England & Wales Health and social care, HR, workforce and communications

Home truths: are our homecare contracts failing vulnerable people and their care workers?


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Viewpoint: Matthew Egan, Assistant National Officer at UNISON discusses their new Ethical Care Charter on standards in homecare commissioning

Day in and day out huge numbers of disabled, old and vulnerable people are receiving rushed, substandard and undignified levels of homecare in the UK.  It’s a scandal. But one that is too often ignored, or shown blatant disregard, by political parties and the mainstream media.

There has been a truly worrying decline in the standard of care that is given to some of our most isolated and disadvantaged people in their own homes. 

UNISON recently produced a report in which homecare workers clearly articulated the many failings of the current system.  It provides valuable insight from the workers themselves, whose views are largely absent from wider debates on the issue.  It details a poorly paid and rushed workforce personally propping up a deteriorating homecare system;  a workforce whose terms and conditions are denying them the ability to deliver the dignified care that the people deserve; and a workforce whose attempts to deliver high quality care are frustrated by the system they operate in.

Homecare workers are currently facing a number of obstacles to providing good levels of care.  The report illustrates how many are forced to deliver care which does not protect people’s dignity, or sometimes even their safety. Visiting times are too short. Poor scheduling forces workers to leave early. Not because they want to, but because they have to.

I never seem to have enough time for the human contact and care that these people deserve” said one worker, in a comment echoed by all.

And the report shows how despite working with often ill and frail individuals the training provided for homecare workers can be frighteningly substandard:

I have been caring for 16 years but previously worked at the hospital. Training now is watching a DVD!!!

It also shows how some homecare workers are being forced to leave their profession because of low pay rates and because they are not paid for their travelling time.

The amount of hours you have to work each month just to be able to bring home a half decent wage is getting worse. You see your family less and less each month because you need the money and you wear yourself out getting in as many shifts during the month to try and bring home a decent enough wage. Unfortunately there are easier jobs which pay more i.e. supermarkets and this is why many good carers leave.

When I reflect on my pay it can often work that I earn £3.50 sometimes less per hour.

The increasing use of zero hour contracts highlighted means that workers are unable to properly budget because they don’t know how many hours they will be given from one week to the next.  It also has a very damaging impact on their ability to do things that many people take for granted, like planning their social life or arranging for childcare.   

It is clear that things cannot continue as they are.  Ultimately the Government needs to finally provide equitable funding for social care. But in the meantime councils cannot shirk their responsibility for the provision of homecare services.

Whilst the vast majority of councils no longer directly provide homecare services, they can play a formative and ongoing role with the private providers who deliver most homecare services. Councils, as commissioners, can and must improve their performance.

UNISON have produced an Ethical Care Charter which provides a list of standards that councils should adhere to when they commission services which will result in better levels of care for the people who receive it.

Amongst the twelve standards there is a requirement for 15 minute visits to be done away with, for time to be given for the worker to actually talk to their client, for better scheduling of visits and for the same worker to be allocated to the same client where possible.

It is backed by the people who receive care, the companies who provide it and the workforce delivering it.

It has the support of groups including the National Pensioner’s Convention and the RNIB whilst private homecare provider organisations like the ECCA and UKHCA recognise the need for it.  By committing to the Charter councils will only commission good homecare providers who otherwise can find themselves undercut by more unscrupulous providers whose main focus is profit rather than the provision of good and effective care.

If we want our elderly and disabled people to get the dignified and humane levels of care that they deserve then the workers who provide it must also be treated with dignity and respect.  Without it then we will be forever committed to this doomed model of undignified and impersonal care.