The ‘pink collar’ crisis strangling the wellbeing – and economy – of Britain

If Lynsey Bleakley’s daughter wanted to follow her into nursing, her response would be: “No, don’t do it!” Bleakley, 46, worked for the NHS for 18 years, mostly as a specialist nurse health visitor – a role monitoring pregnant women, new mothers and the development of children from birth to school age. In 2019, she quit to set up a baking business and never looked back.

Painfully aware of how heavy a toll nursing takes, she is anxious to avoid seeing someone she loves go through it. Although she left for personal reasons, she says she could never return to such a “thankless” and “emotionally demanding” profession.

“I was really passionate about my job, it’s such a privileged job to do, being closely involved with families at one of the most special times of their life,” says Bleakley, from near Donaghadee in Northern Ireland.“Would I go back? Absolutely not under any circumstances. I wouldn’t go back to that pressure, that stress.”

Similar pressure and stress are driving many otherwise passionate workers – mostly women – away from the caring professions, or what are sometimes called “pink collar” jobs (so-called because they don’t fit into the “blue collar” (physical labour) and “white collar” (office based) terms already in common parlance).

As a result, these sectors are in crisis. From nursing and midwifery to social care and early years childcare, all these vital areas have entered a perilous downward spiral of understaffing. Overwhelming workloads, long and unsociable hours, fears over safety for those being cared for, and inadequate pay have been driving pink collar workers to quit in their droves.

The 'drain' factors

The diminishing number of caring professionals is a major problem. Both the NHS and private businesses across these pink collar sectors are complaining that they are unable to fill scores of open positions. The data to support this is fairly stark. In July, a report by MPs warned that the NHS was facing the worst workforce crisis in its history.

In the three months to December 2022, there were 43,619 vacancies in nursing across the NHS, compared to 39,721 in the same period the year before. Private social care and childcare providers are experiencing similar chronic understaffing. England has a shortage of 2,000 midwives, with 600 more jobs needing filling in April 2022 than at the same time the previous year. In 2021-22, there were 165,000 vacancies in adult social care, a 52 per cent increase on 2020-21, according to the charity Skills for Care.

And research by daynurseries.co.uk last June found 77 per cent of nursery staff were dealing with workforce shortages in their nursery. The consequences are disturbing: last year, four in 10 maternity units were forced to temporarily close due to staff shortages, figures obtained by the Labour party revealed. The same year, eight in 10 nurses told a Royal College of Nursing survey there weren’t enough nursing staff to meet all patient needs safely and effectively on their most recent shift.

As for childcare, between April and July 2022, 65 per cent more day nurseries closed compared with the same period the previous year, figures from the National Day Nurseries Association showed. As growing numbers of their colleagues drift away, those who remain are placed under greater strain still. “Every time I go into work I think, ‘We cannot go on like this’,” says Claire*, a trainee nurse in a south London hospital. “The staff shortage has really created unsafe situations. I’ve constantly got the feeling something is going to go badly wrong any minute.”

“It’s both physically and mentally challenging,” says Lucy Marett, manager of Activetime Day Nursery in Harrow, north-west London, of the job. “You’re on your feet most of the day, you’re risk-assessing all the time to make sure the children are safe, engaging with parents and carers about the child’s needs, maintaining control in the classroom. It’s continual.” But despite the intensity of the work, staff at Marett’s nursery earn little over the minimum wage.

With the Government’s previous funding for free childcare failing to fully cover the costs, and with energy and other prices rising dramatically, nurseries struggle to pay more attractive wages. While money is not the only cause of recruitment and retainment problems in pink collar jobs, it’s a major factor.

As David Maguire, a senior analyst at The King’s Fund, a health and care charity, points out, “In a cost of living crisis, if you’re earning minimum wage in the care sector, it’s a much more attractive prospect to work in retail, where you get more regular hours, can plan your social life around it and have more of an idea of how to move up within your role, and [more] training and development to move on with your career.”

In healthcare, the money is a little better, but not enough to stop nurses striking this year. “Lots of nurses are taking on extra ‘bank’ shifts because they need the money,” says Claire. “They end up working 12 hours a day, five days a week, so they’re burned out, and you’re not as attuned to your patients’ needs when you’re that knackered.”

For Laura Mudie, 39, who worked for 19 years in nursing and midwifery, the lack of staff, antisocial work hours and relentless admin fuelled her decision to leave – “something had to change for my mental health.” Recalling her time at Southend Hospital in Essex, the mother-of-two says not only were there too few midwives, and the job was tricky to combine with family life, but an increasing amount of paperwork had “crept in over the years”.

A government consultation on reducing excess bureaucracy in the health and care system in England in 2020 noted that around a third of a community-based clinician’s time was estimated to be spent on administration. Those in clinical settings also report wishing they had more time to spend on the actual caring part of the job. Mudie understands why the paperwork is necessary but it’s adding to the heavy burden on midwives. “There’s only so much one person can do,” she says.

