Former care worker Graeme McIver argues that the system of home care in this country is at crisis point. Preventing the whole rotten system from crashing down is a thin red line of care workers whose kindness and humanity stand in stark contrast to the ignorance, greed and avarice of those who design and implement policy.
There are currently around 10 million people over the age of 65 living in the UK. By 2050 that number is expected to almost double to 19 million. (1) Successive governments have moved the responsibility of providing care services to our senior citizens from the public to the private sector and that process shows no signs of being reversed by any of the main parties. Under the guise of providing a better, targeted and more cost effective standard of care the reality is that our pensioners and those tasked with delivering those vital services are being failed and exploited in the name of profit.
For almost a year I worked in the home care sector delivering care to the elderly and those with specialist needs. My experience opened my eyes to the crisis that exists in the industry and to the way that worker’s rights are routinely attacked and undermined in a way that might have shamed the owners of the dark satanic mills of William Blake’s Jerusalem.
During the first decade of the new millennium, (and under a Labour Government) like many other councils, my local authority, Scottish Borders Council (SBC) started the process of privatising home care services. Private companies were invited to tender for service contracts that the council had previously delivered. SBC were confident that this process would save them huge sums of money year on year.
The companies that were successful in securing these contracts would be paid by the social work department to deliver the services deemed necessary. These firms would then have to ensure that as well as providing care they could also make a profit. The way to do this was to employ staff who were paid less and had poorer conditions than council staff and to try and optimise the number of visits made by those carers in a single shift. As the economic crisis has deepened, the money available to council social work departments has been reduced dramatically meaning that like other essential public services there is a crisis in home care provision. In these difficult trading circumstances, private companies have had to launch a further offensive on workers rights in order to increase profits. At the same time, with the number of care home places at a premium, an increasing number of pensioners are now reliant on home care workers to help deliver the basic necessities of life.
Delivering the highest quality of care to our elderly population should be a priority for our society. As we all get older, it is likely that at one time or another we will require help and assistance to allow us to remain living in our own homes. Delivering this care is a professional and extremely important job yet care workers are amongst the lowest paid staff in this country. In a huge number of cases these workers do not even receive the paltry minimum wage. When conducting an undercover report into the recruiting practises of private care firms, The BBC’s Panorama programme (2) concluded that some carers received less training than they would for a job in a burger bar.
The list of essential tasks care workers deliver each day is astounding. They include helping clients to get up in the morning, assisting into bed at night, washing and dressing, providing medication, making meals and carrying out necessary domestic chores. Carers are required to do clients shopping, collecting medicines, accompanying people to hospital visits and social outings, changing dressings on wounds, liaising with family, the NHS and social services. Administering palliative care in the final days of a person’s life, using complex lifting devices and hoists, checking for signs of illness, malnourishment and bed sores. Gauging risks in the home and assessing deteriorating medical conditions such as dementia and Alzheimer’s. Add to this list the important and undervalued tasks of providing social contact, a friendly ear and helping hand to some of society’s most vulnerable people. Yet a recent study commissioned for my trade union UNISON by the think-tank the Resolution Foundation (3) concluded that for many care workers the rate they received for delivering these vital services was a little as £5 an hour. Add to this the fact that a large number of care workers are on zero hour contracts, do not get paid for travelling time between clients, are not given enough time to perform the required tasks, that many habitually exceed the maximum number of recommended working hours in a week, receive no sick pay and have generally poor working conditions then it is clear that there is a shameful crisis at the heart of the care for the elderly policies of the main political parties. Workers are being exploited for daring to care. This leads to poor morale and a high turnover of staff meaning there are tens of thousands of inexperienced care workers in the system. This large turnover of care staff also means that many elderly people see large numbers of different care workers rather than getting to know and feel comfortable with a select few. This lack of continuity is especially damaging for dementia patients. In May of 2012 Jeanette Maitland from Aberdeen took her local council to court after her late husband Ken, a dementia sufferer was given 106 different carers in a single year. Jeanette argued that Aberdeen's social work department contravened Ken's basic human right to dignity. (4)
The Resolution Foundation report, (Under Payment of the Minimum Wage in the Social Care Sector) stated that there are an estimated 2 million care workers in the UK, 830,000 of whom are carrying out home visits. They conclude that up to 220,000 of all care workers may be paid less than the minimum wage. Last year HMRC, which is responsible for enforcing the minimum wage, served notices on 879 employers (in all sectors) advising them of underpayments to staff.
