The scandal of low-paid care workers

A New Year’s resolution? Let’s stop paying less than the minimum wage to those who care for the elde

A friend who is a care worker employed by an agency has a moan to me about her work. Repeated 15 minute slots with a client followed by a frantic dash to another part of the city she lives in to do the same again. Care in a hurry, on the cheap. Welcome to home care for growing numbers in Britain: some of our most vulnerable people cared for by a growing number of overly stretched and underpaid workers.

Her first concern is about the always rushed, and often inadequate, care this way of working results in. But, to my initial surprise, she also expresses anger about not getting paid for the travel time that necessarily eats up a large chunk of her working day. She typically makes 40 journeys between clients a week, sometimes 50 (not counting her journey to and from work). "Surely", I say, "you must get paid for this travel time, or else I don't see how you would be getting paid the minimum wage". Indeed.

It's well known that social care is a notoriously low-paying sector, with the Low Pay Commission (LPC) estimating that one in four workers get paid below £6.50 an hour. Far less well known is that many of these workers get paid less than the national minimum wage. A new and authoritative report by Dr Hussein of Kings College London now reveals that, even under extremely conservative assumptions, there are at the very least 150,000 care workers getting paid less than the legal minimum - and quite probably far more.

How is it that the law of the land is being so widely flouted? My friend's pay slip sheds some light, exposing the chaotic system of pay that is the norm for many care workers, especially those working for agencies or private firms: constantly shifting hourly rates of pay - varying dramatically by client, length of each care visit, time of day, and day of the week. The opacity of pay rates makes it hard for those affected to fathom if they are getting their legal minimum; indeed the LPC has suggested that some employers don't themselves understand their own pay systems. A closer examination, together with records kept by my friend of her travel time over a period of a month, suggests there are weeks where she has clearly been paid significantly less than the minimum wage (though there are others where this is not the case). And the real story is worse than the pay slip suggests. She had to pay for her CRB check. There are no travel expenses even though travel is essential ('I couldn't afford to work if I didn't cycle'). Regular mobile phone use is essential to stay in close touch with the office - again, no expenses are paid. It just doesn't pay to care.

In theory the legal position governing the minimum wage is clear: workers should be paid for time spent travelling between clients (apart from between home and their place of work). Less clear is who in government or anywhere else is taking the lead for sorting this out and ensuring that the law is enforced. Awareness of this issue remains very low, this Panorama being an exception, and care workers are not anyone's political priority (can you imagine a Cabinet member, or for that matter the media, making a fuss about this issue as they did about graduate interns?).

All those responsible for this saga claim they have an alibi - which is cold comfort to those being under-paid. The LPC has repeatedly flagged up these sorts of working practices as a concern - though it has never taken it upon itself to make specific recommendations to government about non-compliance which in turn would require Whitehall to make a formal response. HMRC, which is responsible for enforcing the minimum wage, says that it takes any allegation of non-compliance very seriously. But it is yet to prioritise this issue as an area for its 'Dynamic Response Team' (lagging response times suggest that it could be, err, a bit more dynamic; though this is in part due to inadequate resourcing). The problems of the care sector currently fall behind unpaid internships in the queue for HMRC attention; though it is said that the care sector will receive priority at some point in 2012. For their part, local councils argue with some justification that they aren't receiving enough funds to cover the full cost of social care. And the Department of Health, who are ultimately responsible for social care in England, concede that Dr Hussein's report is a 'cause for concern' but maintain that pay is a matter for local employers so it's not really a question for them. All the while, the law on the minimum wage continues to be flouted.

There are lots of injustices in Britain that are so entrenched and complex that they would take a generation to turn around. This isn't one of them. The minimum wage is supposed to be a right, not a nice to have. So here's a resolution that we should stick to: let's make 2012 the year when every care worker gets what they are legally entitled to.

A year on from the Spending Review, the coalition's soothsayer has emerged to offer another gloomy economic prognosis. Asked by ITV News whether he could promise that there wouldn't be a double-dip recession, Vince Cable replied: "I can't do that.

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So many teenage girls don’t want to identify as girls any more. And who can blame them?

Among internet-literate teenagers, gender has become the primary way to challenge the mores of older generations.

On the bus back from the cinema, a conversation drifted over from the back row. A mother questioning, curious, her speech accented; her teenage daughter, with perfect RP, fielding her inquiries with the exasperated patience that flourishes between the ages of 13 and 21.

“No, Mum, you’re a cis woman because you’re the gender you were born as.”

“OK. And what about Lily?”

