Introduction.
The author of this paper Angela Cavill-Burch speaks from
personal lived experience of various aspects of the care system in the UK. Her
eldest brother has a severe learning difficulty which he sustained following a
brain injury caused by T.B. Meningitis in 1967, her Mother has had recurring
episodes of serious mental psychosis since 1972, and finally her Husband in
2007 was struck down with a life changing Staphylococcus infection that has
caused a high level Spinal Cord Injury.
Although her Husband qualifies for NHS Funded Continuing
Health Care it has been extremely difficult to find suitable, qualified and
consistent care-workers to enable Angela to return to work, knowing that her
Husband is being adequately cared for at home. Her mother has ended up inappropriately
in a very poor-quality care home due to the lack of supported housing in the
community. The only marginally good story is that of her brother who lives in a
house with a few others with high LD needs supported by a great group of care
workers but his home is nearly a hundred miles away from his family.
Background.
Having heard of various initiatives to plug the huge vacancy
gaps in the care-work industry I feel compelled to write this paper as the last
thing people who rely on the care system need is yet another influx of totally
unsuitable people into the industry.
Lots of events over the last fifteen years have led to a near
collapse of the quality and provision of care-workers.
- · down turn in the construction / other traditional industries leading some to turn to care-work.
- · increase in zero hours contracts leading to bad pay and conditions.
- · handing over of care contracts from being council controlled and run to privately run care agencies leading to a dilution of standards of provision, training, and some financial impropriety.
- · Increase use of personal health budgets, leading to amateur (through no fault) employers of care-workers further de-skilling, de-professionalising care-work.
- · Councils because of the over whelming pressures of the increasing numbers of people in the community with complex health needs, increasing ageing population and ever decreasing budgets have inadvertently pushed quality down.
- · Similarly, the NHS has the same problems, decreasing budgets, many reorganisations, pushing them to get people out into the community care system sometimes too quickly.
·
The housing crisis also has played its part in two
areas, lack of accessible properties for people with complex health needs to
live where it is a safe environment to provide good quality care and lack of
housing that those in lower paid jobs can afford to live in.
As the vacancy numbers rise there seems to be an increasing
pressure to hire anyone willing to try being a care-worker. I have heard that
the DWP are “encouraging” the unemployed to try care-work, locally that
colleges / care agencies are offering care apprenticeships. On the surface,
this sounds like worthy initiatives, but to those of us that rely on care
provision it rings loud alarm bells.
Our Experience
We have had the following bad experiences,
- · A 64yr arthritic care-worker sent to do a night shift, told take a book to read, to cover my Husband who needs constant intervention during the night including re-positioning, physio, toileting etc.
- · A care-worker with uncontrolled diabetes, liable to pass out looking after someone totally dependent on safe care.
- · Frequent late arrivals, non-arrivals, short term cancellations, lack of contingency planning making it impossible for me to return to full paid professional level work.
- · Care-workers turning up with sickness when Husband is immune compromised.
- · Care-workers caught discussing our personal circumstances with unauthorised personnel.
- · Care-workers treating totally compos mentis Husband with disrespect when I was not around.
- · Care-workers that did not have the specific medical training needed.
- · Had to call 999 for one care-worker after he collapsed in our home.
- · Care-workers working too many hours plus travelling too many miles to do a good job.
- · Care-workers not knowing how to cook.
- · Care-workers that hygiene was an alien concept.
- · Care-workers sleeping on waking night shifts.
All, of the care-workers we have had did not give us the
confidence that they knew what they were doing, some we put up with because
they were pleasant individuals to have around and at least I could leave the
home for a short while knowing that between care-worker and Husband they could
summon more appropriate help if not myself rushing back home. I know that our
experience is slightly different as we need quasi-nursing standard care for my
Husband him being such a complex case. Unfortunately, it is the same companies
in many instances providing staff for both complex and simple cases.
Many of the care-workers we had provided would have got away
with their low level of training / suitability in a more social care
setting.
Funding of Care.
Firstly, I think the government has a role to play here, so
that those that have currently paid into the system and believed that by doing
so they would be taken care of in their old age or disability are just that
taken care of appropriately. In the medium-term the government needs to put
extra funds into the system so that it can cope. A decision needs to be made, a
new societal contract made with young people starting work now, that provides
ring fenced funding set aside for their generation reaching the need for either
disability care or old age care. Funded by whatever form the experts in public
finances deem necessary, insurance policies, direct taxation etc.
The drifting on from crisis to crisis, smacks of policy
makers sticking their heads in the sand hoping it will either go away or they
will leave office before they must deal with it.
Taking Mediocrity out of Excellent Care Provision.
Care
Agencies- the role of these Agencies needs to change. The emphasis
needs to change to being more like specialist recruitment agencies, keepers of
databases of care-workers levels of competency, specialist licensed, audited
training schools. Councils and NHS bodies need to take back the control of
care-worker deployment, strengthening the relationship between clients and the
procurers of that service. With agencies involved it has become too hands off
to the detriment of people needing care services.
