Visiting time

Most agree that treating the elderly well is a mark of a decent society and many care workers are desperate to be able to do their jobs well. But the care system itself is in an unprecedented crisis

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The first thing Karen McDonald does when she enters Pauline Kaye’s bedroom is plant a kiss on the 70 year old’s forehead. Soon after, Kaye’s second carer, Jody Matthews, arrives and follows suit. Pauline, who has slept in her living room since a stroke left her completely paralysed in 2006, is bed bound. The bond between the three women and Pauline’s husband of 51 years, Bill, is obvious.

Although it is difficult for Pauline to speak, she manages a few words. “I love them,” she says of McDonald and Matthews, with a mischievous look in her eye. “But not in a sexy way.”

“The carers we have now have a way of dealing with her that is just lovely.”

Relatively speaking, Pauline is one of the lucky ones. On 11 October, the Care Quality Commission (CQC) watchdog warned that the entire English care sector is “at risk” as care homes shut and providers pull out, due to burgeoning costs and reduced fees from local authorities facing severe budget cuts. Over the past year the national living wage contributed to a 30 percent increase in running costs for providers, which have seen a 40 per cent fall in their profit margins, the CQC found. The situation is endangering the quality and safety of care for millions of disabled and elderly people. With demand for services only set to rise, some are asking whether the way the system is funded and delivered needs overhauling.

The social care crisis has been festering away for years and the CQC’s announcement comes as no surprise to those with experience of the system. It certainly wouldn’t surprise 73-year-old Bill, who along with Pauline has experienced the good, the bad and the ugly of increasingly ailing services over the past decade.

“The carers we have now are brilliant. They have a way of dealing with her when she’s upset that is just lovely. They’re angels,” says Bill, as he sits in the kitchen while McDonald and Matthews wash and change Pauline. “But with the carers from other companies we’ve had, they’d say: ‘Oh, we’re sorry we can’t stay. Ta-ra.’ Time’s up, gone. They were under pressure to get to the next job. We’ve had the water that they’d washed her underneath with poured over the pots, and flannels put down the toilet.”

Despite a government pledge to stamp out a culture of 15 minute care calls in March last year, they are still a fact of life for many elderly people across the north who need assistance with a variety of activities such as washing, eating and getting up, and who may have no other source of social interaction. In September it was revealed that a majority of councils in the North West still commission the 15 minute visits.

Fortunately Bill, who suffers from diabetes and bad nerves, manages Pauline’s care budget himself – taking responsibility for employing care providers out of the hands of Hull’s overstretched council. The couple are part of a group that a King’s Fund study, published in September, described as “relatively well off and well informed”, who are able to escape “an increasingly threadbare local authority safety net” that the poorest and most vulnerable must rely on.

That’s why Bill employed the services of Hull’s Bluebird Care, a small franchise that is among a growing number of care companies refusing to carry out work on behalf of cash-strapped local authorities. In July, the Mears Group home care provider cancelled contracts with Liverpool and Wirral councils, citing an “extremely irresponsible” contract offer that did not cover the costs of its carers’ wages or a proper standard of care. Now many care companies, including the Hull Bluebird franchise, will only provide services for those who can pay privately, or have taken control of their council-allocated care budget or that of a family member – an option that, as well as allowing people to choose personalised care packages, means they can also pay top-up fees if necessary.

“Bluebird make sure there’s enough travel time between visits, so that you’re not eating into the amount of time your supposed to spend with a client,” says Matthews, who has worked in care for 10 years. “That’s important because we the carers can pick up speed, but the people we’re looking after can’t. You’re in someone’s home – you can’t just pretend they’re not there.”

Before leaving her last job in a care home, which she says was “horrific”, Matthews cared for Pauline while employed at another company. In fact, one of the reasons she decided to work for Bluebird is because of her long-standing relationship with the Kayes. Matthews describes Bluebird as “the best provider of home care I’ve worked for”, but says the industry as a whole “demands way too much from carers”, pays badly and runs on zero hour contracts, leading to high turnover rates in an occupation where familiarity affords dignity.

The domiciliary care sector is notorious for not paying carers between visits. The National Audit Office reports that up to 220,000 of Britain’s 1.4 million care workers are paid less than the minimum wage when travel time is taken into account. Care homes have also been guilty of not paying staff the minimum wage. In August the government named and shamed a number of establishments in the north of England for the offence.

According to 78-year-old Brenda*, it’s not just carers’ wages that are feeling the pinch. Since moving into a council-funded residential home in East Yorkshire six years ago after being diagnosed with Parkinson’s disease, Brenda has witnessed the home’s staff shrink, with a subsequent increase in workload. Much of the time just two carers are responsible for around 20 residents, many of whom suffer from dementia and other complex conditions.

“When I first arrived the staff used to come and talk to me and I had more of a relationship with them,” explains Brenda. “But now they’re so rushed they haven’t got time to sit and talk anymore. There are social things like bingo, but I stay in my room most of the time.”

Carer Emma Wallworth, from Stockport, tells a depressingly similar story. For eight years she worked at a high dependency care home, but had to move to another care job six months ago because of a back injury caused by years of lifting patients in and out of bed.