Lily – or, perhaps, Daisy or Rose – was a school friend who was now using the pronoun “they”. The heavy overtone of the daughter’s forbearance was that these were matters her mother could not understand.

Among internet-literate teenagers, gender has become the primary way to challenge the mores of older generations. I know four journalists – London-based, middle class – whose children have announced that they do not consider themselves to be girls. It seems too many to be a coincidence. And if pained teenagers are now explaining gender fluidity to their mums on the 108 from Millennium Leisure Park West, you know the idea has truly gone mainstream.

We should welcome young people challenging gender, an arbitrary system that has acquired the status of immutable human nature. Name almost anything now associated with women – high heels, long hair, the colour pink – and you can find a time or place when it was considered masculine. And just as feminists once fought for “Ms” alongside “Miss” and “Mrs”, people should be allowed to take gender out of their honorific altogether and go by “Mx”. Getting used to “they” as a singular pronoun is harder but not impossible. Language evolves.

However, there is more to the current Gender Revolution than upending our assumptions about the “correct” names or pronouns or hobbies or appearance for men and women. In the past few years, the word “transsexual” has dropped out of favour – it is considered impolite to reference sex – in favour of “transgender”. But this obscures the idea that to cross definitively from one gender to another requires surgery and a lifetime of synthetic hormones. For trans men, it’s top surgery – breast removal – and, more rarely, a phalloplasty to make a penis, plus testosterone (“T”), which lowers the voice, hardens fat to muscle and unleashes any latent male-pattern baldness. For trans women, oestrogen (HRT, used off-label) can be supplemented with breast implants and a procedure to skin the penis and invert it, creating a neovagina and clitoris.

These surgeries are non-trivial – I have a friend undergoing the latter this summer and she will be housebound for two weeks afterwards, with a 12-week recovery period. Infection is always a risk. For her, it’s a life-saving intervention: she says she simply would not want to live in a male body.

But 80 per cent of gender-nonconforming children do not grow up to be transsexual; many emerge as happy gay men or lesbians content to live in their birth sex. A strange taboo has sprung up about mentioning this, as if the way that some people do not turn out to be trans invalidates the experiences of those who do. It should not.

But separating dissatisfaction with the social constraints of gender from body dysmorphia is vital. Because we have smudged together the categories of “transsexual” and “transgender”, is every youngster who questions their gender – and, frankly, every youngster should, because gender is restrictive bollocks – getting the message that they must bind their breasts or tuck their penis? I wince when I read oh-so-liberal parents explaining that they knew their toddler son was a girl when he wore pink and played with Barbies. Is there really anything so wrong with being a boy who wants to dress up as Elsa from Frozen? Or a girl who would rather be outside getting muddy than wear skirts and be “ladylike”? Toys and children’s clothes are becoming more gendered: when I was young, we played with Lego – not “Lego” and “Lego for Girls”. As we have shrunk the boxes, is it any wonder that more and more children want to escape from them?

In the year to March 2015, the Tavistock in London – the only specialist gender clinic in the country for under-16s – saw 697 children. This year, it saw 1,419. The largest surge has been among girls aged 14 and over and it is this group I feel most personal affinity for, because, if I were growing up today, I would be among them. A few years ago, I found a textbook from my junior school, with three sentences that floored me: “My name is Helen. I am nine years old. I am skinny.” And the truth was, I was skinny. I had a bowl haircut and wore culottes. Then puberty hit and I piled on a few stone in a year. Taut pink skin turned to lumpen fat and mottled flesh. And everyone had an opinion about it. I was trapped inside a body that didn’t feel like mine any more.

Many of my school friends felt the same way. Some tried to escape through vomiting or starving. Others were part of that charmed cohort who became lissom, beautiful, golden; their parents felt a different sort of ­worry and they were treated to sermons about getting into strange men’s cars.

I won my body back by defacing it; at least, that’s how my parents saw it. An earring, then two. And another. Then piercings that no one could see: nursing each one like a wound or a child. Salvation through pain: a metal bar through cartilage that couldn’t be slept on for a month. A tattoo that hurt like hell. Pink hair, ebbing to orange in a shower that looked like Carrie. And finally – finally – a body that felt like me.

I tell my story not to belittle anyone else’s, or to imply that they have chosen the wrong path. If you cannot live in your body, then change it – and the world must help you to do that. But if you feel crushed by society’s expectations, it might be that there’s nothing wrong with you. There’s something wrong with the world.

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.

This article first appeared in the 26 May 2016 issue of the New Statesman, The Brexit odd squad