Recruitment- although in the public psyche railways are not the bastions of good public service I think the care sector has a lot to learn from this industry. Being under extreme public scrutiny all the time the Rail Industry has in fact developed some very sophisticated training regimes, especially in front line safety critical roles such as train driving and signalling.
One area I would like to see
the Care Sector emulate is the psychometric testing of candidates for
suitability to be a care-worker before they enter the service. There are some
very specific skill and personality traits that are needed to be a successful
care-worker, that presently not enough attention is paid to identifying and
weeding out of unsuitable candidates.
Everyone needs to realise that
Care-work cannot be seen only as an entry level dead-end job, if we are ever to
move the industry on taking out the mediocrity out of excellent care
provision.
The successful care-worker is / has
Some of these can be taught / developed but many are innate
and personality traits, which can be tested for to get the right fit.
Career
Progression- until care-work is seen to be more than a dead-end low value
job, it will continue to be an industry that does not attract career minded
men, and have staffing vacancy problems. It is of course recognised that as in most
career types there will always be a core that train up to the lower levels and
stay at the level, which is absolutely, consistent and complementary with the
aims of strengthening the sector. We need more numbers of base line trained
care-workers for social care than the more highly trained specialist
care-workers. By having well trained base-line Care-workers there is a sound
foundation on which to build a core of better trained specialists.
Care in the community is still
seen as the poor cousin of hospital care and has the lack of kudos status to
match. The UK needs to reform the career ladder available to both in-hospital
staff and community based staff with equivalency between the two and the
ability to move between the two ladders.
Apologies to readers pictures do not copy well to this blog - hopefully you get the general idea.
Care-work and the hospital
role of Health Care Assistant also needs to become a registered career, this
would go some way to address the lack of status in the industry. There needs to
be a route to training and testing to enable people if they wish to progress
all the way from the entry level positions right up to Nurse Practitioner.
For Care-Work I would see it
looking something like the following:
Core-Skills – Adult /Child Safe-Guarding Briefing, Basic First
Aid, Basic Cookery & Nutrition Skills, Appropriate Hygiene, Manual
Handling, Communication in Emergency Situations, Prevention of Pressure Sores,
Exercise for people with poor health, Safe Control of Medicines, Mental Health
Briefing, Dementia basic training, How Temperature & Blood Pressure works,
Conflict Resolution / Avoidance, Safe Pushing of Wheelchairs & etiquette, basic
health and safety.
Add-Ons leading to more specialist level care-work- illnesses/conditions
such as MS, Spinal Cord Injury, Brain Acquired Injury, Learning Difficulties, Diabetes,
Downs Syndrome, Cystic Fibrosis, Motor Neurons Disease, Spina Bifida, Stroke, Heart
Disease, Kidney Disease, Lung Disorders, Asthma, Advanced Dementia, Cancer,
Mental Illness, Arthritis, Achondroplasia, Geriatrics, etc (many more illnesses
/ conditions that need specialist training.)
Add-Ons for Medically Based Specialist Care-Work – safe use
of hoists, advanced manual handling, taking blood pressure & what does it
indicate, various catheterisation techniques, taking a temperature reading,
management of bowel regimes, Glucose Level Management, Nutrition for
Specialised Conditions, use of various pieces of specialised equipment, safe
use of oxygen systems, Basic Physiotherapy, Basic Occupational Therapy (not an
exhaustive list).
Add-Ons for Senior
Care-Workers – how to risk assess, carry out assessments, write reports, lead
a team, audit, interview, train/mentor others (not an exhaustive list).
Qualifications
– there should be a basic entry level nationally recognised qualification,
with extra modules being taken that have points associated with them that add
up to extra levels of qualification. Bit like the Open University qualification
system, in fact it would be good if this organisation were employed to develop
the care-work national qualification system as they already do some nursing
training.
Pay &
Conditions – pay should reflect the complexity of the level of care being
given, with local add on payments for areas where local housing costs or other
local issues, cause problems for lower paid workers or local recruitment. The
national living wage I would content is slightly under what even a basic level fully
trained care-worker is worth. With what care-workers must know and the fact
they are looking after the some of the most vulnerable in our society I feel
their hourly rate should be equivalent to £10 per hour minimum, increasing
proportionally with the modules they require to do their jobs. It would be good
to see a move away from care-work being seen only as hourly work but as a
salaried career. Perhaps a good mixture between the two would cater for those
that want to work part-time and those that need the stability, and credit
rating a salary gives.
Summary
It is absolute folly to perpetuate the idea that Care-Work
is unskilled, menial work. If done correctly it is anything but. We all need to
ask ourselves, who do we want to look after our parents, our disabled brothers,
sisters, kin folk, friends? Surely it is well suited, trained, and paid
individuals that want to work in the sector, not those that couldn’t get a job
elsewhere, so thought they would give it a go or get coerced by civil servants
just seeking to get the unemployment figures down.