Good quality care is not only important for those receiving it, but also for those providing it. Dignity and respect is part of what makes life good.
To be responsible for meeting the physical and mental needs of another human being is a huge responsibility and a job we should value especially highly at a time when demand for carers is so strong.
That our country’s care staff do such challenging and valuable work makes it all the more important that they get a fair deal in their working conditions.
However, carers are often prevented from delivering the services they want to and are capable of. This can happen for a number of reasons that are explored below.
Lots of carers choose to do the work they do because they find looking after another person personally rewarding but we must make sure that their compassion is not taken advantage of. We can do this by ensuring they receive the right treatment in their job, which will be beneficial not only to carers themselves but also to those being cared for as improved working conditions means better care for clients.
Some statistics about care
79% of carers are given schedules that lead to ‘call-cramming’, where they’re routinely given too many visits too close together meaning clients don’t get the service they need and are entitled to. (UNISON ethical care charter, 2012)
58% of care workers are not paid for travel time (UNISON ethical care charter, 2012)
More than half of care workers said their pay had got worse in the last year (UNISON ethical care charter, 2012)
60% of carers said their hours had adversely changed over the same period (UNISON ethical care charter, 2012)
52% of care workers said that concerns they voiced were only sometimes acted on (UNISON ethical care charter, 2012)
41% of Care Workers don’t receive specialised training to help deal with their client’s specific medical needs (UNISON ethical care charter, 2012)
Between 160,000 and 220,000 care workers are unlawfully paid less than the National Minimum Wage (Kingsmill Review, 2014)
In 2012 almost three-quarters of Domiciliary Care visits were for 30 minutes or less. (Kingsmill Review, 2014)
What are the problems we are facing currently?
Race-to-the-bottom practices of employment have a negative effect on both the carer and the client. There are a number of practices in the sector which impact on the experiences of those within it:
15 minute slots & ‘call cramming’
Giving carers too many calls in too short a time leads 79% to ‘call cramming’, meaning they need to rush off or even leave calls early in order to get to the next one in time (UNISON Ethical Care Charter, 2012). Carers are then left with the difficult decision of either not delivering the standard of care they want to and that the client needs, or doing that work as unpaid overtime. This hits the most vulnerable clients hardest but is unfortunately a growing problem as the proportion of 15 minute visits has increased by 15% in last 5 years (Kingsmill Review, 2014).
The treatment of carers
More than 50% of carers surveyed by UNISON in 2012 said that the terms and conditions of their contract had worsened in the previous 12 months. Key problems with the nature of their employment include:
Low wages. 56% of carers are paid between minimum wage and £8 per hour (UNISON’s ethical care charter, 2012), and a further 160,000 to 220,000 carers do not get paid the minimum wage (Kingsmill Review, 2014). Part of the problem is that some carers do not have travel time between appointments included in their wages, meaning those who regularly do 15 minute slots are at risk of being paid just £1.63 for each session of care (Kingsmill Review, 2014).
Use of zero-hours contracts. A fifth of the those working in the care sector, so more than 300,000 people, are on zero hour contracts (Kingsmill Review, 2014). This leaves employees unsure of the hours they’ll work each week meaning that do not have a stable income.
Isolation. The problems within the sector are not only financial. 44% of carers have reported not seeing colleagues on a daily basis (UNISON ethical care charter, 2012). This has a negative impact on staff moral and professional development which in turn links to problems with staff turnover (see below).
Standards of care
The nature of employment in the care sector, in addition to the lack of regulation necessitating training and development of staff means that many employees lack the skills to deliver the care they know clients need and deserve. This is obviously frustrating for those who are so dedicated to caring for people, which impacts on the staff turnover rate which is worryingly high. Again, this lack of investment in carers ends up hitting clients who then cannot get regular staff with whom they can develop a productive, nurturing and beneficial relationship with.
Lack of training. A fifth of Health and Social Care Apprentices receive no training at all and a third of care workers don’t receive regular, ongoing training (Kingsmill Review, 2014). Furthermore, more than two fifths were not given specialist training that they needed to meet the complex and specific needs of their clients (i.e. dementia or stroke-related conditions) (Kingsmill Review, 2014).
Lack of regulation. Of 80 Care Providers investigated by HMRC, 47% were not compliant with National Minimum Wage regulations (Kingsmill Review, 2014). In the financial year 2012/13, the HMRC identified £3.9m in unpaid wages in the care sector, affecting 26,500 workers (Kingsmill Review, 2014). We need immediately a regulatory structure that means paying less than the minimum wage has real consequences. However in the long term we also have to make sure that the sector as a whole is developed so the status of caring is raised and becomes more professional.
Lack of carer continuity. The high staff turnover rate (19% per year in residential care and 30% in domiciliary care) in addition to the fact that a third of staff who do leave do so in the first 12 months (Kingsmill Review, 2014), both contribute to the fact that 38% of carers are often allocated different clients (UNISON’s ethical care charter, 2012). This is an inefficient and costly way of operating when the recruitment of new staff costs around £3,500 (Kingsmill Review, 2014) but also because it has a serious impact on the quality of the care staff are able to deliver. The intimate nature of the job means that the existence of a trusting relationship greatly enhances the experience for both staff and clients.
What can we do about it?
The challenge we face now is how to bring about improvements in a time of austerity when the coalition government has left many councils, particularly those where need is greatest, facing massive budget shortfalls.
I do not believe this is a reason to postpone efforts to improve life for those dependent on care or the working conditions of those who provide it. This task might at first sight appear insurmountable, but the Kingsmill Review shows us that there are changes we can make now that don’t cost anything and future investment would save money in the long run by reducing hospital admissions among other things.
Ideas for reform include:
Proposals from the Kingsmill Review
In November 2013, Ed Miliband asked Baroness Kingsmill to lead a review “to better understand and tackle exploitation in the care sector”. The resulting report, published in 2014, calls for an end to 15 minute visits and for a Care Charter to improve standards among other recommendations that will make the sector more efficient and successful.
Stop exploitative zero hour contracts
Labour have already pledged to stop exploitative zero hours contracts and make sure that everybody working in care receives at least the minimum wage, and where possible a living wage. To read more about zero hours contracts and what we can do about them you can see the report I co-wrote with my Labour colleagues as well as the Pickavance Review.
There are a number of regulations that would go a long way to tackling these problems. Baroness Kingsmill outlined some of the ways we could enhance the powers of the Care Quality Commission in her review. We must also stop the non-enforcement of the minimum wage and in the long term work towards registration and legal training requirements in the sector.
- Local Authorities and UNISON’s ethical care charter
This charter calls on Local Authorities to commit to improving care in their community. I am so pleased that despite the massive cuts in funding that they have faced, Wirral Borough Council have not only signed the Ethical Care Charter but were also one of the first Local Authority’s in the country to become a Living Wage employer. It is so encouraging to see that there is understanding of the problems faced and such commitment to improving it.
Get in touch/offer me your suggestions
As you can see we’ve been taking positive steps both locally and nationally. But please continue to share your experiences with me by contacting me here so that we can continue to improve conditions for all in the sector. See how to contact me here.