England & Wales Health and social care

Viewpoint: Providing Care



Alan Long is the Executive Director of Mears Group and a member of the Commission on the Future of the Home Care Workforce

The care worker’s diary published this week is the uncomfortable truth facing many providers of home care.  I would love to say that such a situation would never occur in Mears, however we like other providers are operating within commissioning
frameworks which do nothing to improve the quality of care services and
create a race to the bottom in relation to care worker terms and
conditions.  While Mears are working hard to improve conditions for our
care workers, the problems highlighted in the diary are down to systemic
issues and without decisive action they will go un-tackled.

Most local authorities commission care on what is known in the industry as
a ‘task and time’ basis.  Quite simply, a commissioner of the service
specifies exactly what is to be provided (i.e. get Mrs Jones up, dressed
and give her breakfast) and allocates the exact time (20 minutes).   This
‘care plan’ is created by a person remote from the end recipient of care
services and reviewed every six months if they are lucky.  Such a system
does not allow for flexibility, innovation or efficiencies and does not
give a care worker any autonomy or agency.    In most cases, care workers –
the people who work directly with customers get no opportunity to shape
care plans and they are actively discouraged from making decisions  which
deviate from the ‘care plan’ even if they are more appropriate for the
real-time circumstances.  If Mrs Jones needs more than 20 minutes that
morning the provider does not get paid so in turn providers base their
staff rotas on the allocated times removing freedom from care workers and
service users.   Every month we have a team of office staff negotiating
around payment arguing the case of why it was necessary to spend an extra
five minutes with Mrs Jones.

In the same way, the commissioners’ approach to contracts is passed down the
line from provider to care worker.  In many cases local authorities
effectively place providers on zero hours contracts.  With no guarantee of
work from one week to the next, a provider simply shifts the risk by
offering zero hours contracts to its workforce.    To change this reality
the sector as a whole, providers, regulators, commissioners need to work
together, after all the care workforce is critical to delivering quality
care services.

Culture change is possible and in Wiltshire a care workforce is developing
who are being offered work on a contractual basis and that have a clear
routes for progression.  Providers are paid on the basis of the outcomes
that they achieve and not simply on the speed in which someone conducts a
task.  This means that quality has been injected into the heart of the
service.  It is still early days but this new approach is having a massive
effect on the morale of our care workers and on service users.

This new approach focusses on working in a re-abling and person-centred way.
Members of staff are given full flexibility to manage their workload and
more importantly how and when they deliver support. They feel empowered,
have increased job satisfaction; are more engaged and motivated.

Delivery plans detail all the information on how the outcomes identified in
the assessment will be agreed and can change on a weekly basis depending on
progress made by the customer. The monitoring tool that is being used from
the outset tracks customers throughout their journey and is identifying
good results so far.

We are already seeing the impact of care workers having the flexibility to
respond to customers to provide the right level of support at the right
time.  One woman who traditionally received support to get up and have
breakfast has been supported to get out and about and create networks.
While this initially required fairly intensive support this approach has
increased her independence and involvement in the community.  Her general
wellbeing has increased to such an extent that she now no longer needs
formal care.

By undertaking single assessments (joined up working between Mears and
Social Services), expectations are clear from the outset. The customer only
ever gives information once and the whole approach is challenging the
convention that formal care has to be the start of a growing cycle of
dependency. The primary aim of the service is to enable the individual to
achieve their desired outcomes.

Find out more about the Commission on the Future of the Home Care Workforce


Photo Credit: Alex E. Proimos via Compfight cc