Somebody I know had the misfortune to break an arm. As a result she had cause to call on the Council for home care help by way of a private provider. Her experience poses questions about the quality of care by these private companies at the very time when the Council is moving to make its own home care staff, 64 of them, redundant. The service will be outsourced. Peter Mallinson, the Councillor responsible for the service, tells us that there’s nothing to worry about, the same quality of service will be supplied for £15 an hour, supposedly a third of the cost of the in-house service.
The experience of my friend suggests that the quality of care will be worse. She has no complaint against the staff themselves, but the system they have to work. The staff who work for the private provider are not given travel time between clients. This can only mean that they either don’t spend the time they should with them, or else they get progressively late through the course of their day.
Some staff don’t get sick pay. This obviously encourages them to work when they are sick, since they will lose money. Given the fact that many of their clients are very old and vulnerable people the danger is that they will pass on any viruses they have, with potentially disastrous consequences.
My friend discovered there was no continuity of service. She was visited by many different staff, which meant that she had to explain her situation again and again. They did not necessarily turn up at the expected time, for instance, in the morning to help her dress when she was eating her breakfast. On one occasion in the evening they did not arrive so she had to chase up a supervisor.
This is no criticism of the staff themselves. They are working a system where the private company employs as few staff as they can get away with in order to make a profit, which is their main motivation, of course.
In the Swindon Advertiser recently it was reported that one of these companies, Agincare, failed to visit a number of vulnerable patients. On this occasion the Council’s Home Care staff were called upon to rescue the situation, in some cases, turning out even after working a full shift. What happened when there is no in-house service to come to the rescue?
With the experience of my friend in mind I asked a number of questions of Mr Mallinson during Public Question Time at the recent Council meeting.
1. Does the Council believe that it is acceptable for the private home care providers they use not to allow for travelling time for their staff between clients they visit?
2. What audit does the Council carry out on these providers? How often and what percentage sample?
3. What arrangements does it have in place for feedback from clients who receive homecare, as to the quality of the service, and whether or not they are satisfied with it?
4. Does the Council provide information to clients as to how they can raise complaints in relation to this service?
When you send in questions early you are provided with a written response at the meeting. In response to question 1 they wrote:
“During monitoring of agencies, staff rotas and scheduling is checked. We monitor the time spent with service users and that there is adequate time to a) deliver the care as planned and b) travel time is factored into carers schedule.”
I asked a supplementary question of Mr Mallinson. Are you saying that these companies do have travelling time in their daily schedules, only it is my understanding that it is common that they do not. A simple question which you might have imagined he could have answered on the spot. He either knows that they do or they don’t…if he knows at all. But Mr Mallinson would not answer, falling back on the stock response of the embarrassed politician. He promised me a written answer within 10 days. We shall see what he says, but certainly it is the understanding of the Council’s own staff that private companies do not programme in travel time for their staff.
In a Panorama investigation in 2009 of some of Britain’s biggest home care private suppliers the absence of travel time was common. See the addendum below.
In response to question 2 they wrote:
“Monitoring is carried out annually for a full monitoring visit and a follow up interim monitoring visit if required. This consists of a contract monitoring visit in which quality standards are reviewed. In addition service users have an annual review by Care Managers as a minimum information from this is fed to brokerage and care packages are revised. The Care Quality Commission (CQC) undertakes announced and unannounced inspections. The intervals will vary depending on the performance of each individual agency. The percentage of cases checked will vary but as a minimum 20% of records are checked. Any services classified as poor by CQC are automatically suspended.”
Some questions arise from this answer. Presumably the annual monitoring visit refers to each agency. I suspect this is a paper exercise. Does the Council not talk to the staff of the contracted companies in confidence? Would that not give them a better picture than paper records?
If service users have an annual review is that carried out by the Council’s Care Managers or those of the contracted company?
I will be asking Mr Mallinson how many visits the CQC has made, for instance over the last year, announced and unannounced.
In relation to question 3 we were told:
“Each agency must, under CQC requirements, conduct an annual survey of Customer Satisfaction. These results are shared with both CQC and the Council. Customer satisfaction is also part of the care management review process.”
At the Council meeting I asked Mallinson whether such a survey should more properly be carried out by an independent source rather than by the company themselves. He couldn’t manage this one – written answer within ten days.
