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 (http://www.thewhocarestrust.org.uk/frames.html) 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 (http://www.first-key.co.uk/) ‘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 www.ace.org.uk/ 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 www.helptheaged.org.uk 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.
50
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
www.bcodp.org.uk
Disabled Living Foundation
www.dlf.org.uk
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.
51
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
category
Sector
Pu P+V
Working
hours
Mean FT
Permanent
contract
Benefits
EnC WRT
Pay (£ per
hour)
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.
52
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
remained.
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.
53
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
54
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.
55
References
Abel, E. and Nelson, M. (eds) (1990) Circles of Care:
An Introductory Essay, in Circles
of Care: Work and Identity in Women's Lives, New York, State University of New
York Press
Baker, C., Gibbs, I., Sinclair, I and Wilson, K (2000)
Supporting Foster Placements,
University of York, Social Work Research and
Development Unit
Cameron, C. Moss, P. and Owen, C. (2001) Entry,
Retention and Loss, A study of
childcare workers and students, Research Report 275, London DfES
DfES (2001a) Children's Day Care Facilities as at 31
March 2001 , England, London:
DfES
DfES (2001b) DfES/gov.uk/statistics/DB/SBU/bo293/sb08
-2001.pdf
DfES, (2001c) Statistics of Schools, 2001,
London: DfES
DfES, (2001d)
Raising standards: opening doors , London: DfES
DH (1989) An Introduction to the Children Act,
London: HMSO
DH (2001a) Children looked after at 31 March,
England, London: DH
DH (2001b) Modern Social services: A commitment to
deliver, The10th annual report of
the Chief Inspector of Social Services, 2000/2001, London: SSI
DH (2001c) Community Care Statistics 2000: Home
help/home care services, England,
London: DH
DH (2001d) Community Care Statistics 2000:
Residential care services, England,
London:DH
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,
PSSRU
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
56
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
children
Establishment
costs(1)
Session, am, pm 20
Establishment
costs
Local authority community home 1,612
for children
Care package
costs (2)
1,837
Local authority foster care for
children
Allowances,
administration,
support and other
services (3)
538
(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
adoption.
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
people
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
Establishment
costs plus external
services Short term 451
57
Local authority day care for
elderly people
Revenue costs Per session (am,
pm)
19
Voluntary day care for elderly
people
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
services
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)
200
Housing association very
sheltered housing for elderly
people
Capital, revenue
costs and external
services (3)
311
Establishment
costs
Local authority residential care 331
(staffed hostel) for people with
mental health problems Care package
costs
405
Establishment
costs
Local authority residential care 73
(group home) for people with
mental health problems Care package
costs
179
Establishment
costs
Voluntary sector residential care 295
(staffed hostel) for people with
mental health problems Care package
costs
358
Establishment
costs
Voluntary sector residential care 160
(group home) for people with
mental health problems Care package
costs
239
Establishment
costs
Private sector residential care 205
(staffed hostel) for people with
mental health problems Care package
costs
278
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
problems
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
569
58
Establishment
costs
Group homes for people with 825
learning disabilities
Care package
costs
1,039
Establishment
costs
Village communities for people 626
with learning disabilities (vol
sector) Care package
costs
794
Establishment
costs
Supported living schemes for 933
people with learning disabilities
(independent and public sector) Care package
costs
1,113
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
worker
Salary and
overheads
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
59
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
60
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.
61
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
problems)
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
relatives
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.
62
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
families
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
63
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
64
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
Childminder
Counsellor
Family centre worker
Foster carer
Health care assistant
Home care assistant
Home he lp/home carer
Houseparent
Learning support assistant
Nurse
Nursery nurse
Nursery assistant
Care occupations that involve some care
work, but do not belong in the care
domain for this project.
