Summary of the impact

The long-term impacts outlined in this case study relate to low-paid women workers in health and local government sectors in the UK. Professor Carole Thornley undertook some of the earliest and most sustained academic research focusing on these workers. Through this she identified systematic undervaluation of their skills and competencies, as well as problems with training, career advancement, pay, and payment systems. The evidence from this research has been used in successive pay determination exercises and reviews of payment systems, valuation of skills, and to inform public policy. This has put these workers higher on the agenda of both unions and employers, informing their practice and leading to improvements in training and pay conditions.

Underpinning research

Since her appointment to a lectureship at Keele University in 1992 (with subsequent promotion to Senior Lecturer then Professor), Thornley's research has explored the complex reasons underpinning women's pay inequality and their disproportionate location in the low-paid regions of the wage hierarchy. The research has demonstrated that the gender pay gap within both the National Health Service (NHS) and local government sectors has been a continuing phenomenon.

In both sectors, the low-paid end of the workforce spectrum is characterised by a high proportion of female workers, especially where employment is part-time, but this issue is compounded by intra-sector inequality. Because low valuations are more frequently given to work carried out in these sectors, large pockets of low pay persist at levels just above the National Minimum Wage (NMW); this impacts disproportionately and negatively on women (Thornley, 2006). The reasons for this include systematic undervaluation of skills and competencies and of tasks actually performed (Thornley, 1996), and problems with training, career advancement, pay and payment systems (Thornley, 1998; 2003; 2008). Thornley's work has also shown that part-time working has an adverse effect, widening the overall gap between men's and women's pay (Thornley, 2007).

The underpinning research has been conceptualised and conducted solely by Thornley through a series of nine successive commissioned research projects for public sector union, UNISON, running from 1994 to 2005 (in 1994, 1996 two, 1997, 1998, 1999, 2001,2001-4, 2005). Each of these has produced one or more reports (fifteen in total). These have ranged from an assessment of local pay determination for nurses in the 1930s, through to detailed studies of nurses' pay, the pay and employment of nursing auxiliaries and health care assistants, and the pay and employment of local government workers and problems within the Single Status agreement pay system. The research has involved literature reviews and primary documentary research, analysis of primary pay statistics, some of the largest national surveys ever undertaken by an independent academic of these groups of workers, and successive research interviews with union representatives, employers, and workers at national, regional and local levels. Thornley's research has been published in highly regarded peer reviewed journals and scholarly edited collections and is of a quality that is recognised internationally in terms of originality, significance and rigour.

References to the research

GRANTS RECEIVED FOR RESEARCH RELEVANT TO CASE STUDY:

2005 Commissioned research paper, fieldwork-based research support, UNISON Health

2001-4 *Commissioned research with full fieldwork-based research support UNISON Local Government (own direct fieldwork budget £4,500-£9,000)

2001 Commissioned research paper, fieldwork-based research support, UNISON Health

1999 *Commissioned research paper, full fieldwork-based research support, UNISON Health

1998 *Commissioned research papers, full fieldwork-based research support, UNISON Health

1997 *Commissioned research papers, UNISON Health

1996 £1,333* 2 Commissioned research papers, UNISON Health

1994 £900 Commissioned research paper, UNISON Health

* UNISON have provided direct administrative support for national survey work, and direct support for case study fieldwork and data input expenses, to an estimated imputed value of £5,000-25,000 per project. Any figures shown represent net commission fee only.

Details of the impact

Thornley's research has made a significant, pervasive, and continuing contribution to understanding the issues facing low-paid women workers; the problems of and reasons for gender pay inequalities; and the nature of the work that women undertake. These issues are of central concern to unions, Pay Commissions, professional bodies, policy makers, employers and workers. The significance of these issues is indicated by the large number of workers implicated: the NHS and local government are the two largest employers in the UK, each with a predominantly female workforce. Around a third of all women workers in the UK economy work in the public sector, and disproportionately high numbers of the women employed in this sector work part-time.

The impact of Thornley's work in the period 2008-2013 has been underpinned by dissemination activities in preceding years. Dissemination of Thornley's research, and the subsequent change in understanding by key stakeholders of the issues raised, has taken place since the 1990s (1994-2005). Key findings from Thornley's research have been disseminated through the publication and distribution of reports (see Section 2), by UNISON, to managers and other key authorities in both the NHS and local government. This has led to invitations for Thornley to present her findings as evidence to the Nurses' Pay Review Body, the Health Select Committee, and the Low Pay Commission. Hansard cites evidence from Thornley's UNISON report about the nature of health care work and unknown reasons for pay discrepancies [for example, source 1]. Thornley's findings were used as evidence by the National Joint Council Trade Union in national pay negotiations (2002-2004), the Local Government Pay Commission of 2003, and the Low Pay Commission. A report from the Local Government Pay Commission [source 2] directly cites Thornley, particularly in relation to her research on the poor implementation of the Single Status agreement.

The deliberative bodies to which Thornley provided evidence made substantive recommendations on the pay of workers, which have fed into policy decisions around wider employment and payment systems issues that have had considerable impact in the period 2008-13. For example, the Local Government Pay Commission Report was favourably received by both Local Government employers and by Central Government policy makers [corroboration from Local Government Pay Commission], and directly informed the 2004 national agreement for Local Government Services which set a deadline for the implementation of Single Status agreements, reached in 1997, requiring individual councils and unions to carry out job evaluation exercises and construct new pay structures by April 2007. Although many Local Authorities missed this deadline [source 3], the structures have continued to be implemented from this point onwards, the effects of which extend throughout the impact period and beyond. These are one of the most significant mechanisms through which equal pay for all workers is being delivered in the UK [source 4].