In response to question 4:
“Service users are informed of how to make a complaint. The information is provided as part of the care management process and is freely available on the website through Swindon Direct and from care managers and Adult Social Care Department. Customer comment forms are part of the review process.”
The thing that comes to mind here is the fact that some service users will be ambivalent about making a complaint, even if they can face up to the people providing it. They may be frail, they may be confused. The Council needs to go out of its way to ensure that where clients are not in a fit condition to complain that their family or relatives are spoken to to check that the service is sufficient or lacking.
This whole issue merits some serious research and campaigning. There is a great deal of anecdotal evidence of the inadequacies of the service provided by private companies. For instance, somebody I know told me that a relation of hers had a carer turn up at 5 p.m. to put her to bed!
At the Council meeting Mallinson was asked by a union rep facing redundancy, what will happen in circumstances as reported in the Swindon Advertiser where a private provider falls down, and there are no in house staff to come to the rescue? The great man, not renowned for thinking on his feet, had to fall back once again on…written response in 10 days.
The economic maestro of Swindon Borough Council, Councillor Edwards, has insisted “we will protect front-line services”. In abandoning the in-house service he has ensured that the service will be provided by staff on worse wages and working conditions; staff who are rushed off their feet; staff who are not trained to the standard of in-house staff. The consequences will be the worsening of the quality of life of sick and vulnerable people.
We will see what Councillor Mallinson has to say in his written response. I think a Freedom of Information request might be in order here.
Martin Wicks
Addendum
Panorama programme on Home care, April 2009
Care of the elderly is a professional job. Assisting medication, feeding, changing, bathing, even using hoists demands a level of expertise we expect in the care of some of our most vulnerable people. But when Panorama went undercover in some of Britain’s biggest homecare suppliers we found carers with little more training than they needed for a job in a burger bar.
Our undercover carers were sent into companies where during months of research, we had heard first hand accounts of serious systemic failings. They completed four days of training with Age Concern Training, exceeding the government’s national minimum standards. Emergency medical cover was on standby throughout the time they were working.
When applying for jobs, both Hayley Cutts and Arifa Farooq said they had some caring experience but no formal training. It wasn’t long before they got work. Hayley’s first job was with a company claiming to be Britain’s fastest growing care provider with around 15,000 elderly clients.
Administrative errors
Hayley’s training at Carewatch consisted of four 20-minute DVDs and a tutorial lasting 90 minutes. A check with the Criminal Records Bureau is a legal requirement but Hayley was allowed to work 14 shifts before she was cleared. The company apologised for what they said was an administrative error.
On shift, Hayley finds tight schedules causing havoc for staff. While visiting a 77-year-old terminally ill man, her colleague’s phone rings. As the elderly client asks for oxygen, his carer is talking on the phone about work throughout.
Carewatch says company policy states that phone conversations should not interfere with work. But the piling on of visits is not unusual during Hayley’s time with the company. This makes visits rushed and those towards the end of the day can even be missed. It also said it was “determined to ensure that any lessons to be learnt from this covert investigation are learnt”.
“You had back to back appointments and you weren’t factored in travel time. So it meant that if I had to drive 20 minutes outside of York, I would be late before I even started. And on top of that, if any service user needed a little extra bit of care, no matter how small like just extra time to get to bed or they needed a little longer on the toilet that day, that time wasn’t factored in,” says Hayley.
The company denies that travel time is not factored into schedules.
Missed appointments
But the pressure on carers’ time is not isolated to this one company. Missed appointments can be a matter of life and death for some, but when Hayley moves to work for Care UK she finds the same story. The company has 48 care contracts around the country, mostly in England, looking after 15,000 clients. Last year it was awarded a £2.4 million annual contract by Hertfordshire county council.
Janet Finn is 89. Suffering from dementia and doubly incontinent. She depends on carers to visit her three times a day for half an hour. In June 2008, Janet’s visits were skipped for an entire day. Her son David found her. “She’d had 24 hours with no food, no water, no medication and she was sitting in her own faeces and urine,” he told Panorama.
Care UK admitted she had dropped off their computer system and apologised to the family. Janet has since moved to a different care provider and now gets four visits a day.
