Do people pay a price for working in caring jobs?

Nursing assistants and childcare workers are typically paid less than those in comparable occupations, research has found, by Professor Elizabeth West

It is widely believed that certain occupations, such as care work, are relatively poorly paid because there are non-pecuniary benefits, such as job satisfaction and social esteem. However, there is little hard evidence for this.

We investigated this assertion, using 17 years of data from the British Household Panel Survey, which contains information about the occupations and wages of more than 23,000 individuals. The answer is not straightforward – people in some caring jobs do pay a penalty, but other groups seem to enjoy a wage premium. Doctors, nurses and teachers, for example, earn more than people in comparable occupations. Our estimates suggest that doctors earn on average £8,000 per annum and registered nurses £2,000 more than people like themselves in similar jobs.

However, severe penalties are paid by people in caring occupations at the other end of the financial scale. Nursing assistants, welfare workers and particularly childcare workers are typically paid less than those in similar jobs that do not involve nurturing skills. And pay rates for these occupations are worse in the private sector than the public sector. So workers are not only paid less than most people, they are poorly paid relative to people in similar jobs.

In our paper, The Financial Costs of Caring in the British Labour Market , we explored some of the possible causes of these inequalities, including gender, compensating differentials and social closure. Are caring occupations less well paid because they are mostly done by women who lag behind men in wage rates? Or are employers able to fill vacancies easily because jobs that involve caring for people are intrinsically more rewarding? Do aspects of the job compensate for low pay?

Finally, we asked whether the presence of strong professional associations, such as the British Medical Association and the Royal College of Nursing, have been able to ensure that their members enjoy a wage premium.

The great discrepancies in wages uncovered in this analysis must be a cause for concern. As the population ages, our health and social care systems will be increasingly reliant on people in caring occupations. These jobs are stressful, and we as a society are entrusting our most vulnerable members – the sick, the old and the very young – to people who are not well rewarded. At the same time, we demand very high standards of moral and ethical behaviour, as well as kindness and compassion from them at all times.

Recent government reports suggest there are grave concerns about some areas of health and social care. Professor Cathy Nutbrown’s recently published interim report on childcare workers suggests standards within the profession, as well as recruitment, retention and career progression, are less than satisfactory.

MPs and peers recently called for an independent investigation into children’s homes in England, arguing that they are failing to manage and protect children, especially children who run away or go missing. These deficiencies have been highlighted by recent cases of child sexual exploitation.

It is important in this midst of this concern to focus attention on the working conditions of staff, because they are some of the most poorly paid employees in the British labour market. At the other end of the scale, the results reported in our paper cannot but infuriate all those people who were, at the very least, inconvenienced when doctors were taking action against reform of their pensions.

Although the health and social care system in the UK was established to promote greater social equality, we provide evidence that these institutions are perpetuating and entrenching even greater social inequality through their employment practices.

Professor Elizabeth West is director of research and head of the Centre for Nursing and Healthcare Research at the University of Greenwich. Dr David Barron is reader in Organisational Sociology, Saïd Business School, University of Oxford.