Sarah Jenkins asks: care is skilled work, so why don’t we pay for the skill?
Imagine being responsible for another person’s medication, money, personal care, safety and emotional wellbeing.
You may need to identify the signs that someone is becoming distressed before they can articulate it themselves. You need to know when to intervene and when to give them independence. You may be dealing with mental illness, physical disability or behaviour that occasionally becomes violent.
Get some decisions badly wrong and the consequences can be grave. We nevertheless routinely describe the people doing this work as low-skilled and that contradiction sits at the centre of Britain’s social-care crisis.
Why does work that requires responsibility, judgement and highly developed interpersonal capabilities command so little economic reward?
Low pay, staff shortages, long hours and insecure employment are usually discussed as problems of recruitment and funding. But beneath them lies a deeper question about economic value: why does work that requires responsibility, judgement and highly developed interpersonal capabilities command so little economic reward?
My research inside a large, not-for-profit social care provider suggests that the answer cannot be found simply by measuring workers’ formal qualifications. We need to examine how care itself has been economically and socially valued.
Responsibility without recognition
The organisation in our research supported adults with physical and mental disabilities to live independently in shared homes. We interviewed 25 frontline workers and five managers.
This was not an environment of tightly scripted, repetitive employment. Quite the reverse. Care workers frequently had substantial autonomy. Together with the people they supported, they decided activities, organised daily routines and adapted support to very different individual needs.
Workers might cook and clean, manage household finances, accompany somebody to medical appointments, provide intimate personal care and administer medication — while simultaneously supporting that person’s independence.
One worker described the unsettling reality: other people’s lives were effectively in their hands. Some felt that their responsibilities had drifted towards nursing without corresponding training, professional status or pay.
The paradox is obvious: a worker can be formally classified towards the bottom of the occupational hierarchy while exercising responsibility most people would regard as extremely demanding. The problem is partly that many of the most important skills in care are difficult to see.
Knowing somebody
Consider what happens when a person with complex needs becomes anxious.
An experienced care worker may notice tiny changes: movement, expression, tone of voice or deviation from a routine. Years of working with somebody create knowledge of their triggers and ways of reducing distress before events escalate.
This is not simply kindness. It is learned expertise.
One worker in our research described supporting a person prone to extremely challenging and sometimes violent behaviour. Over 12 years he had learnt how to recognise the earliest signals that this person was moving away from their normal emotional state. That experiential knowledge enabled him to intervene. Another worker described how, once you know somebody closely, you learn their individual behaviours and can prevent their anxiety spiralling.
This is emotional management combined with observation, memory, judgement and deeply contextual knowledge. Yet there is rarely a machine, certificate or obvious technical artefact that signals to outsiders: skill is being deployed here.
Capabilities such as empathy, emotional awareness and looking after others have consequently often been presented as natural feminine attributes rather than skills learnt through experience. The economic consequences are profound.
The knowledge resides in relationships. And relationships have historically been difficult for economies to value.
The gendering of skill
There is an important reason for this. Care has traditionally been associated with women. So capabilities such as empathy, emotional awareness and looking after others have consequently often been presented as natural feminine attributes rather than skills learnt through experience. The economic consequences are profound.
When an engineer develops expertise over years, that expertise is recognised as human capital. When a care worker develops similarly intricate knowledge of another human being, society can treat the capability simply as evidence that they are a caring person. What appears natural gets deemed as not requiring training. And what does not require training can be classified as low-skilled.
The designation therefore reflects social power rather than merely technical complexity. Jenkins’ study places this gendered devaluation explicitly within the wider marketisation and austerity shaping social care.
Meaning can be exploited
There is another paradox. Care workers often love their work.
Every frontline worker interviewed could describe occasions when their support had materially improved someone’s life. One talked about helping people achieve things most of us take for granted: doing their own washing or taking their first holiday. Another had watched someone move from round-the-clock support into their own flat, requiring only a small number of support hours each week.
Workers could go home exhausted while knowing they had made a genuine difference. This meaning is enormously valuable.
But meaningful work has a dangerous side when an economic system comes to depend upon workers accepting bad conditions because they care about the people affected. A care worker does not respond to inadequate staffing in the same way as somebody producing widgets might respond to a production delay. Walking away can mean leaving a vulnerable human being without support. So commitment becomes leverage. The moral importance of care can therefore sustain precisely the employment arrangements that economically undervalue the carer.
Does ownership change anything?
The organisation studied was unusual because it had converted from a charity into a multi-stakeholder cooperative intended to give service users, employees and the wider community greater involvement. That mattered. The cooperative structure created more space for autonomy, relationships and workers to advocate for the people they supported.
But ownership alone could not eliminate the wider political economy of care. The organisation still operated in a marketised system in which providers competed for contracts under intense financial pressure. Those external constraints limited what even a more participatory organisation could achieve.
We have constructed an economic hierarchy that frequently pays most for managing money, organisations and technology while placing remarkably little monetary value on managing the difficult realities of human dependence.
This is an important lesson for advocates of alternative enterprise. Better governance can change workplace relationships. But enterprises do not float free from the economic systems surrounding them. A cooperative commissioned at an inadequate price still confronts inadequate resources.
Revaluing work
Britain’s care problem is therefore more fundamental than a recruitment shortage. We have constructed an economic hierarchy that frequently pays most for managing money, organisations and technology while placing remarkably little monetary value on managing the difficult realities of human dependence. Then we wonder why people leave.
The language of skills matters because it helps legitimise this distribution. If care is “low-skilled”, low wages appear understandable. Poor pay is interpreted as the market price for easily replaceable labour. Look at the work itself and that explanation becomes much harder to sustain.
Care workers exercise discretion. They manage risk. They acquire tacit expertise. They regulate emotions. They construct relationships that enable disabled people to lead more independent lives. These are skills. Recognising them properly would have uncomfortable consequences because recognition cannot end with changing a job title.
If society genuinely accepts that care is skilled and socially necessary work, then funding, training, voice, status and pay must begin to reflect that fact.
The crisis in care is therefore also a crisis in how we value work. And that is not something the labour market will correct by itself.
This article is based on Jenkins, S. (2026). The Struggle for Meaning in Contemporary Care Work. Work, Employment and Society, 40(1), 67-87 created with the help of ChatGPT.
