Choice, training…or proper funding?

Politicians are obsessed with the idea that increasing choice in the world of social care and health is the way to solve every problem. As one NHS blogger so elegantly puts it, ” ‘choice’ has been the mantra of…well…choice for successive governments for about as long as I can remember”.


This mantra was repeated recently by Peter Hay, president of the Association of Directors of Adult Social Services when he appeared on the Today programme to give his account of the findings in the report by the Equality and Human Rights Commission. The report found that ‘many of our most frail and vulnerable older people are suffering ‘appalling’ levels of care at home’. Barely acknowledging that a 50% satisfaction figure from users of these services was truly shocking, he want on to suggest that there was a ‘plan’ to address the problem….the introduction of choice. Soon it would be possible for an individual to choose a different care worker or a different care provider if the one they currently had did not live up to their expectations. The report paints a depressing picture of the care some 250,000 people receive.  Care workers who can either help someone get out of bed and washed or prepare something for them to eat; workers who rush in and out to complete a task with barely a ‘hello’ to the 80 year old who may not see another person until their next fleeting visit from the same worker that evening; workers who seem cold and distant from someone who needs warmth and to be treated with respect in their own home.

The author of the report, Baroness Greengross, also appeared on Today. She spoke with eloquence of the shameful way many older people are being treated. Presenter James Naughtie asked her where the problem lay. The Baroness was very clear, “(workers) are given insufficient time to complete more than one task”. Absolutely. But then, when asked what could be done…what the solution was, she said it was to provide “more training” for the workers… if giving them more training will somehow suspend time when they enter someone’s home!

One former care worker who has resigned in order to blow the whistle on the practices of her former employer, has written to the Baroness having heard the interview on Radio 4. She writes:

“I fear that your report omits an important point: not only are the human rights of service users being breached on a daily basis, but so are those of care workers.

Bad carers exist but the ones I worked with were excellent and upheld and promoted the right to dignity, independence and choice that the Commission advocates in the news today. They do not need extra training but they need to be listened to and treated with greater respect themselves. Here are some examples of how their rights are breached daily:

  • Domiciliary care workers are not paid to travel between calls and, therefore, are not paid the minimum wage for every hour that they work.
  • It is common to work for 12 hours and only earn 6 hours pay. I know plenty of care workers who work 18 hour days to make ends meet. This is exhausting and damages the quality of service they can provide.
  • As traveling is not viewed as work (despite being essential to the job) carers are not given structured shifts with times for breaks.”

These comments reminded me of when I was working in Stoke in the late 1990s. I was providing housing related support to individuals with mental health needs. One day as I looked for somewhere to park my car I saw my client’s care worker about to enter his property. By the time I had parked and walked a few yards to my client’s house the care worker was already leaving…his work apparently done! Another client was supposed to have weekly support from a care worker to go shopping in a nearby supermarket. He was regularly collected by his care worker who would already have two other clients in the car. When questioned, his care worker said that he didn’t get allocated enough time to work with all his clients and was not paid for travel time. The only way he could do what his employer expected of him and make a living wage was to take three clients shopping at the same time.

This theme of care workers being allocated insufficient time to provide a decent level of care was documented brilliantly in the BBC Panorama programme ‘Britain’s Homecare Scandal’ (now unfortunately removed from Youtube). Hidden cameras revealed that visits only intended to last, say, 20 minutes,  often lasted less than 10; a ‘hot meal’ no more than a couple of slices of toast; assistance with going to bed a hurried and undignified affair.

What Panorama made clear was that the problem was not a lack of choice or insufficient training for care workers. The problem was one primarily of lack of funding. This lack of funding has led to a culture of competitive tendering by local authorities, desperate to make their budgets go further, and prepared to convince themselves that bids at ludicrously low hourly rates would still provide their vulnerable and older populations with a decent standard of care.

“..Contracts are being auctioned off by some local authorities in what are called ‘reverse e-auctions’ where bids go down rather than up. The programme reveals that in South Lanarkshire the price of care has been driven down to less than £10 an hour. While the lowest bidder won with a bid of £9.95 per hour, the council says the decision to award the contract to…..was based only 40% on cost with 60% of the decision based on quality of care.”

Whilst this example is extreme the trend is undeniable. In a market dominated by lowest price, impossible promises are being made to local authorities prepared to believe that they are being offered prices that are not too good to be true.

The vast majority of people who become care workers like working with people and want to provide a service that is sensitive, respectful and makes a difference. But given insufficient time to do a good job and knowing that they will be letting their clients down again and again, it is no wonder that they learn to cope by becoming distanced from those they are there to help.

For a vulnerable person receiving a poor service, the option of choosing care from another, equally poor service is no choice at all.

With the ongoing cuts in local authority budgets; a Central Government imposed council tax freeze and a Care Quality Commission with a lamentable record of inspection – it doesn’t look like the situation will change any time soon.

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