In the government White Paper to reform care and support, published 2012, Andrew Lansley, former secretary of state for health, and Paul Burstow, minister of state for care services claimed the coalition government’s central ambition was “to support people to live a full and active life, to live independently and to play an active part in our local communities.”
The Care Quality Commission’s (CQC) recent report, “Not just a number: review of home care services,” provides evidence of the severe deterioration in the quality of care for elderly people living in their own homes.
After inspecting 250 providers of home care to more than 26,000 people across England, the CQC found that 26 percent failed to meet basic national standards of care. These include showing respect to patients, telling them what’s happening at every stage, providing care, treatment and support in a safe environment that meets their needs by staff with the right skills. Care providers are required to routinely check the quality of their services.
Introducing the report, CQC Chief Executive David Behan said, “People have a right to expect to be treated as an individual, to be able to exercise choice, and to make sure their carers are aware of their specific care needs. We found plenty of evidence of this however we also found elements of poor care which happen too often.” (emphasis added)
The report says home care visits are often delayed or sometimes cancelled without prior notice and, on many occasions, people receive no prior notice of visits by an unknown care worker. Risks associated with a person’s care or medical conditions are not being assessed and care plans are not being updated for several years. Some services did not have clear systems to monitor the quality and information in care plans.
These failures are a result of the drastic funding cuts to local authorities and the systematic privatisation of services by successive governments. The coalition government cut spending on communities and local government by 15 percent, forcing the local councils to slash the services including home care, day centres and further closure of remaining council run care homes across the country. Some government MPs are pressing for further cuts to government spending in the next budget.
Charity organisations, which the government says will fill the gap in service provision, have seen their incomes fall. Hospitals are compelled to meet early discharge targets because of bed shortages, increasing the pressure on community, social and home care services.
One result of the cuts is that local councils or the private providers they employ are tending to reduce the time home care workers spend on their visits to elderly people in their homes.
Criticising short visit times, UK Home Care Association (UKHCA) points out that 73 percent of home care visits in England last just 30 minutes or less, with extensive use of 15 minute visits. It points out that majority of councils expect the provider to cover care workers’ travel costs out of the hourly rate paid for the time spent in a person’s home. The majority of private providers do not pay for the travel time in between the visits to their employees and rush through visits, jeopardising both care of people and the safety of the workers according to many reports.
Many home care workers were frustrated with the way in which they had to work. Some staff said that they had been sent to people’s homes with very little understanding of their needs and how to meet them. Because there is often limited time to read the patient’s care plan, the care worker is forced to ask the patient what is needed.
Care workers in both the home care industry and residential and nursing homes are among the most oppressed and exploited layers of the working class. It is estimated that 150,000 to 200,000 care and support workers in England are earning less than the national minimum wage. Median gross pay of care assistants and home carers has decreased by almost two percent since 2010, according to the Office of National Statistics. The Report of Skill for Care points out that 60.7 percent of the workforce is on zero hour contracts and have no financial or job security
Following the election of the Thatcher government in 1979, the wholesale privatisation of care services began and the Blair Labour government took forward the same policies. The coalition government has accelerated the process. Large portion of the home care services in the community and residential and nursing homes are run by thousands of small and big “for profit” private care companies as a result.