Britain’s Homecare Scandal

I saw Panorama last night. It was an undercover report into the poor state of home care services provided to elderly people in their own homes by a few private companies.

I wish I could say some of the findings surprised me, but they didn’t. Some of the extremes presented perhaps, did – but cutting short visits because of overloaded rotas, lack of basic training and cost cutting above everything else – it all rings a bell with me having worked closely with home care agencies for a good few years.

image moogan at Flickr

It never fails to anger me either. These companies are paid to provide a service and a service of care at that and sometimes, particularly when the user of the service is particularly vulnerable, take advantage of the situations they are in to promote abusive environments in just those situations in which they should be empowering and promoting.

In the world of the local authority, home care for the elderly seems to be something of a burden. The process of tendering by councils was explored in the programme and the competition to drive costs lower and lower by the councils. This hit particularly close to home as I have a lot of anger at the moment towards my own local authority as a result of their tendering processes and a contracts department that sees little beyond figures.

Of course local authorities, being funded on taxation, need to have some kind of accountability regarding contracts but there has to be a better trade-off between cost and quality.

I have to say that I have come across more than a few exceptional home carers and home care agencies. I have particularly strong ties with one of the agencies we use because I’ve worked very closely with the area manager. I know when I ask for something or for someone with a particular sensitivity – for example a carer with experience of working with someone with dementia, or sensory impairment – she will locate such a person and if she can’t, will ensure that the carer is fully briefed before attending. As for me, I’ll tinker around with timings to make sure that I can be realistic about how long things take and try to not rush people through tasks. Her agency recently lost the contract in our local authority. That annoys me too. She told me, off the record, they just couldn’t make their bid low enough to make money or keep their experienced carers.

I hope more people become aware of what is happening in the home care sector. It is such an easy area to cut costs in because while spot checks do happen, they are not as frequent as they should be and a user who doesn’t remember or cannot report back on poor treatment, is almost too ripe to be picked off by unscrupulous, hurried or inexperienced carers.

Part of the problem is also the poor pay and poor status of those who are employed in home care jobs. They are seen as ‘entry level’ jobs for those who have little experience – perhaps straight from school. Obviously there is a place for entry level positions but how much more of a role for experienced, quality, respected home carers to be mentoring newer starters. There is little scope though for higher pay rates when the margins are cut so tightly in order to win the local authority contracts.

I have a rather old-fashioned solution that has made me the mockery of colleagues in the past, but I honestly believe the local authority should employ carers directly. Even with lower than deserved pay, they would at least have the benefit of a secure contract, good training which could be followed up, a clear appraisal and management structure and good benefits such as holiday pay and pension.

In my experience, some of the most effective and competent care managers have got to where they are at from being hands-on carers (er.. myself included.. ok, I didn’t say I wasn’t biased!). My experience of working as a carer (I was in residential care rather the domiciliary care) has informed so much of my judgement and perception through my work as a qualified social worker that I know I would have been infinitely less able and competent if I hadn’t had that experience and likewise for some of my colleagues who have worked in domiciliary care. You see and know the pressures of time, the type of work that is expected and most importantly, the corners that can be cut – and can then spend more time pursuing them.

The career structure though, from home (or residential) carer, to senior home care manager to a care manager post including sponsored training through the social work degree seems almost to have disappeared in the local authority where I work – and possibly others too. In-house care is all too rare, although I don’t think there is any doubt that better quality could be provided due to better conditions and prospects being established. But the tide seems to have good out too far now – in the tide of privatisations and tenderings.

The NHS and Community Care Act 1990 is too firmly entrenched in our system now and private enterprise is pushed as the solution. I just have an issue about profit-making companies ‘selling’ care and cutting corners in order to amass greater profit.

Direct Payments were seen as a possible solution save that the people who are most dependent and vulnerable and have no other family are not in any place to make arrangements to hire and employ carers or personal assistants directly. Personalisation agenda? I don’t want to be overly sceptical but I can’t see any solutions to the problems thrown up by Direct Payments which have had a particularly poor take up by those who are over 65 and those who are mentally ill.

For me, one of less obvious but equally horrific failings highlighted in the programme was that of the regulators, CSCI (Commission for Social Care Inspection) – which ceased to exist last week and became a part of the amalgamated CQC (Care Quality Commission). How ineffectual is this body? It has moved to desk-based inspections of care homes – has it done the same with domiciliary agencies? Is there any way that inspections and regulators can actually provide a service which is better than a mere star rating and mealy-mouthed platitudes even in the ‘one star’ organisations. The language of the inspection reports is rarely cutting and usually couched in comforting language except in the most exceptional examples – possibly due to fears of legal action by the companies involved.

As it’s probably clear by now, I have a lot of difficulties with home care, the way the system is tilted towards an almost industrial-style turnover of short impersonal visits by staff that are constantly changing and perhaps poorly trained, regulated and paid.

It is not the staff on the ground who bear the responsibility for this, some of whom are desperate to do a good job, but they are pushed to work to timetables that are impossible – to do more work than is physically possible in the time that is available – by companies who are desperate to make increased profits and local authorities pushed to reduce costs at all levels.

And what do the home care agencies and managers do? They blame the care workers they are sending out on minimum wage and with little guidance.

I think this might have turned from a review of a programme into a more general rant but it is an issue I feel exceptionally strongly about.

It truly is scandalous. Older people are not other people. They are all of us eventually. They are and will be our grandparents, our parents, our siblings, spouses and children. We might want to forget. But some day we won’t be able to.