Ripple effects

While the issue has created an acute crisis in the NHS and wider care sector, it is clear that the ripple effect has resulted in chronic problems in the wider economy. A lack of nurses has resulted in longer NHS waiting times, contributing to an increase in the number of people who are too sick to work. And the UK’s patchy childcare is preventing many new parents from returning to their jobs as quickly as they might.

“The shortage of nurses is a major challenge to Britain’s health and its economy,” says Samuel Huckstep, of the Centre for Global Development. “Longer NHS waiting times have now resulted in the number of workers economically inactive due to illness reaching a record high, while many sick (up to 10 per cent of the workforce) continue to work.” But boosting the workforce across all sectors – not just pink collar – is proving difficult.

The UK’s “economically inactive” cohort is very large. At the beginning of the year it came in at just under nine million people. This means nearly 40 per cent, or two in five adults aged between 16 and 65, are not contributing to the economy. Not all of these people want to, or are able to, find a job; many, for example, are students.

However, within the amorphous grouping of “economically inactive” are 1.13 million people under the age of 65 who have taken early retirement – some of whom would have had long and successful careers in care or care-adjacent industries. “Many of these adults will be living comfortably in their early retirement, and government policy is unlikely to prompt them to ‘un-retire’,” argues Louise Murphy, an economist at the Resolution Foundation.

Then there are the 2.5 million people who are not in the labour force because of long-term sickness, a number that has increased by 460,000, or roughly 25 per cent, since the start of the pandemic. Some of these people will have permanent conditions but others are no doubt stuck on the NHS’s ever-lengthening waiting lists.

Another 1.7 million people are counted as “looking after family/home”. In his “Back to Work” Budget speech last month, Jeremy Hunt said almost half of non-working mothers said they would prefer to work if they could arrange suitable childcare. This tallies with a survey conducted in 2021 by the Centre for Progressive Policy think tank.

It found that 1.7 million women would like to work more hours but were unable to do so because they had issues with childcare. Another 1.3 million had turned down jobs for the same reason. The result was up to £11 billion in forgone earnings, according to the CPP’s estimates. So the need and importance of pink collar jobs could not be more clear and the stakes could not be higher: lives, livelihoods and indeed the whole economy are threatened. As Maguire says, “The health and care sector does a huge amount, not just directly in terms of providing care to people but also for boosting the rest of the economy and helping people carry on in work.”

Fixing the crisis

The UK’s labour shortage is – belatedly – pushing the Government into action. Hunt’s Budget last month announced reforms to childcare funding, which from 2025 will see existing free provision for three- and four-year-olds (up to 30 hours a week) extended to children as young as nine months in an attempt to get more parents back to work.

But where will this additional childcare come from? England has seen a steady decline in providers in recent years. By the end of March 2022, there were 19,100 fewer registered with Ofsted than in 2015, a 22 per cent decrease, attributed to financial pressures and staff shortages. Higher wages would, of course, tempt many in the sector to stay. Few feel the Government has thrown enough of it at the problem, preferring sticking plaster solutions to any long-term strategy.

Hunt’s offer of incentive payments of £600 for new childminders has been criticised by Neil Leitch, chief executive of the Early Years Alliance, as “paltry” and “unhelpful”. But with the UK tax burden at a post-war high, there’s not a great deal of money to throw around. Radical answers are needed.

A fully integrated health and social care system would help, suggests Professor Carol Atkinson, who researches work and employment (specialising in the adult social care workforce) at Manchester Metropolitan University. The idea has already got off the ground in some areas but a massive up-front cost will be required to overhaul the whole system.

In the long-term, it would relieve pressure on the NHS: better social care would mean fewer people ending up in hospital, and better links between the sectors would mean fewer patients “bed-blocking” while awaiting social care. Pink collar jobs must also be made more attractive, experts argue, and not only through better pay (although that is crucial). Social care is sometimes seen as a “last resort”, but it doesn’t have to be, says Prof Atkinson.

Just a glance in the direction of Scandinavia will illustrate that if workers in the care sectors are well remunerated and respected by society at large, the value of the work in the eyes of potential recruits rises exponentially. “They are inherently meaningful [jobs] so part of the process is allowing that meaningfulness to be one of the primary factors, to design those jobs in a way that allows meaningfulness to be prominent in those roles.”

Getting this message out in schools and colleges could be helpful, she suggests. “There’s something about employers and providers thinking about the things they can do without additional funding to make the sector more attractive to come into and stay in,” agrees Maguire. “[Offering better] professional development, for instance – so if you can’t pay people more, can you give them a better place to be when they’re at work?”

Claire points out that at her hospital, there are no changing rooms for the nurses, who must don their uniforms in the toilets. The rest area where they take their lunch breaks is full of “ripped chairs and dirty floors.” Improving these basics would surely be a start.

The UK is not the only country facing these problems. European Commission reports last year found Italy and Germany were the only EU states not subject to concerns about staff shortages and/or poor working conditions in health and care. The World Health Organisation has advocated solutions including better working conditions that promote a work-life balance, protection of workforce health and wellbeing and continuing the professional development of workers.

“There are all sorts of levers that can be pulled on,” says Maguire. “It’s important not to let a sense of hopelessness kick in.”

*Name has been changed