A personal account of the contradictory world of the private home care industry by an employee of one of the many agencies contracted by councils up and down the country to provide a care service for their elderly.

Care worker with elderly client“Guess how many hours I worked last week?” Mary asked me.
“Erm…70?” I guessed.
“No. Eighty-Two!” she said, with hints of both triumph and outrage in her voice.

It is 7pm, and Mary and I are at Ewan’s house, waiting for the wheel-chair dependent, former forge worker to finish urinating into his leg-bag before we hoist him into his bed for the night.

Mary and I are both domiciliary carers employed by Champion care, one of many agencies contracted by councils up and down the country to provide a care service for their elderly and disabled residents like Ewan. As usual we’re talking shop, gossiping about what we and our colleagues have been up to in the last week.

“82? Did someone pull a sickie again?” I ask, only a little outraged and surprised.
“Of course they did! Sarah and her mate phoned in sick on Saturday morning. Again.” she replied.
I asked how many weeks it was since she had a day off.
“Seven. I haven’t spent a whole day with my grandkids since I started working for the company!” was her blunt and frustrated reply.

Mary’s a self-confessed work-a-holic, and like many of our other colleagues, she wants to work at least 50 hours a week in order to pay the bills. She normally, however, ends up working around 65 hours a week. Guvinda, a full time pHD student on his summer break, works even more, regularly racking up 90 hours of care-calls a week.

Like the vast majority of Champion care employees, they both really do care about the welfare of Ewan and our other care users. They would be the first to say they enjoy looking after elderly and disabled people.

What they, I and the rest of Champions care team don’t enjoy, however, is the low pay ( £6 per hour), long hours (the average is 60-65 spread out between 7am and 11.30pm 6 days a week) and the fact that we don’t get paid for the considerable time and money we spend travelling between our care-users homes or for our obligatory annual training.

This unhealthy combination of time-pressure, long-hours and a lack of days off isn’t just a minor inconvenience for us individually; it has a number of serious collective consequences:

It means that some members of staff pull “sickies”, to simply get a much needed day off, whilst others fall sick but, through a cocktail of paracetamol, caffeine and a fear of overburdening their already overworked colleagues, somehow keep on working.

It means that many staff quit without giving the recommended 2 weeks’ notice, sick and tired of being sick and tired, leaving more work for the rest of us.

It also means that visits to our care users are often not made on time, are usually rushed, and that dangerous mistakes – such as forgetting to prompt tablets and other medication – can and have been made (all of which can be classified as bad practice at best and abuse at worst).

No wonder every month a care user or two leaves Champion in search of greener pastures, opting for another care provider, losing Champion Care some income in the process.

Yet somehow Champion care is rated as being a “good” care provider by the Care Quality Commission (the regulator for health and adult social care services in England).

Why Can’t Champion clean up its act?

“So why don’t we employ some more carers?” I ask Paul, my coordinator.

It is 8pm on a summer’s evening, the sun’s low in the sky and we’ve just finished putting John, an elderly gentlemen who suffers from Alzheimers and very poor mobility, to bed. We’re on our way to another call in Paul’s car.

Our manager doesn’t like him or the other coordinators covering calls but often, particularly at the weekends with Sarah and others pulling sickies after a night out, he doesn’t have a choice. John and our other vulnerable care users quite simply need our care if they are to stay healthy.

“Yeah, we definitely need to recruit more staff, but it’s difficult, not too many people like the idea of wiping poo off peoples bottoms for £6 an hour, or not getting paid for training or transport and it’s become so much harder since we became part of Champion [the multinational corporation], with their stricter employment procedures and also the new regulations [Common Induction Standards].

We can’t just start people on their shadow training after they pass the interview now, they’ve got to do their training sessions with that skills for care training company first and we’ve got to wait for their CRB (Criminal Record Bureau) to come back before they can start work, which takes weeks, sometimes months.”

It’s a fact Paul and I know all too well: that even in a recession with high unemployment levels, many people don’t want to work as domiciliary carers because, with its low pay, lack-of-guaranteed hours, temporary contract and extended, unpaid vetting procedure, it can be a rubbish job.

“OK, well, if we’re struggling to recruit, why don’t we simply reduce the number of hours we have to work by handing over some of our care users to other local care agencies?” I suggested.

“Don’t be daft! It’s a business.” he laughed.

He had hit the nail on the head. Champion Care is a profit-making company first and foremost. The quality of care and working conditions will always be ignored unless they affect the bottom line.

A familiar story

Despite Champion Care being one of Britain’s largest care providers, its interlinked problems of poor working conditions and an inconsistent standard of care are by no means unique. Unfortunately they are shared by the vast majority of independent care providers – the hundreds of businesses, and a few charities, contracted by councils up and down the country to provide community care.

As Charles Patmore notes in Understanding Care Providers:

‘Independent agencies often struggled to staff home care visits in a reliable, regular fashion. This reflected that they could not guarantee staff hours of work and that pay-rates were low and for weekends far inferior to Social Services home care providers…Pay was only for time spent actually serving customers…Travel time between customers was not paid, which could lead to staff refusing visits which involved very time-consuming routes.’

The independent care providers’ shortcomings are highlighted further when compared with the councils social services (“in-house”) care services:

Social Services home care staff … were generally employed in a conventional fashion for a guaranteed number of hours per week…Pay also covered time spent travelling between customers and in staff meetings [and training]…Managers could guarantee what hours were definitely available from each worker, which helped them plan rotas.

For weekend work Social Services provider staff had a large advantage. Often they received a 50% premium on their weekday hourly rate for Saturday work …and double pay on Sundays’.