After thousands of complaints and over 900 missed calls Hertfordshire Council got rid of Care UK, just 10 months after they had been awarded the contract. But the company still has a contract in neighbouring Harrow where a care inspector’s report found Care UK “is run more in the interests of the staff than the people they are supposed to be caring for.” The inspectorate gave Care UK Harrow a zero star rating and assessed its standard of care provision as “poor.”
By the time Hayley went undercover in Harrow, Care UK should have put right 20 of the 22 failings indentified by the inspectorate in October 2008. However she found some of those failings were ongoing, including a lack of care plans in clients’ homes, care plans that were up to two years out of date, problems with the provision of medication and erratic timings of visits to clients.
Care UK told Panorama that where they had not met the high standards they set themselves, they apologised wholeheartedly and had acted to ensure performance improves. They said within a week of Hayley’s departure all care plans had been fully updated and that the incidents referred to in the programme, while distressing to the individuals and families involved, are extremely rare.
Online auctions
Care of the elderly is a lucrative industry after the doors were opened to private companies in the 1990s. Research from the London School of Economics, commissioned by Panorama, found that 70% of home care is provided by the independent sector today and is worth £1.5 billion. The figure was just 2% in 1992. English local authorities spend around £22 an hour providing elderly care, but the independent sector provides it for around half that.
Panorama went to South Lanarkshire in Scotland where an online auction decided the council’s new care provider. Domiciliary Care won the auction which saw bidders bidding down, not up. It’s one of Scotland’s largest care providers looking after more than 1,500 people. While it won with a bid to provide care for £9.95 an hour, South Lanarkshire says the decision to award the contract was based only 40% on price with 60% based on quality of care.
Andrew Wilson, 78, was one of the clients whose care went to Domiciliary Care (Scotland). Mr Wilson is hard of hearing, blind in one eye and unable to walk more than a few steps. With no close family he lives alone and depends on carers. He allowed Panorama to fit secret cameras in his home for 19 days.
The cameras showed him receiving a bed bath with his carer constantly on the phone and revealed that of his four half-hour visits a day, the lunch and teatime visits were often curtailed. While his care assessment says his lunchtime carer should prepare and cook a meal, he was routinely fed on sandwiches, packets of quavers and toast.
Domiciliary Care denied neglect, saying their carers were under no obligation to go shopping for Mr Wilson but routinely did so as there was often no food in the house.
‘Tragic and scandalous’
After four days of training, which exceeded national minimum standards, Arifa Farooq found a chaotic system with carers relying on clients to tell them what they needed. Care plans should be provided for every client detailing what the carer should do on every visit including any medicinal requirements. A copy should be kept at headquarters and one at the client’s home. Arifa found that frequently there was no plan. She saw confidential care plans stacked in the boot of a company car and strewn across back seats.
During her time with the company, Arifa found she often had little time to spend on a visit, with one call lasting just three minutes. South Lanarkshire council, who awarded Domiciliary Care the contract, declined to be interviewed but watched the covert footage and said they found Panorama’s allegations deeply concerning and have launched a full investigation.
Six months ago, Domiciliary Care was taken over by Choices Care Group which says it is appalled by our findings. It says some of the problems are inherited and that an internal investigation found some of the programme’s allegations to be proven, including curtailed visits. It went on to say that changes are now being implemented.
As a result of our programme South Lanarkshire council have removed three clients from Domiciliary Care including Andrew Wilson. He is now with a different care provider and tells reporter Paul Kenyon his life has changed entirely.
A Department of Health spokesman said: “Every older person is entitled to high quality, safe and dignified care, whether it is provided in their own home or anywhere else. Anything less is unacceptable.
“The new Care Quality Commission has tough powers to penalise or close down providers who offer substandard care. We expect CQC to use these powers to crack down on cases such as those highlighted by Panorama.”
Joan Bakewell, broadcaster, author and now a government advisor on ageing is horrified by Panorama’s findings. “There are places where achieving old age is something to celebrate,” she said.
“As things stand the UK is not one of them. Selling elderly care to the lowest bidder can do nothing to improve that. Neither can the pitifully low wages offered to carers.”
“I’m not altogether surprised,” Bakewell told the programme, “but the proof is really tragic and scandalous. It’s easy to say but something has to be done. Somebody must take responsibility for these lapses in standards and must ensure that standards are kept in the future.”
Martin Wicks 