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Tuesday, 13 September 2011

On Homecare - politicians not brave enough to confront the truth

A perfect storm is a term used to describe a situation where a range of negative circumstances come together all at once. It is a term perhaps appropriate for Bristol City Council's Lib Dem plan to privatise its homecare service. In combination, the factors detailed below show how an already dire situation will be made far, far worse if the privatisation goes ahead.

1. Instability in Private Sector Businesses and Public Sector Cut Backs

Companies who run residential homes are laden down with debt at a time of drastic local authority budget cuts. Cut backs have reduced the number of care home beds that Councils book for respite care. Councils are imposing lower prices be paid 'per bed' and the number of residential home companies going bust is at an all time high.

Council's are shifting their focus away from residential homes towards providing homecare support as an alternative. This policy has been in operation for over a decade, widely supported by organisations who represent older people's interests and applaud efforts to keep people in their own homes for as long as possible. However, the ethics which underpinned the policy move towards at-home support have now been replaced by an urgent desperation to cut costs.

Last week, a Bristol job centre was advertising a full time homecare job for £100 a week. This is during the same week when the Association of Directors of Adult Social Services described the system in place for providing adult social care as 'bust'. Three quarters of all Homecare workers in the private sector have NO guaranteed hours of work. They work on zero hours contracts and their weekly income is unstable. They are routinely bullied into working long hours. Many private sector homecare jobs are advertised as paying £7.50 - £8.50 an hour but the pay packet that workers end up with rewards them with much less than that. Because they are only paid for the minutes they spend in a service users home, a twelve hour shift can produce only seven or eight hours pay. Unsurprisingly, many are struggling with personal debt problems. At least 10% of jobs in social care pay less than the national minimum wage. Abuse of their employment rights is commonplace. 

These workers deal with the most intimate aspects of people's lives, bodies and personal finances. Treating care workers badly does the service users no favours whatsoever. When CareMark Bristol went bust recently, it was the Council's own Homecare Service that stepped in to ensure that service users were not left stranded. This is not an isolated incident.

The UK Homecare Association has reported big safety concerns for service users and homecare workers. Adult social care is in a massive mess across the country. Homecare, as a solution for looking after older vulnerable people, is coming under more and more pressure. Care homes are closing down, either because they are mired in disgrace for abusing those they are supposed to care for, or no longer financially viable to maintain, or because Councils are turning to homecare as a much cheaper alternative.

2. Loss of Public Confidence in Private Care

There has been a massive loss of confidence in private sector care provision and Bristol has been in the public spotlight. The potential to accumulate great wealth from running a private care business was clear from the lavish wedding celebrations shown in the C4 Dispatches programme about the Dewani family, well known in Bristol for their impressive business acumen in the care sector. However, scenes of abuse at Bristol's Winterbourne View (nothing to do with Dewani and run by Castlebeck) were broadcast to the nation on Panorama. What we witnessed as viewers was reminiscent of the torture of Iraqi prisoners at Abu Ghraib. 

Soon, the care workers exposed will face trial at Bristol Crown Court. They will have the opportunity to explain themselves, the criminal charges against them are very serious. The national media will be camped outside Bristol’s Court on Small Street. The directors of the company concerned remain in their jobs and, so far as I am aware, may have been disgraced in the court of public opinion but they face no personal criminal investigation. Castlebeck is still in business.

It’s only a few weeks since staff at Bristol's Rose Villa were investigated on allegations of abuse - the home's owners decided to shut it down rather than contemplate any potential remedies for institutional malpractice.  Bristol's Amerind Grove Nursing Home, a big home in the City which has nearly 200 beds, received a terrible inspection report in March 2011. They were found to have failed on 11 essential standards for which they have a direct responsibility in law to maintain. It was found that residents had suffered 'pain and injury', their 'right to safe care' had not been protected, they were 'frustrated, ignored and upset'. Staff had not received any training in dementia care or the Mental Capacity Act, were inexperienced, in a rush and not 'always competent'.

Amerind Grove is run by an organisation that the public would not necessarily think of as a bunch of uncaring, money grabbing spivs, but by BUPA. BUPA trades on its reputation as a not for profit organisation which exists for the benefit of its members. Mark Elliott, Regional Director of Bupa Care Services said of Amerind Grove that since the inspection, ‘significant improvements’ were made immediately, the home now has a 'professional team' delivering 'the highest possible standards of care.’ 

