There is a subtle but important link between two of today’s depressing news headlines: the scandal at Mid Staffs Hospital and the confirmation by the IFS that economic sluggishness means the worst of public sector austerity is still to come.
When talking about the poor performance and low productivity of the UK economy there is a tendency to focus on high skill, high tech areas like life sciences and new materials. As I wrote the other day, R and D investment and commercialisation of these areas is stagnant at best and more likely in decline, but even if were they booming, these sectors – which will only ever account for a very modest proportion of the total workforce - would not be the answer to the biggest problems of our labour market. These lie in a low pay, low skill, low productivity service sector increasingly detached from the managerial and professional classes.
As a number of writers have argued, the most important challenge for the UK economy is improving the quality and productivity of service sector employment. And, by the way, improving the quality of services is also a more environmentally sustainable model of growth than producing and consuming more ‘stuff’.
But what’ the link to the Francis Report on Mid Staffs? Over the last twenty years a major trend in the public sector has been the development of a tier of poorly paid assistants (many of not most of whom would require tax credits to reach a living income) in jobs with a low skill requirement who are slotted in under the main service professions. In teaching for example the number of teaching assistants has risen from 79,000 in 2000 to over 220,000 in 2011. There has also been a steady rise in the number of health and social care assistants. And the category of police community support officers (PCSOs) which has only existed since 2002 has gone from 6,000 in 2005 to over 15,000 today.
The basic idea is that assistants don’t have highly developed skills and competencies as they will be overseen by professionals who do. But a number of processes undermine this model. Rising demands and multiplying bureaucratic processes, on the one hand, and the natural tendency of professionals to want to spend their time on the most rewarding and career enhancing activities, on the other, mean that assistants often end up performing vital task with limited supervision.
To the case study evidence of service failure by health care assistants provided by the Francis Report and a steady trickle of stories about PCSOs failing to manage difficult situations, can be added telling research from schools which shows that teaching assistants are among the least effective (and most expensive) ways of spending money to improve children’s attainment. Indeed, because teachers often ask assistants to work with the lowest performing children (leaving the professional to work with the more engaged pupils) they can end up worsening outcomes for this group.
Most teaching, health care assistants and PCSOs are hard-working and effective but the system is failing and the assumptions underlying it lie cruelly exposed. The idea of growing a low paid cadre to take the unrewarding, unpleasant, monotonous work off the hands of the better paid university qualified professionals seems like common sense but increasingly it looks like it is plain wrong; bad for staff, bad for service users, bad for the reputation of public services and bad for the economy.
Raising the skill threshold and performance expectations of the public service assistant cadre, while maintaining this as an entry point for non-graduates, should be a priority for public service reform. It is the key productivity challenge and it will require an integrated response starting in schools and FE colleges and reaching into the heart of management, work design and professional boundary setting. But if the public sector could grasp this challenge it could provide a vital lead to the rest of the service sector, which is characterised by very similar problems.
For while it may not be sexy, or offer politicians the photo opportunities they love in laboratories or science parks, it is change here at the bottom of the labour market that is most vital to public service improvement, economic dynamism and social justice.
Learn about the twelve-month journey of The Good Work Guild and the recommendations its global network of Fellows and work practitioners have made.
Our healthcare system needs transformational change that creates the space for a new paradigm to emerge. Read about how our public entrepreneurship project can support this.
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