I have just completed Taking Care, a review of the pay and conditions of care workers, which will be published this month. This is my fourth report into working conditions in different sectors. The last one was about the fashion industry and the unhealthy working environment of models.
It received extensive publicity and became known as the Skinny Model Report. I very much doubt that this latest report will receive anything like as much media attention, even though there are an estimated 1.5 million care workers in the UK, probably the biggest single group of workers in the country.
Care is not a glamorous occupation. It involves dealing with vulnerable people on a daily basis, entering elderly and disabled people's homes in distant locations, providing intimate care and support, prompting for vital medication and engaging with elderly people with dementia, Alzheimer's and multiple conditions in short bursts of time throughout the day.
These activities don't take place in a high-tech hospital with white-coated doctors and eager students. They don't take place in a colourful room with engaged staff and constant activities for people who are collected at the end of the day. They take place in people's homes and in care homes where there are multiple residents, each with different conditions.
The role that care plays in our society is vital. Care workers deliver support to people nearing the end of their lives, disabled people and people with chronic illnesses, enabling them to live comfortably and in a dignified way.
Care workers are undervalued, underpaid, undertrained and underregulated. They don't have the status of nurses. They don't have the status of childminders. They are subject to no regulation and no registration. This workforce of 1.5 million people is almost invisible.
All too often during the course of my review, I heard the words 'I'm just a care worker'. How unfair that sounds. Care workers often have to deal with complex feeding methods, use hoists for moving clients, dress wounds, administer medication and provide vital emotional and domestic support. It's not a job for the faint-hearted and it's certainly not 'just' a job.
Yet care workers are subject to among the worst conditions of any workers in the UK. Their wages are almost universally either national minimum wage or no more than 15% above that. Frequently, even the national minimum wage is ignored, with employers refusing to pay domiciliary workers for the time it takes to travel to their clients.
Many care workers don't even know what hours they'll be working from week to week. 'Zero-hours contracts' play a huge role in the sector and destabilise workers' lives.
Qualifications are patchy. The Care Quality Commission's requirements have been reduced and the provision of care has been increasingly focused on the independent sector. Training varies considerably, with no real common framework for care workers. The workforce tends to be older women or migrant workers. Younger people are reluctant to enter the industry, because there is no career progression.
Care is in crisis. This review into the exploitation of care workers, in which I was ably assisted by three dedicated researchers, Neil Gandhi, John Davitt and Eline Jaktevik, was prompted by concerns about how these workers are treated and their capacity to deliver quality care. Poor conditions for workers often lead to poor quality of service for clients.
The pressure of austerity measures on local authorities has led to years of underfunding for care workers and service users alike. Our review focuses on practical ways to improve working conditions without increasing funding, but the call from all sides for greater investment in care is overwhelming.
Underfunding is a false economy: if we truly valued care, there would be less need for vulnerable people to go to hospital, a benefit to the public purse and to service users.
The care sector is big business. Training body Skills for Care estimates that it is worth about £43bn to the UK economy and is growing as the population ages. Care of the elderly is a lucrative industry and yet it is characterised by a plethora of small businesses dependent on diminishing local authority budgets. Even the largest provider, Four Seasons Health Care, has only a 5.2% market share.
It is a sector that has been beset with scandal. Companies such as Southern Cross Healthcare, which operated 750 care homes and employed 41,000 staff until it closed in 2012 with huge debts, have given the industry a reputation for poor financial management.
Many smaller providers are hanging on by the skin of their teeth. The sector is also haunted by the spectre of abuse, such as the horrific case last year of the Orchid View care home. Given that it is likely that most of us will need paid-for care in the last two years of our lives, it's a sector that merits a brighter light being shone on it.
Baroness Kingsmill is a non-executive director of various British, European and US boards. She can be contacted on firstname.lastname@example.org.
Follow her on Twitter: @denisekingsmill.