I am sure my experience is not untypical for workers in the care sector. After a period of unemployment and temporary work in a call centre I was pleased to be offered a job that I felt would be socially useful and personally rewarding.
After a three day induction period and a few hours of “shadowing” another member of staff I was given my first rota of clients to visit. During my induction myself and other new staff were required to sign an opt-out from the working time directive in order to be offered a job. We also had to state our preferred working hours. Given that I knew weekend working was required I stated I would be happy to work alternative weekends. In return, I was told that I would be given a day off during the week that I worked on a Saturday and Sunday. I also stated my availability was between 8am and 8pm each day although I was promised large breaks between the morning and evening shifts. It was made clear to the new intake that the care company we were working for had an acute staff shortage and that we would be required to help cover this shortfall until more carers were recruited. Whilst I expected a heavy schedule I was not prepared for what came next.
During the first 47 days I was employed by the company I worked on 45 of those days. By the time I had worked for 68 days I had the grand total of 4 days off. My working hours per week started at a reasonable enough level of 45 hours but by week 9 of my employment I was working in excess of 80 hours per week. This was not unusual by any means and I knew of several colleagues who were working from 7am until 11pm seven days a week. One confessed they had not had a complete day off in 15 weeks.
It ultimately got to the stage when following advice from my trade union I insisted to the company that I was opting back into the working time directive and would no longer work hours that I felt compromised both my health and the safety of my clients.
Working or being available for 16 hours a day did not mean that you received that level of payment. There were no increased payments for unsocial hours or shift allowance of any kind. Weekend working saw a slight increase in the hourly rate but only a minimal amount. During the course of a shift I would receive a number of breaks for which I was not paid. I also was not paid for travelling times between clients. Some of my visits required a 16 mile return journey whilst I could easily clock up 60 miles of travelling during the course of a single day. Home Care workers are routinely not paid for this time. The petrol mileage allowance was also at a paltry level. No payment was made for the first 10 miles travelled in a day and then it was £0.20 per mile after that. For driving 60 miles in my own car I would receive £10 a day.
Payment was not made by hourly rate. Instead wages were worked out on the number of visits made to clients during the course of an hour or contact time as it is known. This could mean an occasional single one hour block, more usually two blocks of half an hour but often several blocks of 15 minutes.
If a carer is only scheduled to do 3 x 15minute blocks in an hour then they would only be paid for 45 minutes. In reality however, journey times between client’s houses and delays often mean that the carer works for the full hour and is unpaid for the rest of the time. As this situation regularly occurs carers find them selves in the position of having been working for only three quarters or less than the minimum wage hourly rate. (Galashiels is a former textile town and I often thought that terrible though the conditions were in the Victorian mills at least the workers were paid an hourly rate for the job.)
The scandal of 15 minute visiting times has recently caused a storm in the media. Early this month the Leonard Cheshire Disability charity (5) stated that 15 minute visiting times were a disgrace and called on the government to abolish their use. They claimed the short visit forced some elderly people to choose between going thirsty or visiting the toilet.
Despite facing growing evidence that these short visits are completely unacceptable the government has refused to outlaw their use.
Speaking to the BBC, Tracey Currey, a former care worker said she had left the sector as her employer would not let her do more than the "bare minimum" for clients.
"I was forever in trouble with my company because I always went over my time.”
"There was usually a care plan in place telling you what was needed at each visit but there was always more to do. I would stay and do everything that was needed. What is a carer to do on arriving for a 15-minute call to find the client soiled, confused and extremely distraught?”
"What would the priorities be? To administer the medication as instructed, or to clean and change the client, or to make a hot drink and try to calm and reassure the client? All three in my book, but the present times do not allow for this.”
"It is simply atrocious how this has gone on for so long. Care companies, agencies and councils getting away with this, money having become top priority and the compassion, love and care that should be shown to each and every elderly person has long gone, been thrown out of the window."
In UNISON’s ethical care charter (6), the trade union concluded that almost 80% of workers they surveyed in the home care sector have; “…(their) work schedules arranged in such a way that they either have to rush their work or leave a client early to get to their next visit on time. This practice of ‘call cramming’, where homecare workers are routinely given too many visits too close together, means clients can find themselves not getting the service they are entitled to. Homecare workers are often forced to rush their work or leave early. Those workers who refuse to leave early and stay to provide the level of care they believe is necessary, also lose out as it means they end up working for free in their own time.”
