Few could take issue with the notion of a National Care Service, given life in last week’s Queen’s Speech. Unison certainly doesn’t. We want the promised universal access and national standards. We believe that the NCS should provide care on the same basis as the NHS and could be funded through increased National Insurance contributions and/or other means of taxation.
No-one pretends that funding of care is a straightforward issue – but with the first woman destined to reach 126 years now amongst us – it is a crucial one. It’s also a problem that the public have not got their heads around it seems. A survey by the Institute for Public Policy Research and PricewaterhouseCoopers published earlier this year showed that only 46% of the 2,000 adults polled were aware that social care is means tested, 52% felt that they should not have to pay for relatives’ care and 69% did not feel well enough informed about the care system.
I recently listened carefully to contributions on the NCS and the future of care from David Behan, director general for social care at the Department of Health, Alan Rosenbach, head of strategy at the Care Quality Commission - and others who represent unsung, unpaid carers - at a Westminster Health Forum event. The speakers were all engaging, but there was one huge female elephant in the room – the paid workforce and what’s happening to those already employed to do the caring. The National Care Service will be built on current foundations and in Unison's experience, they’re very unstable indeed.
In New Labour’s quest for a market in all things and councils’ desire to cut costs, over 80% of the home care workforce – almost entirely women - is now employed by private contractors, agencies and not-for-profit providers. Unison's tracking of home care inspections has shown that even when the in-house service was ‘excellent’ or ‘good’, government inspectorates have put consistent pressure on councils to cut workforce costs and outsource, leaving only a small number of highly skilled and specialist home carers employed by councils. And as overdue Single Status pay reviews have highlighted just how underpaid home carers have always been compared to refuse collectors and gardeners, councils have rushed ever faster to take them off the pay roll.
This means that most of the women who do the tough and increasingly demanding job find themselves working for one of a myriad of providers ‘commissioned’ by councils to care for the housebound elderly, disabled and vulnerable. With 85% of care costs attributable to the workforce, there’s been constant pressure to bring them down – the success of which was lauded in the government’s Case for change report last year. It said: 'Already since 2004, this Government has achieved efficiency savings of £513m in social care alone, and we want to build on those achievements.'
Counsel and Care found in their 2009 survey of National Care Forum members, published in The real cost of quality care and support, that most providers are caring well for clients, with 88% of not-for-profit and 66% for-profit employers in the ‘good’ or ‘excellent’ bracket. But that means that many are not. Unison's recent survey of our members’ experience of outsourcing and regular reports of failed contracts, have illustrated how it is undermining the workforce and therefore the quality of care – particularly in the ‘for-profit’ sector. Here are just some of the workforce issues reported by our members:
- The National Minimum Wage (NMW) – currently £5.80 pence an hour - as the standard pay rate on many contracts
- ‘Piece work’ being introduced on some contracts, reducing pay below the NMW as home carers have to work unpaid overtime to meet the targets
- 'Spot contracting’ of small blocks of care to avoid TUPE Regulations which protect pay and conditions on transfer
- Little extra paid to supervisors
- No payment for travel costs between clients or payment for travelling time
- Workers required to provide their own cars, with no payment
- Workers required to pay for their own uniforms, or for their cleaning. On one contract, Unison members had to pay for the company logo to be put on the uniform too!
- Minimum levels of holiday, maternity and sick pay
- Little – or no - access to training
At the heart of these problems are the under-funding of the home care service and poor commissioning. Increasingly home care is commissioned through ‘reverse e-auctions’, which focus only on lowest price, not quality of care. The fact that private – as opposed to ‘not-for-profit’ providers – have to pay their shareholders’ dividend from public funds first doesn’t help either! The UK Home Care Association and the English Community Care Association have reported the under-funding problem to the Low Pay Commission for years. Last year the LPC noted that 38% of providers had to raise wages to meet the 2007 NMW rate and that two thirds of providers were refused an increase in the contract price to reflect the 2007 NMW increase.
All of this is bad news for the service and its users, who increasingly lament the high turnover in carers resulting from inevitable recruitment and retention problems and the 15-minute slots allocated to their care. What an irony then that on November 17, the Financial Times reported a 25% increase in last year’s profits of Care UK - one of the largest private providers, which recently lost contracts in Norfolk and Hertfordshire. The FT also reported that the very same contractor – with 48 contracts and 15,000 clients in England alone – had also received a zero star rating from the Commission for Social Care Inspection in Harrow, where it has a £2m contract. It was failing on 25 counts and seven months later was still in breach of 22 of them. Our members in Norfolk , now transferred to another private company, know all about that.
The NCS will only improve on current standards and attract the extra million carers needed by 2020 if the issue of under-funding of home care is confronted and dealt with. With regular reports of councils making home care workers redundant too, the NCS has an uphill battle. Unison wants to help make it work, but the goodwill of women – as paid and unpaid carers- must surely have its limits.
