Do you expect to enjoy an old age living safely at home, looked after by professional carers if needed? The signs are not promising for England’s ageing baby-boomer generation. The ‘malnourished, minimum wage’ social care system provides nothing like the standards we would want for today’s elderly, and ‘governments of all colours have failed to adequately fund social care’, according to shadow health secretary Andy Burnham.
Despite the growing population of elderly people, home and day care spending by councils in England fell by a staggering 23 per cent between 2009/10 and 2012/13. Back in the early 1990s, homecare was almost exclusively provided by local councils, which directly employed their own carers. Fast forward to 2014, and nearly 90 per cent of publicly-funded homecare is dominated by a mixture of large, mainly private equity-funded businesses, smaller local agencies and a few providers from the charitable and voluntary sector. These providers also supply care to self-funding clients who need but do not qualify for state financial assistance. In essence, the provision of homecare has been almost completely privatised.
The female-dominated homecare workforce is suffering, in a sector characterised by councils commissioning strictly-timed slots of care, widespread use of controversial zero hours contracts, low rates of pay and low levels of union membership. Workers typically end up with just 50-60 per cent of the average hourly amount paid to providers by councils. Unison said its survey of homecare workers in 2012 showed a ‘committed but poorly paid and treated workforce which is doing its best to maintain good levels of quality care in a system that is in crisis’.
Freedom of information requests from Unison last year showed that nearly three-quarters of councils were still commissioning inadequate 15-minute care visits. There are more than 1.4 million zero‑hours contracts (Office for National Statistics estimates) – making them much more prevalent than previously thought.
Most councils have slashed spending on social care for the elderly as a result of the austerity agenda imposed by central government, and some providers who tender for council work are said to be looking for an exit strategy. Given this perfect storm, is it time for a radical new approach?
Shadow health secretary Andy Burnham’s comments on the inadequacy of the system were made in the light of a BBC File on Four investigation earlier this year. Of the 100 councils that revealed their hourly rates, the average minimum paid to providers was £12.26 per hour. Most councils have cut the minimum rate in the past few years, undoubtedly as a result of steep cuts in allocations from central government.
The provider Home Instead Senior Care, which runs franchises nationally, says it can’t work with some councils – including Warrington, which pays £9.09 per hour – because it’s impossible to deliver quality care for the rates offered. It charges councils or self-funding clients between £16 and £17 per hour for the service it provides.
The UK Homecare Association (UKHCA), which represents a third of independent and voluntary sector providers, wants its members paid a minimum of £15.19 per hour. This assumes care workers on the national minimum wage of £6.31 per hour for those over 21. For this model, it also adds on the costs of carers’ travel between jobs, national insurance, holiday pay, training and pensions and the costs the provider accrues – which the UKHCA says can ‘add another 30 per cent’.
Only four councils were paying the amount put forward by the UKHCA. Freedom of information requests also showed that for tender decisions, 17 councils said that when weighting cost against quality, they allocate at least 60 per cent of the marks on price. In the London Borough of Wandsworth, 100 per cent of the marks are allocated on price.
Gena Grant told me about her role as a home carer for 25 years in Wandsworth. A 65-year-old single woman, she is paid by care agency Home from Hospital Homecare. She tends to work around 16 hours a week. In reality she spends much longer working and travelling by bus between clients – time for which she is not paid. Unison’s 2012 survey showed that 58 per cent of respondents were not paid for their travel time between visits, and that this practice ‘eats away at homecare workers’ already low pay’.
Grant used to be employed directly by Wandsworth, which has now outsourced most of its homecare. She retired from her job with set hours at the council on a pension, then took work with the agency. She was not offered the chance to contribute to an occupational pension at the agency until recently. She is paid £7.24 per hour during the week and £7.72 at weekends – far below the voluntary London living wage rate of £8.80 (the UK living wage is £7.65).
Grant is a local representative for the trade union GMB. She says the job’s worst aspects are ‘low pay, poor conditions, and exploitation of carers by making them work all over the place. Low levels of union membership compound the problems. In care work you don’t see people much. We’re isolated. All the carers working for private sector agencies are on zero‑hours contracts.’
