A major policy plank in health and social care involves rebalancing ‘skillmix’ or occupational grademix to effect cost efficiency savings. In line with this, there has been a large expansion in recent years in the employment of care assistants/support workers. This article focuses on the largest employment area for these occupations – healthcare. It draws upon commissioned research projects to detail the context for the introduction of these new grades, to highlight issues in practice and usage to date, and to analyse tensions between policy objectives around efficiency and equity in the employment of these workers.

The Low Pay Commission was established in July 1997, and produced its ‘First Report’ in June 1998. It formed part of a series of initiatives marking a new Labour Government in the UK, which included inter alia the White Paper ‘Fairness at Work’, setting out new state positions on union recognition and wide-ranging changes to the benefits system. This article provides an initial comment on this institution, focusing on context, process, and remit, and on relevance to broader debates on the meaning of ‘fair’ wages and economic ‘efficiency’. The first section explores the political economic context. The second compares and contrasts the Commission's deliberations and recommendations. Finally, an assessment is made of these recommendations and the implications for trade unions.