How much do we really Care?


3:51 pm - June 30th 2013

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by Joseph Cottrell-Boyce

Last Thursday the BBC released a video of 83-year-old Muriel Price, sobbing pitiful protests to an empty house as she lay stranded in her bed, her agency carer having failed to turn up to work. Her quiet desperation painted a shameful picture of how little our society values the elderly and vulnerable.

I found it hard to watch Muriel’s video, but wasn’t remotely surprised by the content. Just as with other recent care scandals in the UK, the pattern of failure and neglect was all too familiar to me.

I stumbled into agency care work as a 19 year old looking for employment that required neither qualifications nor experience. After two days of basic food hygiene and health and safety training I was sent to out support young adults with learning difficulties in day centres and residential homes for £5 an hour. I was utterly unprepared for the demanding work. Some of my clients had extreme behavioural difficulties; no one had told me what I should do when a charge of the same body mass as me bit an old woman in a shopping centre for example, or kicked children in a playground.

There was also little support; often I’d be left bathing, changing and moving clients alone, when for safety reasons these should have been two-person jobs. This was backbreaking work for me, and often humiliating for the person being cared for. Then there would be the times at the end of an exhausting 7am – 3pm shift when my manager would call and inform me he hadn’t managed to find cover for the afternoon and I’d have to do a ‘double’ sixteen hour day.

Although most of my colleagues were diligent and genuinely caring, I regularly witnessed malpractice. In one care home, waking night staff would tie emergency alarm cords out of reach of disabled residents, leaving them crying impotently for help in the night as the staff would catch up on sleep. I saw teenagers with learning difficulties locking in rooms for hours to ‘cool down’, by staff who’d had no training to deal with their complex needs.

Then there was the casual neglect. I’d regularly come on shift to find that an incontinent client had not been changed in the preceding 8 hours, or incapacitated clients who should have been up, washed and dressed had instead been left in bed while their carers watched TV.

To my great shame as an awkward 19 year old I never spoke up or reported wrongdoing. I did the best I could and kept my head down. I also saw the futility of complaining about individuals; this wasn’t about a few bad eggs, it was a systematic problem. We were all undertrained, underpaid and overstressed. I knew that colleagues who were negligent were also exhausted by erratic shift patterns, long commutes between different jobs and the usual stresses of trying to feed their families below the poverty line.

As frontline workers, we were also in the firing line for the failings of more senior staff; either our own managers or thinly spread social-workers. If something did go wrong or if our company lost contracts we knew that as agency workers we could be sacked at a moments notice.

The net result of all this was a sense that our work was unimportant. To many, care work was just another insecure stop on a merry-go-round of crap, poorly paid jobs and occasional spells on the dole.

It shouldn’t be like this.

Caring isn’t just another job; it is a vital component of a civilised society. The justifiable public outrage at widespread substandard care is testament to this. And despite all the stress, the antisocial hours, the lack of training or support and the rubbish pay, in many ways I loved my job. I got a buzz from enabling people to lead fuller lives than their circumstances would otherwise allow. At times the work could be genuinely rewarding and even fun. I’d go home drained, but feeling far more fulfilled than I had in the mind numbing call centre job I had paid my rent with up till then. Caring should be a vocation, but the current framework denies workers the support and security to make this possible.

Norman Lamb MP, Minister for Care and Support, has recently called for recommendations on how to reform the care system, stating the need for sweeping change. This is encouraging, but really the recipe for reform is very simple and is already working in other countries.

A few years ago I met a Swedish woman who had recently qualified as a care worker after two years of formal training. She was on a decent salary and was employed directly by the state on a permanent contract. She also had opportunities for further training and education to develop her career in the sector. She felt valued and supported and consequently took her job very seriously.

In Sweden, caring is a profession. In the UK it’s a dead end.

The neglect experienced by Muriel Price was not inflicted by one lazy carer; it is systemic neglect which implicates our priorities as a society. If we take the care of our most vulnerable seriously we need to invest in carers, giving them the tools and support to do their job properly and pay which reflects the demands of their vital work.


Joe Cottrell-Boyce is a Policy Officer at the ICB’s Traveller’s Project

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Reader comments


As I posted a couple of years ago in threads here about the Big Society meme: It’s sad about Fred, of course, but no one had volunteered to cover for that morning.

There are also news reports about the ways that the banks treat pensioners – try:
http://www.independent.co.uk/news/business/news/lloyds-banking-group-forced-to-admit-issues-with-its-ppi-complaints-procedure-after-claims-it-told-staff-to-ignore-possible-fraud-8653265.html

2. So Much For Subtlety

Joe Cottrell-Boyce is a Policy Officer at the ICB’s Traveller’s Project

So the author saw enormous abuses which he did not report. He did, however, get a better job in another industry.

Why am I not surprised that he calls for people like him to be paid more? Without any explanation of why the sort of person who can tie an emergency alarm out of reach of an elderly and frail patient would suddenly become a much better human being if they were earning a little more.