‘What good is, say, 10 hours a week when you’ve a responsibility to pay your rent or mortgage?’ she asks. ‘My worry also is that they don’t pay you for travelling time and because this is carers’ only source of earnings they work every hour in every day. When I had to work longer hours I sometimes took on another job as a casual in the evening, just to go home with a decent wage.’
Carers are expected to ring back immediately when they are left phone messages by the agency, but Grant says they ‘never get paid for phone calls’. The calls are to discuss work issues such as timings of care visits and whether cover can be provided for other carers. One Saturday night she had three half-hour slots of care with three different clients, but the work took her three hours including travel time. ‘You feel you get from management the attitude “take it or leave it”. One colleague asked if her petrol could be paid for, and she was told to save up her receipts and send them to the tax man at the end of the year.’
Frail clients can be in hospital for weeks at a time, with no pay for their carers unless they are allocated other work. Carers often want to keep time slots free in the hope that they can look after the same client on their return from hospital – but in doing that the zero hours contract system penalises them.
Grant says Wandsworth Council appears to be commissioning maximum time slots of half an hour, but clients often need longer: ‘Sometimes you work more than that to get the work done. This morning I went in to help one elderly man and half way through washing him he wanted to go to the toilet. You can’t just say you can’t use the toilet. Because of budget cuts people are only getting half an hour for a breakfast call. What if I go to a service user and the bed is wet?’
Rita works for a care agency and is on a zero‑hours contract. She says she has to work seven days a week to make ends meet. She is nearing retirement age and wants to give up, but her partner died and she only has his small pension coming in. Her rent is £500 a month, and her council tax £88. This month she has to pay her MOT and tax on her car. She hasn’t had a pay rise in over five years.
She says: ‘I have no social life. I have to work seven days a week to survive. Sometimes other carers don’t turn up and I have to take their work on at the last minute just to make some money. I’m so dead tired. But taking one day off makes me worry that I won’t be able to pay the rent.’
‘To tell you the truth, I’ve had enough,’ Rita continues. ‘But I don’t have the money to retire comfortably. If you care for the elderly you should be paid a good salary to reflect the dedication you have to show. Some of these people don’t have any family and the only person they see at night is their carer.’
She worries that carers are missing out on training – for example on safe handling. ‘There’s a client that the carer is hoisting on their own,’ she says, ‘which is dangerous for both of them.’
Another carer, Jenny, says she ‘normally’ works about 38 hours per week for her homecare agency to cover rent of £638 a month for her council flat and her bills. She says the agency has not provided any moving and handling or dementia care training for about a year, and that there’s a ‘danger in sending out unqualified people to do things like use hoists’. In one case carers were ‘holding the neck to bring a person forwards, when they should have gently moved her shoulders forwards. It was very dangerous. They could have broken her neck or her spinal cord.’
Unison has now published an ethical care charter, calling for conditions to improve in three stages, beginning with ensuring 15-minute visits aren’t used ‘in general’. It also seeks an end to zero‑hours contracts and calls for payment of at least the living wage and an occupational sick pay scheme. The charter has been signed by Islington, Southwark, Wirral and Reading councils in England, with Lancashire opting to do its own version based on charter principles.
While a positive development, is the charter really enough on its own? In April the Institute of Public Policy Research produced a report predicting a social care ‘gap’ by 2032 of more than 1.2 million people over 65 with support needs who won’t be receiving any informal care. It’s highly likely that reduced spending is already having a negative impact on the health and wellbeing of users and their carers, according to another report from Nuffield Trust QualityWatch and the Health Foundation.
Paul Maloney is a regional secretary for the GMB, representing 80,000 members in the south of England. He says: ‘Now that profit is coming in, care is suffering. Carers have no time to engage in the social aspects needed to give reassurance and all-round care and comfort.’
He is also concerned about the fallout for both workers and elderly people if companies fold. He says local authorities would have to take over responsibility for continuity of service and bail out failed companies.
His solution would be to bring care provision back into the public sector when tenders lapse. ‘Governments and councils will say they can’t afford this and ask who would pay. My answer would be to bring the privatised utilities and public services back in‑house. Our young people can’t get jobs. Why don’t we give them accredited training in health and social care, and give them work within the care sector? We could offer them stability of employment and pensions. It’s pretty simple.’
Ann McGauran is a freelance journalist, with a background in public policy. www.annmcgauran.org.uk. Twitter: @AnnMcGauran