Many of the findings of Thornley's research, particularly concerning the substitution of lower-paid workers for higher-paid workers, and the pay inequalities experienced by women workers, challenged policy makers' prior assumptions, transforming their understanding of the problem and their approach to dealing with it. Thornley's work continues to make a path-breaking contribution to understanding local government sector employment and, in particular, the issues facing UNISION's branches and activists in negotiations over the Single Status agreement [corroboration from UNISON]. Birmingham City Council has recently (October 2013) been ordered by the Supreme Court to pay an estimated £890 million to over 11,000 mostly female workers occupying lower-paid posts. Although a Single Status pay scale was introduced in 2008 it was found to be sexist, continuing to reward those in predominantly male-held posts (such as road workers, street sweepers and dustmen) with greater pay than those in predominantly female-held roles (such as cleaners, care assistants, caterers). Led by trade unions, the fight for pay equality has taken place over the past six years and resulted in the compensation pay out by the City Council [source 5].

Thornley's work on skills, tasks and the valuation and pay of both registered and non-registered nurses in the NHS has been particularly influential on managers' perceptions and in policy terms. Her research has helped encourage recognition of the essential contribution of these workers and consequently led to improvement in their working conditions [corroboration from UNISON]. In addition to providing evidence for national pay negotiations, resulting in similar outcomes for low-paid health workers as in local government, Thornley's work has had a sector-wide impact on the valuation, education, skills and training of healthcare workers.

A significant example of this impact is in the review, development and implementation of a national approach to supporting and developing the clinical healthcare assistant role in Scotland. Thornley's research is liberally cited in the main review document published in 2010, and used by the review to elaborate understandings of healthcare assistant work, specifically in relation to the role and its evolution, the general age and experience of healthcare support workers, and their interest in undertaking training [source 6]. This evidence sits alongside guidance and educational resources for clinical and non-clinical healthcare support workers developed as a result of the review and launched in June 2010. This is part of an online toolkit aimed at NHS executives, boards and educational professionals and sets out nationally agreed education requirements and core skills [source 7]. As one of the main reviews of its kind to date, the Royal College of Nursing recommends the toolkit as a core source of guidance on good practice for healthcare workers across the UK, stating that it promotes high-quality care for patients and good standards of practice for all staff [source 8].

Understandings of healthcare assistants' work developed though Thornley's research continue to inform key stakeholders. For example, the Royal College of Nursing policy briefing on Healthcare Support Workers draws on this, as does the July 2013 Cavendish Review for the Government into the use of healthcare assistants and support workers in the NHS, both of which cite her research [source 9]. Her work is also cited in healthcare assistant training publications, such as Clinical Skills for Healthcare Assistants, to emphasise the importance of such skills for high-quality patient care [source 10]. Thornley has also written an invited piece on issues of healthcare worker employment for NHS publication Employing Nurses and Midwives, distributed to NHS managers and board members [source 11]. She is also highly cited (20 citations) in the review of healthcare support workforce regulation commissioned by the Nursing and Midwifery Council [source 12].

Sources to corroborate the impact

Source 1: HC Deb 24 February 1999 volume 326 cc363-70: http://hansard.millbanksystems.com/commons/1999/feb/24/health-care-assistants#S6CV0326P0_19990224_HOC_94

Source 2: Local Government Pay Commission Report 2003

Source 3: Personnel Today, 27^th March 2007, `Equal pay for council workers: whose bill is it anyway?': http://www.personneltoday.com/articles/27/03/2007/39877/equal-pay-for-council-workers-whose-bill-is-it-anyway.htm

Source 4: UNISON website, `Campaigning and Bargaining on the Living Wage — A statement of general principles': https://www.unison.org.uk/upload/sharepoint/Briefings%20and%20Circulars/BG%20UNISON%20Living%20Wage%20Principles%20FINAL.pdf

Source 5: Birmingham Mail, 4^th October 2013 `11,000 Birmingham City Council staff set to get equal pay payouts'. Available from: http://www.birminghammail.co.uk/news/local-news/birmingham-city-council-staff-set-6134322

Source 6: NHS for Scotland (2010) Healthcare Support Workers: The development of the clinical healthcare support worker role — a review of the evidence. NHS Education for Scotland. Available from: http://www.hcswtoolkit.nes.scot.nhs.uk/media/3752/hcsw_literaturereview.pdf

Source 7: NHS for Scotland, Healthcare Support Workers Toolkit website: http://www.hcswtoolkit.nes.scot.nhs.uk/developing-hcsw-roles/

Source 8: Royal College of Nursing, Healthcare Assistants — Regulation: http://www.rcn.org.uk/development/health_care_support_workers/professional_issues/regulation

Source 9: (July 2013) The Cavendish Review. Commissioned by the Secretary of State for Health. Available from:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/236212/Cavendish_Review.pdf

Source 10: Ingram, P. and Lavery, I. (2009) Clinical Skills for Healthcare Assistants. Wiley Blackwell.

Source 11: Thornley, C. (2008) `Balancing Cost and Fairness for Health Care Assistants, Employing Nurses and Midwives (June issue, number 120).

Source 12: Griffiths, P. and Robinson, S. (2010) Moving forward with healthcare support workforce regulation. National Nursing Research Unit.

Corroborators: Local Government Pay Commission; UNISON