My experience chimed completely with UNISON’s conclusions. Not only was the 15 minute visiting time not enough but sometimes, especially when there were acute staff shortages such as at weekends or holiday periods then carers would be contacted at short notice and asked to fit in extra clients to already crowded rotas. This could mean that in a 1 hour period you may have to fit in extra 15 minute slots or additional half hour blocks with no scheduled travelling time in between. In such circumstances it is simply not possible to provide the levels of care required. Even when you have a rota that seems to be manageable care workers can often experience unexpected delays such as clients soiling themselves or taking extra time on the toilet. You can therefore fall behind schedule very easily and you can only make it up by cutting the time spent at your next visit(s) or by being late and working through unpaid break times.
A number of my colleagues would relate stories of how they often worked unpaid in order to provide a level of care they felt was necessary for the people they cared for. I would try and arrange my breaks so that I could sit with one regular client I became particularly close to in order to have what he would call a, “grand blether” every day. The scheduled visit was only due for 15 minutes to administer medication however it was clear that what he really needed was social contact and personal interaction that the care-plan simply did not recognise or cater for. I was not paid for this time although I consider those hours I spent with him as incredibly rewarding for both he and I. However, it was impossible to give that level of care and support to every client that deserved or required it. Hundreds of thousands of care workers across the county encounter such ethical quandaries everyday and are exploited for their care and kindness.
I also found a myriad of other unfair and unjust employment practices during my time working in the care sector. Work rotas were continually changed at a moments notice making it impossible to plan your week with any degree of certainty. As the company seemed to be suffering from continual staff shortages and a large turnover of carers it was difficult to get holidays booked or scheduled weekends off. Although it did not happen to me personally I heard reports of carers who had called in sick being told that they would have to arrange to get their schedule of clients covered. This meant that carers who were unfit for work had to contact colleagues themselves to arrange cover for their clients. Some carers would have to arrange to cover in excess of 20 or 30 visits a day. I also heard reports of carers who had contracted illnesses such as the winter vomiting bug being told to attend clients.
Instructions from the company were implicit that mobile phones were not to be answered during client visits. Yet as the office was continually calling carers telling them of additional visits or changes to their rota then staff had to use their own phones to ring back the office for updates once they found they had missed calls. If you were delayed at a client’s house then again you used your own phone to inform the company.
I felt unprepared and ill equipped to deal with some of the issues I came across as a care worker and spent my own time researching ways to deal with clients who were deaf, who had suffered strokes or who were diagnosed with dementia.
I finally left the company angry at the treatment of my fellow workers and dismayed at the levels of care offered to some of my clients. I had been particularly frustrated by the company’s refusal to resolve issues affecting one client with severe physical needs caused by a neurological condition. Despite needing to be lifted on a hoist to get the client out and into bed, onto the toilet and into a shower only one carer was allocated to the task for the majority of my time with the company. I considered this a risk to both the carers and the client as two people are required to operate the lifting equipment safely. Added to this issue was the fact that the time allocated to care for the client was simply too short. Despite continually raising my concerns both verbally and in writing nothing changed. On one occasion I hurt my back whilst tying to transfer the client into bed and left a note in the communication book expressing my concerns. The company’s response was to attempt to discipline me for what one member of the management thought was an “inappropriate comment in the service user’s observation book.” In all honesty I relished the change for the process to proceed and to be represented by a trade union official but unsurprisingly the company did not pursue the matter after a preliminary investigation during which I made my views clear. Shortly afterwards the client’s care package was switched to a different provider.
I joined the union and encouraged other to do the same but there are clearly problems in organising across a disparate and isolated workforce. Although technically you are part of a large team, carers spend most of their working time on their own and sometimes rarely see work colleagues.
I worked for a Scotland’s biggest home care provider, Independent Living Services (ILS) based in Alva. In April of this year the Scotsman reported that company had been taken over by The Mears Group for £22.5 million (7), “triggering cash windfalls for senior management…ILS Executive Chairman Scott Christie and other senior management are set to scoop about £2.55million from their 30 per cent stake in the company. Christie himself owns more than 20% of ILS after leading a buy-in in 2005, indicating a personal windfall of about £1.7million.”
