Good Quality Care

Yesterday, I went to visit a service user that I’ve been working with for a good while. Mrs K has Alzheimer’s at a fairly advanced stage and has and continues to be well supported in her home.

She currently receives a care package via the local authority and is fortunate enough to have had the same care worker coming to see her for about 18 months. That’s quite rare. There is a relatively high turnover of care staff.

I have met her care worker numerous times and we’ve chatted at frequent intervals – not least because Mrs K can’t get to the door to answer it so I time my visits to periods I know the care worker will be there to ensure access.

Yesterday, we had a chat as we waited for Mrs K to join us. I knew she (the care worker) had switched agencies recently when the council had retendered it’s care services and the previous agency she had been with had lost its contract. She moved to another agency so as to maintain the caring role with Mrs K (and other service users that she sees). She also told me the new systems in place have cut her pay by about £1 an hour. She is not paid for travel and it is becoming difficult for her to maintain this way of working. It’s not quite minimum wage but it isn’t far off. And this is in central London.

There is a push toward quality care and dignity being provided for service users (quite rightly of course) but noone is willing to pay the price for quality care and dignity for care staff. The local authorities are pushing agencies to drive down the prices of contracts and the agencies, increasingly, are peopled by those who are more distant from the hands-on care role and to them, someone who has 15 years experience is simply more expensive than someone who is new to the job.

This, for me, is the problem of delivering quality care. Quality care costs. Noone wants to admit it. There is no reward for loyalty or delivering high quality to the users of services. There are simply  more checks and controls. Care staff have to ‘clock in’ and ‘clock out’ of homes by phoning in. No payment is made at all for ‘no answer’ visits, despite the travel time being completed.

Simply, how can you expect people to deliver a service that should be based upon dignity if they are afforded no dignity themselves as employees. I know many care staff who struggle massively with their own consciences because they feel they cannot maintain the ways of working that are being asked of them but they feel a responsibility to the service users whom they can build relationships up with over time. It is the agencies that take advantage of this to maintain low pay and poor working conditions and the local authorities are often complicit by demanding ever lower costings.

At a time when funding for adult services is coming into focus, noone wants to accept the fact that a quality service that everyone deserves regardless of their ability to pay – will cost more.

But it will.

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4 thoughts on “Good Quality Care

  1. I hear you on the quality care that no-one wants to pay for issue. It’s the same here: there are constant calls for more dignified, individualized care, yet also more budget cuts and bureaucracy (and agencies losing their contract every year so you get new care workers, etc.).

  2. This is the problem. Local authourities seem to be involved in some kind of race to the bottom in terms of costs yet they hope that the regulatory framework will mean standards cannot drop below a certain point.

    As you point a regular carer is worth so much to a person; certainly almost every person I ever dealt with would no doubt list it as one of their top priorities.

    An interesting thing I read the other week in a similar vein was about the cap in standards you get when a sector, like residential care, is dominated by private providers. Standards are effectively capped by the cost of providing the care, they cannot rise any higher or the providers would withdraw. This apparantley is the reason why it is so high to force up standards.

    A good case for voluntary or state provision if ever there was one.

  3. Thanks both. I agree, Neil an d have long been in favour of in-house provision of services – but I think it’s gone too far to move back now.

  4. I think the problems with care agencies differ from area to area, but certainly in my LA with the arrival of personal budgets the smaller care agencies not on the LA ‘preferred providers’ list have had a very profitable 18 months. This is because they often offer a much higher quality of service, with regular carers with smaller case loads, ultimately this better fits the personalisation agenda than the large and clunky care agencies with immovable time slots and high case loads. Personalisation has given both service users and social workers more scope to escape the confines of the ‘normal way’ of doing things.

    Some of the smaller agencies that are very very successful, have a fantastic reputation and refuse to sign up to be a preferred provider are those run by ex/retired social workers… food for thought?

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