Bankers haven’t been short of pay. This has been the consequence:

“Taxpayers and customers have lost out. The economy has suffered. The reputation of the financial sector has been gravely damaged. Trust in banking has fallen to a new low. ”
http://www.telegraph.co.uk/finance/newsbysector/banksandfinance/10128351/Banking-Commission-Andrew-Tyries-findings-in-his-own-words.html

Andrew Tyrie, chair of the Parliamentary Commission on Banking and chair of the HoC Treasury Select Committee

4. James from Durham

SMFS

Ever considered reading an article?

How about more pay attracts a higher calibre of worker?

How about the need for more training so that a 19 year old can deal with the situations descibed?

But in SMFS world, disable people, the elderly either don’t exist or it must be their fault they are in the situation they are in. Because good SMFS types never get ill or disabled.

Essentially the boss class needs to relearn an old saying: You pay peanuts, you get monkeys.

SMFS: “Why am I not surprised that he calls for people like him to be paid more? Without any explanation of why the sort of person who can tie an emergency alarm out of reach of an elderly and frail patient would suddenly become a much better human being if they were earning a little more.”

Most people who are asked to do *deliberately* impossible jobs will cut corners, especially when they know they are in an endemically rotten system designed as a scam from the top down. I’m sure management never issue explicit orders to tie emergency cords out of reach, but I’m sure they’d find ways to tip workers who didn’t meet impossible targets into the increasingly feared jaws of the JobCentre (and you don’t get Legal Aid for that sort of thing any more). They needn’t fear for running out of workforce, because the JobCentre can always find them more and order them to take the job on pain of destitution.

That’s how corrupt management works. Pass formal responsibility for failure to deliver (and illegality, in this case) on down the chain…

Oh dear oh dear. This isn’t exactly a poster advert of the glorious NHS that is beyond criticism on this site.

“In Sweden, caring is a profession. In the UK it’s a dead end.”

It is no surprise for you to hear then that in fact a lot of services provided by Swedish healthcare is done through private companies. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443216/

I would suggest that the changes taking place in the NHS might not be for the worse and that in fact the system we have now is broken and too expensive.

Do care homes even fall under the provision of the NHS?

9. Planeshift

@7 abuses happen in private care homes as well.

But you do have a general point. We’ve long treated social care as the poor cousin of the NHS, and thus as a result it has been staffed by min wage and increasingly zero hour contract staff in both public and privately run services. Private sector homes are simply not – on the whole – going to tripple wages.

Unfortunatly the only way to raise standards is to plunge a shit load of money into the sector, so competition can be based on quality as well as price. As there is no money, (and even if there was social care is not sexy enough to get it) this means the only way of doing so is to encourage private sector finance – whether through insurance or whatever – and allow individual choice of location. This will take decades to fully filter through though as the inverse care law will simply ensure only those rich enough to get decent care will have it. People without family will always end up with the poorest care available in the market. The only hope that enough private sector providers enter the market so that standards are raised in the entire sector – so the kids who start at min wage in the slum care home at least feel the experience is likely to get them up the ladder so to speak.

“It is no surprise for you to hear then that in fact a lot of services provided by Swedish healthcare is done through private companies. ”

In Britain, GP surgeries, the main source of primary healthcare, are mostly private businesses.

According to OECD figures, Sweden spends about the same percentage of national GDP on healthcare as we do so there seems to be little prospect of saving public expenditure. It probably makes more sense to look and see whether there is evidence that the quality of healthcare is better in Sweden than in Britain.

No, Bob.
No no no.

We must never ask how the Scandies actually do stuff.
We must use them only to justify high public spending.

CJCJ @ 11

We must never ask how the Scandies actually do stuff.
We must use them only to justify high public spending.

The one thing we NEVER ask is it something to do with the fact they have have a decent civil culture, while we have a brutal dehumanising society where profit is the only thing that matters?

The point being why does their system appear, on the face of it at least, to work and our system regularly throws up situations that the OP outlines and ones ten times worse. You can argue over and over and over again till the cows come home, but in any profession that is based people doing intensive labour needs to attract people with certain qualities.

I bet my last fiver that if you run that service in the public or private sector in such a manner as to require that these people are ‘rewarded’ with the lowest terms and conditions the Country and the ‘agency’ that runs it expects impossible goals, you are not going to get the best people for the job.

If you have a contract that means you do not get paid for journey times between jobs, but only work done and clients ‘dealt with’ then it stands to reason that such a system will end up creating a rather perverse incentives to your staff.

Who many times do we have to look at elderly people suffering abuse before we start to question a system? At what point does cutting terms and conditions look like a failing strategy? For me at least, and the majority of decent people, it looks like we are past the point long ago.

7

The examples given in the OP relate to private companies as in the term ‘agency work’. You are entitled to support private care but it might serve your argument better if you didn’t attribute bad practice in the private sector to the NHS.