Adoption worker
Counsellor
Nurse
Occupational therapist
Play therapist
Project worker
Psychologist
Social Worker
Teacher
Vicar/pastor
Warden
Nursery supervisor
Nursing auxiliary
Nanny
Occupational therapist
One to One assistant
Playgroup/preschool leader
Playgroup/preschool assistant
Play therapist
Playworker
Project worker
Psychologist
Residential social worker
Social Worker
Teacher
Warden
65
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
numbers
Percent of
Workforce
1. Child Care
workers
Nursery Nurses14
Playgroup leaders15
Educational assistants16
Other childcare
occupations17
Total in Group
650
651
652
659
111,410
27,270
154,129
264,507
557,316
2.1 percent
2. Youth Work and
Residential Care
Matrons18
/houseparents
Total in Group
370 71,249
71,249
0.1 percent
3. Adult and Elder
Care
Assistant nurses and
auxiliaries
Care assistants and
attendants19
Total in Group
640
644
156,979
517,893
674,872
1.2 percent
4. Other
occupations
N/A
Total in Group
Rest of SOC
codes
25,654,847
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
workers.
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.
66
Table A3.2 The age distribution of the care workforce,
LFS, 1997 – 1999, UK
Care Groups Age groups
Total
25
years
and
under
25-34
years
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
care
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
67
Table A3.5 Marital status distribution of the care workforce,
LFS, 1997 – 1999, UK
Care Groups Marital status
Total
Married Living
together
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
Total
Degree Above
A
levels
A
levels
O
levels
Other No
qualifications
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
68
Appendix Four
Selected disability organisations
Action for Blind People
www.afbp.org
ADAPT Trust
www.adapttrust.co.uk
AFASIC
www.afasic.org.uk
Arthritis Care
www.arthritiscare.org.uk
Article 12
www.article12.uk.com
ASBAH
www.asbah.org
British Council of Disabled People
www.bcodp.org.uk
British Deaf Assocation
www.bda.org.uk
British Dyslexia Association
www.Bda-dyslexia.org.uk/
British Epilepsy Association
www.epilepsy.org.uk
British Institute for Brain Injured Children
www.bibic.org.uk
British Institute of Learning Disabilities
www.bild.org.uk
British Stammering Association
www.stammering.org
Brittle Bone Society
www.brittlebone.org
Centre for Accessible Environments
www.cae.org.uk
Contact a Family
www.cafamily.org.uk
Council for Disabled Children
www.ncb.org.uk
Cystic Fibrosis Trust
www.cftrust.org.uk
69
Disabled Living Foundation
www.dlf.org.uk
Dog AID (Assistance in Disability)
www.dogaid.org.uk
Down’s Syndrome Association
www.downs-syndrome.org.uk
Dyspraxia Foundation
www.emmbrook.demon.co.uk/dysprax/homepage.htm
Fragile X Society
www.fragilex.org.uk
Guide Dogs for the Blind Association
www.gdba.org.uk
Henry Spink Foundation
www.henryspink.org
Hyperactive Children’s Support Group
www.hyperactive.force9.co.uk
Mencap
www.mencap.org.uk
Muscular Dystrophy Group
www.sonnet.co.uk/muscular-dystrophy
National Asthma Campaign
www.asthma.org.uk
National Autistic Society
www.oneworld.org/autism_uk
National Deaf Children’s Society
www.ndcs.org.uk
National Eczema Society
www.eczema.org
National Federation of Gateway Clubs
www.mencap.org.uk
National Library for the Blind
www.nlbuk.org
National Portage Association
www.portage.org.uk
PHAB
www.phabengland.org.uk
RADAR - Royal Association for Disability &
Rehabilitation
www.radar.org.uk
Reach -resource centre for children with reading
disabilities
www.reach-reading.demon.co.uk
70
Royal National Institute for Deaf People
www.rnid.org.uk
Royal Institute for the Blind
www.rnib.org.uk
SKILL - National Bureau for Students with Disabilities
www.skill.org.uk
Scope
www.scope.org.uk
SENSE - National Deaf/Blind and Rubella Association
www.sense.org.uk
Sickle Cell Society
www.sicklecellsociety.org
Values into Action
www.demon.co.uk/via/
Young Minds
www.youngminds.org.uk