Bill Kaye pays for his wife’s care leaving them able to escape “an increasingly threadbare local authority safety net”
Bill Kaye pays for his wife’s care. Main photo: carer Jody Matthews and Pauline Kaye have formed a rare friendship. Photos: Darren O’Brien/Guzelian

“When I started there were plenty of staff. By the time I left there were 38 residents and only four carers, one of whom only distributed medication. The company had profits to consider and that meant cutting costs,” says Wallworth. “If someone died, their room would be occupied the next day. It felt like a conveyor belt. The CQC says that residents must not be institutionalised, but because of the pressure heaped on staff that’s exactly what’s happening.”

The crisis is also having a serious impact on the NHS, where bed blocking by patients who are well enough to leave hospital but cannot access appropriate social care has reached record proportions. NHS England data shows that 115,425 bed days were lost in June this year due to delayed discharges, an increase of almost 80 per cent on the same month five years ago and the highest since records began in 2010.

Some local authorities are attempting to improve care services and reduce bed blocking by co-ordinating more closely with the NHS in the community, with Salford’s Integrated Care Organisation (ICO) leading the way. In July, Salford City Council transferred control of its budget and 450 social care staff to Salford Royal Hospital, which now has responsibility for domiciliary and nursing home care – though most services will still be provided through independent companies.

Andy Burnham, Labour MP and Greater Manchester mayoral candidate, who has long campaigned for the integration of health and social care, said that although the initiative was a step in the right direction, he would “actively pursue” the direct employment of carers in NHS organisations like Salford’s ICO, if elected.

“I don’t think the private sector has delivered on social care,” says Burnham. “I’m not saying all companies but what’s been produced is a fragmented and patchy system that echoes healthcare pre-NHS, where if you had money you were OK but if you didn’t you weren’t. We should be aiming for a National Health and Care Service that gets rid of the 15-minute visit and zero-hours culture and invests in the people who care. If you invest in your workforce you will deliver better care.”

Burnham proposes plugging the gaping hole in social care finances – which cannot be closed through integration alone – through extra taxation.

“It is surely better to fund people’s care needs in the same way we fund the NHS, which is that everyone contributes and everyone is covered. As a society we’re paying for it anyway but just unfairly. People are getting care by topping up what the state provides, either through using up their family savings or informal carers who are run into the ground.”

In response to the crisis, the government has pointed to fledgling health and social care integration programmes like Manchester and Salford, and promised an extra £3.5 billion for adult social care by 2020 – a move Chris Hobson, chief executive of NHS Providers, which represents the country’s hospitals, described as “too little, too late”. Senior Tories are reported to be joining the call for the chancellor, Philip Hammond, to stump up more money for social care in this week’s autumn statement.

The elderly population in the north of England, as elsewhere in the UK, is only set to increase in the coming years. Although solving the issue of social care may be complex, divisive and expensive, the way vulnerable citizens are treated lies at the heart of what makes a decent society. Everyone of us is guaranteed to age, but there is still uncertainty as to whether that accolade will be achieved.

*Name changed to protect identity

Care plan

History of social care
Social care includes a wide range of services, provided either in people’s homes or in care facilities by independent care services or local commissioners. It wasn’t until the establishment of the welfare state after the Second World War that social care to provide for the health and wellbeing of citizens was put on to a full statutory footing.

Kings Fund Report
A report this year by healthcare charity the King’s Fund said: “Cuts and the unwillingness of successive governments to reform the funding system have left social care in a perilous state. More than £5 billion has been cut from local authority social care budgets over the past five years, which has had a huge impact on older and disabled people, their families and carers.

Care Quality Commission report
Social care regulator the CQC has concluded that the sustainability of adult social care is reaching tipping point, in its annual report last month. “The combination of a growing and ageing population, more people with long-term conditions, and a challenging economic climate means greater demand on services and more problems for people in accessing care.” It also expressed its concern about maintaining care quality under budget pressures.

DevoHealth – Manchester’s £6 billion experiment
The 10 boroughs of Greater Manchester have joined forces with 12 clinical commissioning groups and 15 NHS trust foundations to become England’s first combined authority to take full control of its £6 billion health and social care budget and integrate the two parts of it. The experiment aims to improve the health and wellbeing of the region’s 2.8 million residents by providing faster and more efficient health and social care.

Fending for themselves
Last week Age UK revealed 1.2 million people are living without any support – a rise of 48 per cent from 2010. Some 696,5000 people in need of help with everyday tasks are being left to fend for themselves while 487,4000 elderly people receive some support but not enough. “It is shameful… and we are extremely worried,” said charity director Caroline Abraham, who called for the government to give the issue priority in the forthcoming Autumn Statement.

Harrowing home care
A report by the Alzheimer’s Society last week revealed dementia sufferers are receiving “harrowing” examples of poor care at home. A lack of training of carers means many are being left in dirty clothes, soiled sheets and even going without food and water. As many as 400,000 dementia patients receive care in their homes. Jeremy Hughes, chief executive of the Alzheimer’s Society, said: “There is simply not enough money invested in the social care system.”
Daniella Ansell

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