The Department of Health and Social Care has refused to agree to a plea from a group of MPs to tackle the disparity in pay and conditions between health and social care staff.
The Public Accounts Committee called for the department to address a “wide gap in pay and career structure between people who work in the NHS compared with social care” more than three years ago.
But in an update on its progress implementing the recommendation, DHSC permanent secretary Chris Wormald said it was impossible to compare – and therefore set comparable conditions for – jobs in the two sectors.
In a 2018 report, PAC said DHSC should ensure its upcoming social care workforce plan “addresses the previous criticisms made by the committee and make sure it tackles the longstanding barriers between health and social care, particularly disparity in pay and conditions and the transfer of pension arrangements”.
The department has for many years urged the government to take action to improve conditions and make jobs more attractive in the social care sector, which is struggling to address longstanding – and worsening – recruitment and retention issues.
But Wormald said the government had rejected the recommendation due to the difficulty of comparing NHS and social roles.
“No formal assessment of the activities carried out within [adult social care] roles has been made (or could be made, for all roles) in a comparable way to the defined activities carried out in NHS roles,” he said in the letter written in December, which was not published until last week.
“That would be a necessary condition to allow a formal, transparent and fair alignment of pay, terms and conditions.”
“In reality, care workers carry out a wide and diverse range of activities and responsibilities, and it is right and appropriate that independent employers reward them accordingly.”
Most care workers are employed by private sector providers who set their pay independently of the government. Wormald said this is very different from the national, collectively agreed terms and conditions that most NHS staff are employed under.
He also said it is important for local authorities to be able to commission services flexibly to suit the care needs of those they are responsible for helping, and for those who fund their own care to be able to find the right kind of support.
In its 2018 report, PAC also said difficulties in transferring pension arrangements across the health and social care sectors in its recommendations to DHSC discourages closer integration.
Responding to the MPs’ recommendation to make it easier to transfer pensions, Wormald said: “The department always takes a flexible approach in responding to any problems that may occur, including transfers between the NHS and local authorities (and vice versa), on a case-by-case basis.”
What are the government’s plans to support the social care workforce?
The social care workforce is “critical to enabling the highest standards of care and support”, Wormald said in his letter to PAC chair Meg Hillier, in which he expressed the department’s desire to help it “reach its full potential”.
The government outlined details of its plan to support the workforce in its white paper People at the heart of care, which was released on 1 December, and included a commitment to investing “at least £500m” into training, progression and wellbeing.
The paper sets out the government’s 10-year plan to transform the care system in England and cites staff turnover; vacancy rates; workforce mental health and burnout; and training and career structures as issues that need to be addressed to better support the workforce.
But the government has been criticised for a lack of action on pay.
The Local Government Association said many of DHSC’s plans to support the workforce would be hard to deliver without meaningful action on pay because people will not have a guarantee of increased pay and reward for increasing their skills and may continue to use social care as a “stepping-stone” to the NHS or elsewhere.
More than 20% of care workers are paid only the National Living Wage of £8.72 per hour, with one in five under the age of 25 paid less than this.
The government says its planned National Living Wage increase will give the lowest-paid care workers a real-terms pay rise but the LGA said this would not be enough for the sector to become competitive with the NHS and other key employers.