Paul Bell talks to the Co-op Party Councillors Conference:
What are the current issues in adult social care?
UNISON’s experience of organising in this sector and the Ethical Care Charter
Links between the charter and co-operative values.
But I want to begin by spending some time going over the results of our Suffering Alone at Home report which we released in January with a focus on the lack of time in our homecare system because I believe that it demonstrates the lack of dignity in our care system for both the elderly and disabled people who rely on these important services.
Our report, which you can access online via our Save Care Now website, combined both an FOI request to every council in England and Wales and a survey of 1,102 homecare workers across the UK. It revealed that 74% of councils in England and Wales commission 15 minute visits.
I ask you, what can be done in such a short period of time? Hands up anyone here who managed to get up, get washed and dressed and fed in 15 minutes?
I’ve never managed to do it and yet this miserly amount of time is being given to elderly and disabled people with serious care needs who are in need of homecare. It is truly mind-boggling that this is permitted in a supposedly civilised society.
Our survey of homecare workers explored in more detail the lack of time that homecare workers have and the impact of this.
So I will read through some of the key findings, some of which are very shocking and illustrate them with some feedback from our homecare workers.
74% of members say they aren’t given enough time to provide dignified care.
58% had been asked to provide personal care in 15 minutes (this is an important finding because a lot of councils say that they only commission 15 minute visits for the purposes of welfare) – but we know from speaking to homecare workers that these visits are in fact often being used to deliver personal care.
Worker testimony 1
“One client had cancer of the bowel, so frequently had bad days of passing blood and not realising she had. I had 15 minutes to normally get her ready for bed, toilet her, give her personal care and give her tablets and supper. When it came to her bad days I personally felt under pressure, rushed, harassed and frustrated and felt this was unfair towards the client as I wanted her to feel at ease. She was bound to feel embarrassed, humiliated and under pressure to hurry up”.
Some more stats:
57% of respondents had been asked to provide personal care in 15 minutes or less with an elderly person they have never met before 61 per cent said they had not had enough time to provide a dignified level of personal care to a care user aged over 90 years old.
Worker testimony 2
“I had to visit a lady who is 102 years old to shower her, help her get dressed, make food, tidy the kitchen, give her medication, and put her bins out, in 20 minutes – that’s all the social services would allow. If the carers go over that time we don’t get paid. It’s humiliating as we haven’t got time to have a chat”.
85% said they regularly did not even have time for a conversation during some domiciliary care visits.
32% said they had no time to address people’s personal hygiene needs such as washing, and 24% had no time to take people to the toilet.
49% said a quarter of an hour wasn’t long enough to prepare a nutritional meal, and the same proportion said the shortness of the visit meant there was no time to assess any change in the person’s health.
All this is despite homecare guidelines recently issued by NICE that state that care workers should spend at least 30 minutes on home visits to older people in England.
The guidance states: “Homecare visits shorter than half an hour should be made only if: the homecare worker is known to the person, and the visit is part of a wider package of support, and it allows enough time to complete specific, time limited tasks or to check if someone is safe and well.”
The range of conditions of the people they care for include dementia, mobility issues, multiple sclerosis, victims of stroke, mental health problems, Parkinson’s disease and learning disabilities. Another key finding illustrated just how isolated and lonely a lot of the people are. That is:
96% of homecare users do not see anyone else other than their homecare worker for many days at a time.
As one homecare worker said,
“In the past I have been the only person that a service user has seen on Christmas Day and their birthday. It makes you feel very sad and you just try and do your best to make it a bit more special”.
Unsurprisingly this toxic combination made the care workers feel quite upset.
Worker testimony 3
“Guilt, that is what you feel. I am not in this type of work just for a wage. I want to make a difference to people, more so those who have no one. I want to let them know there are people who care. It’s not all work. We all matter at the end of the day. That will be me one day. And God help us if it keeps going the way it’s going today. Because there is no care left in the community from what I witness now.
