Understanding the care workforce crisis: a research-policy relationship

Credit: Cavan via Adobe Stock.

2 November 2023

By Claire Cameron and Eva Lloyd, Visiting Professor, UCL

A growing research literature has demonstrated that positive experiences early on in life are associated with more positive adult outcomes, so investing early is key for societal wellbeing. Central to this is the children’s workforce, from health visitors to early childhood education and care practitioners and social workers. In a newly published edited volume from past and present TCRU researchers, Social Research for our Times (UCL Press), we examine how social research and policy can interact (or not) to achieve progressive objectives for children and the professionals who provide their care. Whether the research is ‘strategic’ (with a longer-term orientation) or ‘tactical’ (responsive to the immediate concerns of the government of the day), among the ingredients for success are a genuinely collaborative ethos and close dialogue between policy makers and researchers.

On early childhood education and care (ECEC), the picture is mixed. Supporting nurseries and other services for young children, England’s ECEC workforce numbers 334,400 women (and a few men). Among these practitioners, there is a long-standing split between a minority of better paid qualified early years teachers and a larger group of poorly paid nursery or childcare workers. Most of the former work in publicly funded schools offering part-time provision for children aged 3 and 4 (and some 2-year-olds), while most of the latter work in the private-for-profit sector, with children aged 0-5, where pay rates are lower than in any comparable, gendered occupation.

Such inequity in the workforce seems both unjust and unlikely to optimise children’s outcomes. But policy measures to address this have not resolved the issue. Indeed, research by TCRU has highlighted how the steady marketization of ECEC through mergers and acquisitions, and financed by ever-enlarging debt, has exacerbated the trend towards a low-pay, low-cost model that is simultaneously unaffordable for parents and less effective for children. This model relies almost entirely on women workers; earlier research by TCRU on the gendering of care work highlighted the widespread belief that work defined as ‘care’ is innately something women are equipped to do and therefore assumed to be low skilled. Where care work has been defined as ‘education’ or ‘health’, it has tended to be better paid and adopted within the public sphere.

So, such research evidence has had a tenuous influence on ECEC policy in England. But there are more positive examples from this sector, not far away. Following engagement with families, professionals and researchers, recent reform of Ireland’s ECEC system and its infrastructure has included positive steps forward in the form of a comprehensive workforce plan that will raise qualification levels, introduce a career framework and support recruitment, as well as a transformed funding model. The Expert Group convened to develop proposals for the new funding model – of which one of the authors of this blog post (EL) was a member – commissioned eight studies exploring solutions to relevant policy issues in other marketized ECEC systems, to inform the process.

Another positive example, this time for England, is provided by TCRU’s research on the experience of children in residential care. Integral to the influence of this government commissioned comparative study of provision in England and Denmark was a civil servant who took a keen interest in all stages of the research and facilitated its wide dissemination – itself reflecting the prioritisation of education and social justice by the incumbent government. Our finding, that the educational qualifications and organisational commitment to learning under the auspices of Denmark’s ‘social pedagogy’ model produced better experiences for children and more satisfying work for practitioners, informed implementation projects and employer interest. (Alongside, TCRU colleagues were instrumental in developing a related professional association for the UK, the Social Pedagogy Professional Association.) The same policy impetus from government meant that contemporaneous TCRU research on the education of children in care similarly resulted in positive change. This included bursaries for university study for these young people and the UCAS application form ‘tick box’ inviting them – having grown up in almost unimaginably difficult circumstances – to notify universities that they had been in care as children.

Looking to the future, TCRU researchers are currently providing evidence for child and family health policy through the NIHR Children and Families Policy Research Unit (CPRU). This unit has a close dialogue with colleagues at the Department of Health and Social Care (DHSC) to determine and provide evidence to both government departments and arms-length bodies, such as NHS England and Public Health England. CPRU’s strategic work springboards research in high priority areas, such as establishing a useable dataset to analyse the health visiting service in England. This has paved the way for other studies that have found high variation in the way health visiting is delivered across England; there are also studies under way to evaluate the impact of health visiting on all children and children living in adversity. The potential value of this work is high, given the challenges of insufficient workforce and high caseloads: only six percent of health visitors have a caseload smaller than the recommended maximum of 250 children. A related piece of PhD research in TCRU found stark variation in the delivery of health visiting. By collaborating closely with the DHSC, we hope to influence critical changes to policy and practice that benefit both children and the child health workforce.

These examples exemplify the pivotal role of high-quality social research in securing effective public policy and services and furthering positive outcomes for children and young people. For 50 years, TCRU has been a leader in shaping the research and policy debate in its fields, as well as in methodological innovation to facilitate that, including to better hear the voices of ‘hard to reach’ communities. We should not lose sight of how such capacity and infrastructure supports ‘strategic’ and ‘tactical’ social research alike.

Social Research for our Times (UCL Press) is published on 6 November, free to download. Register here to join us for the book launch event.