Clearly the vast majority of independent home-care providers virtually guarantee home care of a significantly poorer quality than that offered by social service care-providers, particularly during evenings, weekends and in cases where the care user requires specialist care or lives in a remote location.

So why on earth have England’s councils spent the last 20 years reducing their “in-house” provision of home care in favour of independent care providers?

They argue that by carrying out this privatisation process, they can not only save themselves money but also “improve” the quality of care for their elderly and disabled residents who need it.

For example, one local council recently noted that its in-house home care service has ‘seen its share of overall provision reduce to 35% of the [local home care] market and it has reduced in overall size as less complex work has transferred to other providers in response to financial pressure’.

The council has reduced its home care budget by increasingly contracting out home-care to local independent providers who cost on average £17 per hour instead of the in-house cost of £25 per hour.

It’s a classic case of putting the core neo-liberal idea – that the state should play a reduced economic role in modern society on the grounds that state intervention leads to inefficiency and waste – into practice.

And as Dr Malcolm Carey notes in his analysis of the privatisation of Britain’s social services over the last 20 years, it has had the classic opposite effect:

Far from resulting in a more efficient or effective social care system, it has led to one that is ‘highly bureaucratic, exploits labour and is deeply ineffective at responding to the needs of vulnerable adults and children’.

Nonetheless, councils up and down the country are under no pressure to make a U-turn in their efforts to privatise their home care services. Indeed due to the championing of neo-liberal policies over the last 30 years, by Margaret Thatcher’s conservatives, New Labour and now the coalition government, the opposite has certainly been true.

So what should be done? If elderly and disabled people are to receive the consistently decent level of home care which they deserve, they clearly need to receive care from domiciliary carers who are fairly paid and who aren’t consistently stressed, tired or rushed for time.

Such large scale change isn’t going to come from the share-holders and bosses of the UK’s independent home care providers as it would not be financially profitable. Nor is it going to come from the councils.

We need those who the system exploits- the care-users and home care workers- to take action. But what kind of action?


Individual Solutions and their limits

“How was the day centre today?” I ask Ewan.

It is 4pm and I’m back in Ewan’s house microwaving a shepherds pie ready-meal for his tea. “Yeah, ok,” he replied. “Did you do that woodwork class?” I probed. “Yeah, it was alright,” was his reply as he manoeuvred his wheel-chair into position next to the table and switched on his telly.

After finishing his meal, I emptied the urine out of his leg bag and walked with him down to his local social club where he goes to have a drink with his friends most days.

Out of any of the care users I look after, Ewan almost certainly has the best quality of life, mostly due to the efforts of his older brother Adam, who ensures his finances are in order and that Ewan takes full advantage of the benefits and services available to him. Adam is also a voice very familiar to our office staff: he doesn’t hesitate to put a complaint in if Ewan’s carers turn up late or do a poor job and has even been known to contact Ewan’s social worker and switch care-providers if something particularly serious happens.

Due to this very real threat of losing out on the several thousand pounds-a-month of income that Ewan’s care package is worth, the office staff and manger in our office take Adam’s complaints quite seriously.

Ewan’s example shows that if you are an individual care user, or the relative of a care user, who has the time to consistently complain and take appropriate action against poor levels of care, you can ensure a better-than-average standard of care.

Unfortunately, however, the vast majority of care users don’t have an Adam to look after their interests. Individual solutions are considerably less effective when it comes to addressing domiciliary care workers’ poor terms and conditions.

For example, several particularly overworked care workers in Champion care have independently secured personal wage increases by threatening to quit. Faced with the prospect of having to find cover for the 70-80+ hours of care calls that each of them worked, the manager chose to increase their pay rather than accept their resignations.

However the pay rises they achieved were small ( £0.50-1 extra per hour) and the extra-money they gained certainly didn’t solve their primary problem of being hugely over-worked.

This is because home care work is fundamentally teamwork. The vast majority of our care users require care, 7 days a week, 52 weeks a year so if a domiciliary carer wants a day off or a holiday, the company needs to have another member of staff available to cover the care-calls that they can’t do.

When it comes to the task of seriously improving home carers’ working conditions, collective and coordinated action is the only possible solution. In other words: a trade union.

Unionising the home care sector

Whilst the aforementioned situation of there being high demand but low supply for home care labour puts us in a good bargaining position, the task of unionising an independent home care provider is nonetheless much more easily talked about than done.

I’ve talked with other home care workers about why it’s so important to join the union, with limited success. Very few people want to join a union when asked individually, no matter how glossy the union leaflet, so meetings are essential if the majority of any workplace are to become unionised.

However the single biggest obstacle to such a unionising effort in any independent care provider is the impossibility of getting every member of staff together in one room at one time – at any time between 7.30am-11.30pm at least 4 or 5 members of the care team will be working.

In the independent home care sector the only solution to this problem is to hold multiple trade union meetings, like they do in hospitals.

But the ‘why you should join the union’ meetings will probably not result in care-workers joining the union en-mass unless it is made clear that the trade union involved will fight to bargain for the improved terms and conditions that the care workers want, such as improved pay at unsociable hours and pay for inter-care-user travel time.

Such industrial bargaining efforts might even evolve into a fight against the privatisation of community care by calling for an end to the contracting out of care services.

This would not be unprecedented or unrealistic. As reported in U magazine; in April this year, Musgrave Park Hospital’s Unison branch completed its 19-year-long anti-privatisation campaign when the last remaining privatised contract at its hospital ended, seeing more than 200 cleaners, caterers, porters, security guards and telephonists return in-house.

We need the same to happen for all the nation’s private care workers.

All the people’s names, and the company’s name, in this article have been changed to protect their privacy. Image from http://fightingmonsters.wordpress.com