It’s like a conveyor belt — “I had a user who was receiving end of life care, the lady had terrible diarrhoea, was covered in faeces. I found myself extremely stressed as I had very little time to give to the lady the care she deserved and comfort her husband who needed some time and who was in tears. It was just awful”
Now I think that these findings perfectly encapsulate so much of what is wrong with our social care system – a system that routinely denies dignity to the elderly, disabled people and the workforce. The reasons for this crisis is simply funding – billions have been taken out of the service.
It is almost completely privatised and there are a lot of unscrupulous employers in the sector (private equity companies for example).
There are very poor commissioning practices from many local councils – who all too often commission at very low rates and then allow these companies to operate how they want with little oversight.
We undervalue our care workers as evidenced by the fact that over 200,000 are illegally denied their wages, due to not being paid for their travel time or time spent training.
And as a country we of course do not place anywhere near enough importance on providing care for our elderly and disabled people. Surely we have to ask ourselves how can we allow such an appalling state of affairs to persist? And I think we all need to consider just what steps we have to take to force our government to rectify the situation.
As a union we have been focusing on improving our homecare system by getting councils to adopt our Ethical Care Charter. This is a system of standards that we are asking councils to adopt when they commission their homecare services.
20 councils in England and Scotland have now adopted it.
Southwark Council recently carried out an evaluation of the impact of the Ethical Care Charter since they adopted it. They found that recruitment and retention rates for homecare workers had markedly improved, take up of training had improved, staff morale had improved and the experiences of service users had also improved.
So it’s a good campaign and it is making a difference but the situation in our wider social care system is stark and troubling that we need to do much more.
We’ve had George Osborne allow councils to raise resources for pay for social care – his first real acknowledgement that our care system is grossly underfunded – but it’s still nowhere near enough – we need his successor to cough up the billions extra that the system needs and we also need to get rid of private care companies from our social care system – they should have no role in the delivery of care to elderly and disabled people.
But how can we achieve this? We will continue to highlight the crisis in our care system and the impact on the workforce and we will start to focus more on residential care later in the year too – as well as trying our best to influence all politicians.
But we need to do more and I would welcome your views. What do we need to do to get social care to the top of the political agenda where it belongs? Because at the moment it is an absolute disgrace and the elderly and disabled people in our society who rely on it deserve so much better.
So, one of the ways we push forward this agenda and values, was through the Ethical Care Charter, which local councils could sign-up to. The values of the Ethical Care Charter are in stages:
The starting point for commissioning of visits will be client need and not minutes or tasks. Workers will have the freedom to provide appropriate care and will be given time to talk to their clients.
All homecare workers will be regularly trained to the necessary standard to provide a good service (at no cost to themselves and in work time).
Homecare workers will be given the opportunity to regularly meet co-workers to share best practice and limit their isolation.
Clients will be allocated the same homecare worker(s) wherever possible
Zero hour contracts will not be used in place of permanent contracts
Providers will have a clear and accountable procedure for following up staff concerns about their clients’ wellbeing.
All homecare workers will be paid at least the Living Wage. If Council employed homecare workers paid above this rate are outsourced it should be on the basis that the provider is required, and is funded, to maintain these pay levels throughout the contract.
All homecare workers will be covered by an occupational sick pay scheme to ensure that staff do not feel pressurised to work when they are ill in order to protect the welfare of their vulnerable clients.
The time allocated to visits will match the needs of the clients. In general, 15-minute visits will not be used as they undermine the dignity of the clients
Homecare workers will be paid for their travel time, their travel costs and other necessary expenses such as mobile phones.
Visits will be scheduled 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
Those homecare workers who are eligible must be paid statutory sick pay
These are human values. Human values are trade union values. And these values are co-operative values.
Finally, while as trade union we will not support spinning-out of the public sector to co-ops, mutuals or social enterprises, we can fully get behind and work with you on mutualising the private sector.
We are of the same movement. Homecare is in need of desperate change. We in this room are the ones to make that happen.
I will end on this from the German Chancellor, Angela Merkel:
“When it comes to human dignity, we cannot make compromises”.