Modern Slavery

Risk in

Adult Social Care

Dr Caroline Emberson,

The Rights Lab,

University of Nottingham

Presentation outline

• Public procurement of Adult Social Care in England

• Modern slavery in care: a cause for concern?

• Evaluating modern slavery risk in adult social care

• Q & A

Public Procurement of Adult Social Care in England

The changing context of care

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000

1980 1984 2014

Changes in care home placement providers

LA-run homes Private sector homes Voluntary sector

Source: Jarrett (2017) The care home market (England) House of Commons briefing paper

Placement funders in residential care

Funder %

Local Authorities 49

National Health Service 10

Self-funders 41

Source: Competition and Market Authority (2017) Care Homes Market Study: Final Report

Current features of care provision in England

• A regulated market

• Fragmented provision: a mix of local authority and private

residential care and nursing homes

• Patient-safety focused Care Quality Commission registration

• Choice and control

• Empowerment of the elderly and the disabled

• Employment of home-care workers ‘at the margin’ of state

regulation (Hayes, 2017)

• Community-based approaches: Shared lives

Modern slavery in care: a cause for concern?

English care sector employment characteristics

• Labour intensive

• Flexible working arrangements e.g. bank staff, zero-hours

contracts

• Relatively low entry-level qualifications and experience

• Relatively low wages

• Increasing staff turnover

• Use of migrant labour

• 1.34 million workers in care and115,000 personal assistants

(Skills for Care, 2017)

• ‘Employment of PAs characterised by informality and legal

confusion’ (Hayes, 2017)

Potential forms of modern slavery in care

• Forced labour

• Work or services exacted from a person under force or the

threat of force and for which the person has not volunteered

• Domestic servitude

• Being forced to work, usually in private households,

performing domestic chores and childcare duties. Freedom

may be restricted and the person may work long hours for

little or no pay, often sleeping where they work

Evaluating modern slavery risk in adult social care supply chains

Generalisable findings

• Regulatory gaps

• Inadvertent use of unregistered agents

• Permitted use of unregulated agents e.g.

• international recruiters, so called ‘introductory agents’ (Brindle,

2014)

• personal support and day-care providers

• ‘Structural vulnerabilities’ (Allain et al. 2013)

• Reports of the exploitation of migrant workers

• Use of fake documentation

• Weakened managerial oversight

• Successive Government policies leading to displacement and

dismantling of employment relationships across the care sector

Managers’ perceptions of modern slavery risk

• 10% of managers reported that they had, or might have, come

across an incident of modern slavery in adult social care

• Reported incidents included:

• Investigations into the quality of care

• EU workers housed on site and paid at a different rate

• Agency staff working a night shift at one home, followed by

a day shift at another

• ‘Dubious’ overseas employees

• Risks identified included:

• Increased staff turnover

• Workforce vulnerability

Reported ILO (2012) indicators of forced labour

Rank ILO indicator Count

1 Abuse of vulnerability 13

Excessive overtime 13

3 Deception 10

4 Isolation 9

Intimidation and threats e.g. in relation to the immigration status of a care worker 9

6 Physical and sexual violence 8

Withholding of wages 8

8 Restriction of movement 6

Debt bondage (i.e. where a care worker works to pay off a debt to their employer) 6

10 Retention of passport or identity documents 4

Other 4

12 Abusive working or living conditions 3

Example (1)

“One lady I know brought a load of people from the Philippines

and she also had a supermarket, and without them having any

choice, she used to deliver bags of rice and things to them and

deduct that from their wages whether they wanted it or not. So

they were paying inflated rent prices. She was telling them

what they were going to buy just because it was increasing her

revenue.”

“Staff who came over with her were very scared to speak up

about it because of the power that she had over in their own

country. So not only would she have made their lives difficult

here, but she would have carried that on when they returned

home. That’s not unusual.”

Example (2)

“We had a nurse that was here, working here, and she was from Pakistan. She got pregnant and staff here were absolutely mortified when she went back to Pakistan, left the baby in Pakistan, and came back. They were going, “What have you done that for? You can’t do that.” She was having to pay somebody, whoever she borrowed the money off to come over here in the first place, for the fees that she’d paid and she also had to send money back to her husband’s family for looking after the baby.”

Example (3)

“But because they’ve actually charged those people money to [Nursing Home 3] because like they don’t know what is happening, they will come to these people because they know their situation and then maybe say, “Okay. We can’t pay you like the normal wage because you don’t have papers”, and because they think these people are helping them, you see they cannot speak out. Because they know they don’t have right to work. So those people, they will be actually be treated like slaves because they don’t have the rights.”

What can be done?

• Prevention

• Understand and mitigate risk

• Shorter labour chains may carry lower risk

• Care home staff may be cross-trained to avoid the use of agency

labour

• Direct Payment Support Services may be used for payroll and tax

• Community-based approaches may help e.g.Slavery-free Cities

• Detection

• Build employment-agency related checks into Direct Payment reviews

• Triangulate care home risk profiling with local ethnicity data

• Extend auditing to include specific investigation of labour supply chains

• Remediation

• Build capability for effective modern slavery response through partnering

Further work

• Multi-stakeholder Initiatives

• Encourage sector engagement through MASH, ADASS and

the Commissioning and Market Shaping forum

• Supplier development

• Residential care and nursing home monitoring and training

• Closer scrutiny of employment agencies

• Community-engagement

• Better understanding of risk and response in the direct

payment supply chain

Q & A

Questions for discussion

In the Adult Social Care sector,

1. What, if any, additional risks do you see?

2. Who should take the lead in reducing the risks posed?

3. Who else should be involved, in what capacity?

4. How might accountabilities be managed?