Scott Christie of ILS
Whilst the Chairman was becoming a millionaire the majority of the company’s employees in my area earned £6.30 per hour (and often much less than the minimum wage when the contact time fiddle was factored in) for delivering the best standard of care they could trying to ensure that our pensioners are treated with dignity and respect. I have to say that without exception my colleagues and the management staff in the local office all went above and beyond the call of duty in extremely trying and difficult circumstances. Whilst angry at the treatment of work mates I was inspired by the care and compassion they displayed and their dedication to the clients. It was a humbling experience at times. They deserved to be honoured and fairly rewarded but instead they are exploited by a system that places the pursuit of profit before the needs of our elderly population and those employed to look after them.
In the UNISON’s ethical care charter the union states;
“…the selflessness and bravery of homecare workers who, to their own personal cost, refused to accept the imposition of outrageously short visits and worked in their own time to ensure that their clients received good levels of care. Some homecare workers were doing tasks and errands for their clients in their spare time, despite the seemingly best efforts of the current care model to strip away any sense of personal warmth or humanity. Homecare workers are personally propping up a deteriorating system of adult social care, but they are being pushed to breaking point. That they are still willing to deliver good levels of care in spite of the system is nothing short of heroic. For the system to work it needs to be underpinned by adequate funding and a workforce whose terms and conditions reflect the respect and value they deserve. Crucially they must be given the time to care.”
The union has challenged councils and care providers to sign up to an ethical care charter based on recommendations from the report carried out by the Resolution Foundation. The charter calls on councils to;
- Give workers the freedom to provide appropriate care and be given the time to talk to their clients.
- Allocate clients the same homecare worker(s) wherever possible.
- Match the time allocated to visits to the particular needs of the client. In general, 15-minute visits will not be used as they undermine the dignity of the clients.
- Pay homecare workers for their travel time, their travel costs and other necessary expenses such as mobile phone use.
- Schedule visits so that homecare workers are not forced to rush their time with clients or leave their clients early to get to the next one on time.
Whilst I welcome the charter and the work that the union has done in highlighting the exploitation of care workers there is a bigger and more fundamental issue that needs to be addressed. Of course care workers should expect to at least be protected by minimum wage legislation and it is a disgrace that even this most basic of rights is not being applied. Yet the bigger question for society is why are governments, councils and care providers allowed to place such a pathetically low value on care workers? I can think of no clearer indicator of the madness of the capitalist economic system than the fact that on the one hand our government goes to court to defend the bonuses of the bankers who plunged the world into economic meltdown whilst at the same time being complicit (along with the other major parties) of maintaining a system that means those who provide one of societies most important functions are deemed to deserve amongst the lowest pay imaginable?
A warning about the crisis in the care system has emerged from one seemingly unlikely source. Gary Farrer, the Managing Director of a private care provider, SureCare has cautioned that it will take a “catastrophe” to bring about the much needed revolution in the way the elderly are cared for.
He told Care Industry News (8);
“There also needs to be a cultural change in how we view older people. They should be seen as being precious rather than a nuisance. We should be learning from their wealth of experience. It is a huge shame that when you hit retirement age, the next step is seen to be death.
“We are facing a care time bomb, a world in which more and more of us will be working until we are 75 and living past 100.
“Our carers tell us that, more often than not, what elderly people want more than most is time. I think we are starting to see a shift back towards the importance of community. Even the supermarkets are picking up on this trend and opening smaller, more community-based stores in towns.
“The way our elderly are treated by central Government is scandalous. They make sure the buses run on time and our bins are emptied, but they are happy to allow people who have given great service to this country to receive care visits of just a few minutes a day.
“We need a Government to be bold enough to find the extra investment needed to give our elderly the dignity they deserve but, alongside this, we also need a change in attitude.”
The system of home care in this country is at crisis point. Preventing the whole rotten system from crashing down is a thin red line of care workers whose kindness and humanity stand in stark contrast to the ignorance, greed and avarice of those who design and implement policy. Our Grandparents, our Mothers and Fathers, the generation who fought the wars that our governing class are always keen to exploit for political gain are looked after and cared for by a group of workers often paid less than the legal minimum. What a scandal. What an indictment of 21st Century Britain, one of the richest nations on the planet.
(1) The Ageing Population
(2) Panorama - Britain’s Home Care Scandal
(3) The Resolution Foundation report (Under Payment of the Minimum Wage in the Social Care Sector)
(4) Ken Maitland Court Case
(5) Leonard Cheshire Disability Charity – scandal of 15 minute care visits
(6) Unison Ethical Care Charter
(7) ILS take over – The Scotsman
(8) Head of Care Company Criticises Government
Other articles by Graeme McIver in The Point can be found here