18 thoughts on “Britain’s Homecare Scandal

  1. I found it totally sickening, but then I wasn’t that surprised either. One thing that gor me was the situation with the lady who got hit in the face by the hoist.She looked as though she’d been subjected to a brutal beating.Nothing really happened as far as a proper investigation into the accident. I was totally flabbergaasted by the carer’s lack of training. This wouldn’t be acceptable in a hospital environment, so why is it ok in the community ? In the NHS – whilst not everything in the garden is rosey, at least there are certain standards that are adhered to, why not in the home care sector ? I’d like to think the CQC will pull it’s finger out sooner rather than later and effect strict controls and proper inspections.Then again I doubt this will happen any time soon. It makes me want to weep.

  2. Like you I was unsurprised by the content of the programme. Even people who know nothing about ‘the business’ – but who are avid telly watchers, will have seen similar programmes over the past few years. One of the characteristics common to most of these programmes (and on radio too) is the absence of the regulators who should hang their heads in shame at the failure of their work. And, while I would want to make clear that I have known and worked with good inspectors there is something rotten in the state of Denmark. All services seem to be inspected less frquently now than in the past even though the move to star ratings was supposed to lead to more frequent inspections for the poorer performers.
    It was encouraging that the Scots regulators were prepared to face the music in relation to the performance of the comany run by “Lady” Mary Beattie, however if you adopt the ‘no comment’ mode that she did ion balance it’s proably better not to turn up but to send a tub of lard as happened on Have I got News For You some years ago!

  3. This doesn’t surprise me either, and it doesn’ surprise me that it was Domiciliary Care; I had a brief but unpleasant experience with them a while back. I’m really glad Panorama made a programme about this.

  4. Seratonin Sister and Les – Yes, the more I think about it actually, the more frustrated I am with the CSCI/CQC. I think they have turned the residential home inspections (which I know far more about personally) into a mockery by removing the regular spot inspections so I can’t imagine them dealing particularly well with domiciliary inspections. Everything seems to be reduced to box-ticking

    Julie – I’d never heard of them before but isn’t it scandalous that they could get away with it..

  5. CSCI hasn’t moved towards desk based inspections of care homes or dom care agencies. All services still receive on the spot visits although the frequency depends on the rating given and it can be as long as three years for those rated excellent.
    Both the services in England that were shown on the programme had been rated as poor by CSCI – personally I think the failings were with the Local Authorities that continues to commission them even after they were rated poor.

    • My thoughts about CSCI/CQC come from a conversation I had last year. I went to visit a residential home – I was horrified at what I saw. I came back to the office and immediately phoned CSCI. I was told by the inspection officer that they hadn’t visited to inspect for a couple of years. Is it really so hard to manage one announced and one unannounced inspection each year? She (the inspector) told me they had completely ‘desk based inspections’ because the home had been ‘good’ a couple of years ago. Everything can change in a couple of years and honestly, I felt it was some kind of betrayal of trust in the inspection service if they can leave a service alone if they are supposedly ‘good’.
      The star system tells you very little and reports are written in such vague terms that somewhere has to be at the point of instigating extensively abusive environments before receives any kind of poor report.
      Wasn’t there also a case earlier in the year when a supposedly ‘good’ home had to be closed down suddenly with all residents moving out because of some kind of poor practice. I imagine that if there were regular unannounced inspections a lot more useful reports could be put together.
      Of course the local authorities are ultimately culpable but a regulator needs to regulate, check and inspect. That is the purpose of it.

  6. I’m a homecare worker, Panorama has only scratched the surface.

    Carers are to affriad to complain through fear of having their hours cut. Service Users are too affraid to complain through fear of being put in a home. Sometimes the family complain but it’s rarely in writing.

    In my opinion this service needs to be taken back in house. Where it can’t be taken back, Social Services should be encouraging providers to work unions. Until we can recruit, retain and train staff, we will always have this problem.

    • Taking services back inhouse is not the answer. Lets have a level playing field,. If local authority commissioners were not always going for the lowest price (depite what they say, they do !) then independent home care providers would be able to pay the same hourly rate to their care workers as the LA.

      • Perhaps – I just think it’s not only about pay but conditions as well. I agree absolutely that local authorities shouldn’t be tendering to the lowest common denominator though.

  7. Robin is abs. right, however what exactly do ukhca do!
    When you report neglect, unlawful behaviour their reply is that they do not get involved, So what is their role other than be a front for agencies. Research has proved that if you don’t care for the carer then their is the potential for abuse and its always the carer who takes the rap.

  8. All of the posters are correct. Home Care is in crisis as a result of Councils constantly trying to drive down costs and there being an entire failure to enforce monitoring and standards.

    By the way, I have added a link on our site to the BBC video and also to this site.

  9. As always, the issues come down to money and priorities. The elderly population, although often as vulnerable as children, are not massive vote winners and money is directed elsewhere – hence lack of funding for councils, leading to low pay for care workers, cutting corners by care agencies and ultimately an abysmal service. Things will only change when governmental priorities change…

  10. I do not think the answer is necessarily taking services back into LA provision but making sure standards are maintained which will not happen when all LAs are doing is looking to reduce price.

    However internal services cannot compete on price due to the real problem which is too many layers of management which increase unnecessarily the cost of services.

    • That’s a fair point and perhaps again, I was being oversimplistic. Basically there needs to be more money.

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