Two pieces of research have been released this week, which both reach the same conclusion about the state of the UK’s thousands of care workers. In arriving at the same point, but by focusing on different symptoms of the system in doing so, both pieces of work highlight the desperate need for a long-term funding settlement for elderly care in the UK, something which the current care-cap initiative attempts but still falls far short of what is actually needed.
Leonard Cheshire Disability asked 63 local authorities which of them used care visits of 15 minutes or less. Three fifths of the respondents (38 in total) said that they used 15-minute visits, leading campaigners to brand this type of ‘conveyor-belt care’ are cruel and one which deprives people of basic dignity. The charity has called for a minimum 30 minute care visit duration when the Care Bill is debated this week and despite ministers stepping away from a statutory minimum visit time, Norman Lamb the care minister has also weighed into the debate, saying “It’s unrealistic to think that 15 minutes is enough time to help people who are older or who have a disability to do everyday things like wash, dress and get out of bed. It’s not fair on those who need support and it’s not fair on care workers.”
Hear, hear. Yet anyone working in care knows all too well that local authorities are under intense pressure to manage budgets whilst struggling to cope with an increasingly aged population. Despite a somewhat disingenuous statement from ADASS that not all visits need to be more than 15 minutes (that is perfectly true) and a suitable riposte from the UKHCA pointing out that councils are buying a service from human beings for human beings and that 15 minutes is too short (also perfectly true) there is a feeling of deja vu here, and much of the debate has been recycled over the preceding months.
Elsewhere the EHRC has followed its 2011 research by calling for the national minimum wage to be paid to all care workers and an end to local authority commissioning practices that drive down pay rates to workers. The report warns that the way care is currently commissioned is unsustainable,leading to inadequate pay, poor working conditions for care workers and
increasing threats to older people’s human rights. They estimate that up to 220,000 of the 830,000 domiciliary care workers in the UK are paid less than the minimum wage, which is £6.31 an hour. Yet the job requires “significant compassion and skill, maturity and resilience”, the EHRC said.
Travel time is the real villain of the piece here and not zero hours contracts or electronic monitoring as some would have us believe. Much of domiciliary care is conducted in ‘runs’ – groups of visits that allow one worker to go from client to client in the most efficient way possible, minimising both travel distance and time. This works well in urban environments, but when clients are more dispersed problems can arise, particularly as demand peaks at the beginning, middle and end of the day, so not everyone can have their dinner at 7pm. It is when travel time is taken into account that a care worker’s wages will dip below the minimum wage as a large part f their day can be taken up with unpaid travel.
‘Just pay them for travelling’ is the refrain, but local authorities simply do not have the funds to do this, and nor do the various agencies that deliver care into the community either. To be able to make a meaningful profit on such care either means not paying for travel time (the status quo) or paying the bare minimum to staff, which given the quality all right-minded agencies want to deliver, would never work.
Where both pieces hit the mark is over the perception of care workers, many of whom are as compassionate, skilled and hard working as any of their peers in competing industries. The belief that care can be salami-sliced as a sort of commodity is dangerous, but until the public sector, which currently accounts for roughly 86% of all care commissioning loosens the purse strings, the strategy will have to continue to be one of ‘make do and mend’ and the morale of these workers will suffer accordingly. It is perhaps only when the people who hold these purse strings have to receive care themselves in the future that the penny will finally drop, albeit too late for this generation of elderly and infirm.