14. Charlieman

@13. steveb: “The examples given in the OP relate to private companies as in the term ‘agency work’. You are entitled to support private care but it might serve your argument better if you didn’t attribute bad practice in the private sector to the NHS.”

Part of the problem is that social care and medical care for the elderly are confused in citizens’ minds. The artificial divide between care provided by local authorities and NHS care further creates a system where looking after a particular old person becomes an exercise in passing care costs and responsibility.

The system is designed so that nobody wishes to take responsibility — responsibility costs money — and care is diminished.

15. So Much For Subtlety

4. James from Durham

How about more pay attracts a higher calibre of worker?

So this is a thread about how working class people are horrible and they need to be replaced by middle class people? Or perhaps that immigrants are just vile and need to be replaced by nice White middle class people? What? What is the argument here? Why is it you think poor people are inherently likely to be vile to patients?

How about the need for more training so that a 19 year old can deal with the situations descibed?

How much training do you need to know that the sick and frail need their emergency alarms? How would a two year degree help to explain to people that those alarms are, you know, needed? You think one day in class the penny will suddenly drop and they will have a flash of awareness and enlightenment?

But in SMFS world, disable people, the elderly either don’t exist or it must be their fault they are in the situation they are in. Because good SMFS types never get ill or disabled.

It is ironic you accuse me of not reading the article when nothing I have said remotely corresponds to this at all. But I suppose just as Nelson’s patriotism kept him warm, your self righteous saves you from the need to have a credible argument.

Cylux

Essentially the boss class needs to relearn an old saying: You pay peanuts, you get monkeys.

So these largely immigrant workers are monkeys are they? Again what is it about poor people that means you think they lack compassion?

jungle

Most people who are asked to do *deliberately* impossible jobs will cut corners, especially when they know they are in an endemically rotten system designed as a scam from the top down.

I agree. However that does not seem to be the whole story here does it?

“I’d regularly come on shift to find that an incontinent client had not been changed in the preceding 8 hours, or incapacitated clients who should have been up, washed and dressed had instead been left in bed while their carers watched TV.”

Watching TV is not a sign of anything other than moral turpitude. Which the author did not report. Hence did not stop.

There are management problems here – especially the imcompetence in getting shifts covered – but most of what we see here is just vile people being vile to other people.

I’m sure management never issue explicit orders to tie emergency cords out of reach, but I’m sure they’d find ways to tip workers who didn’t meet impossible targets into the increasingly feared jaws of the JobCentre (and you don’t get Legal Aid for that sort of thing any more).

Sorry but they were not tying up those cords because they were busy. They did it, says the author, because they wanted to kip.

You seem to have some psychological need to blame someone beside the workers. Which is better than calling them monkeys I suppose.

That’s how corrupt management works. Pass formal responsibility for failure to deliver (and illegality, in this case) on down the chain…

Which is interesting but not what this article says is it?

There are many qualities needed in a carer. I don’t think a two year Master’s degree can teach them.

If anything this seems to be drawn directly from Robert Putnam’s book – small, cohesive, ethnically homogeneous societies like Sweden produce people who care about each other. Large, bureaucratically run, incompetent, run societies with large ethnic and racial divides like Britain won’t. After all, how many of those immigrant workers will think the elderly are the bastards that colonised their homelands and tortured their grandfathers?

@15 SMFS
I’m sorry you think you don’t need training to work with people with complex behavioural and mental health needs? Have you ever experienced how exhausting it is supervising alzheimer’s sufferers?

No one’s saying replace working class people with middle class people, but if you pay people below the poverty line (£5 hour = £9620 per annum) the resulting stresses of life will impact on people’s work performance. ‘Working class’ doesn’t mean living in poverty.

The OP’s point is that if you present a profession as being without value, some people (and the article stresses only some) will not take their work seriously.

17. Planeshift

“There are management problems here – especially the imcompetence in getting shifts covered ”

Or the fact that wages are so low for such a stressful and demanding job, that posts cannot be filled. And owners of care homes are too thick to understand economics – i.e. that in such situations they need to raise the wages and conditions on offer in order to attract staff. (public sector has no money to do this because successive governments have tried to get social care services on the cheap)

@smfs – you pay miserly wages, you get miserly people.
If you were being put into a care home would you prefer to go into the one that paid its staff the national minimum wage, or the one that paid it’s staff at least double that?

I have semi direct (Second/third hand) experiance of this myself.
My stepfather had a stroke a few years ago and is confined to a wheelchair, every morning a carer comes and helps my mother get him out of bed bathed and dressed. but occasionaly (not super often but still it happens) because of schedualing f’ups by people in the office no-one turns up and they end up waiting around for hours wondering whats going on.

Eventually my Mother phones the office to ask whats happened only to be told by the person who wrote the scheduale “oh im sorry Becky was suposed to be there today, but i forgot shes on holiday this week”

Now granted in our case this is’nt a huge emergency, as mum can in a pinch do it on her own (it just takes alot longer) but it begs the question that how often, do situations like this with people being left alone stuck in bed all day actually happen?


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