Councillor Jon Rogers, the politician at Bristol City Council responsible for Health and Social Care confirmed BUPA's story to the local newspaper and added that Amerind Grove is now: ‘a more effective home, staffed with trained carers who show real pride in the valuable job they do.'

Two weeks ago, I just happened to pass Amerind Grove Nursing Home. I was struck by the BANNER ADVERTISEMENT across the entrance to the Home promoting A CAR BOOT SALE TO BE HELD IN THEIR GROUNDS. Unimpressed, it did not scream out to me that they were desperate to gain respect for offering the highest possible standards of care.

I have also noticed that the adverts at the job centre which offer not a penny more than minimum wage of £5.93 an hour to work in a care home are at, you guessed it, Amerind Grove.   Since no experience is required for these jobs, it puts pay to the 'trained carers' explanation. As for the, 'pride in the valuable job they do', dreams of Cllr Rogers . . . dream on. Amerind Grove could not legally demonstrate any lower valuation of these jobs than £5.93 and in three weeks time this value will become unlawful because the national minimum wage increases to £6.08. Perhaps BUPA will now have to offer a children’s face painting service during October half term to boost attendance at the car booters?

In 2009, Sunnymead Manor Residential Home in Southmead, owned and operated by Mimosa Healthcare, was exposed for poor care standards. The then Executive Member for Health and Social Care at Bristol City Council attempted to reassure the public by making a personal visit to the home. Her inspection was so rigorous that she offered the local newspaper this breathtaking line: ‘we spoke to quite a number of residents and they seem contented enough.’ It took until the following year, for the facts to surface again. In November 2010 a member of staff blew the whistle on Mimosa for disgusting conditions, poor care, lack of attention, poor infection control and dirty facilities at Sunnymead. In December 2010, the same company issued a public apology for appalling care standards at another of their homes, Kingsmead Lodge, in Shirehampton, Bristol.

In May 2010, June Davies was convicted in Bristol Crown Court of abusing a resident in her care at the Honeymead Care Home in Bedminster. Two weeks ago, Kirsty Green was sentenced at Bristol Crown Court for stealing £46,000 from a bedridden older person in her care. Kirsty worked for Stepping Stones Homecare, as did Jane Hoy who was convicted for the same offence a year before.

Before you jump to many conclusions about the wickedness of care workers, it is worth pondering for a moment that both Bristol City Council and the Care Quality Commission regulate these outfits. If you feel sickened by stories of older people being abused or are cross about companies that fail to provide the care they are paid for, you should also be asking questions about regulation.

3. A crisis in regulation

In a race to the bottom, the system of private sector care regulation has been watered down by successive governments. Last week, members of the UK Care Homes Association decided they no longer had confidence in the Care Quality Commission (CQC). The Royal College of Nurses are currently surveying their members about similar concerns.

Today, it is reported in Community Care Magazine, that the CQC are, yet again, reducing their regulation. This time they are reducing not the frequency, but the scope of what they decide to inspect. There are 16 quality standards and providers will now only be tested on a few of them. 

Their approach to regulation from now on will 'assume' providers comply with these standards and only look further if there is evidence they might not. This means that providers will not have to demonstrate that they meet the standards, the inspectors will simply assume they do unless they see evidence indicating otherwise. As things stand, businesses providing social care are regulated ONCE EVERY TWO YEARS. That is how 'light touch' the regulation is.

Further, in June 2011 the CQC disclosed it is so short of staff that it is carrying 128 vacancies for inspectors. Despite the continual massive shift in provision away from care services which are owned and run ‘by the public, for the public’ towards the private sector, the CQC runs on a budget which is 65% of what regulation cost back in 2006.

In the six months between October 2009 and March 2010 the CQC carried out 6,840 inspections. Between October 2010 and March 2011 the CQC carried out only 2,008 inspections. The number of inspections had fallen by 70% in just a year. In October 2010, the system of rating providers with an inspection star score (one star, two star, three star) was abolished. The Association of Directors of Adult Social Services said this was a dangerous move which would reduce the safety of older people receiving services.

The alleged purpose of this weak system of regulation is to reduce 'bureaucracy' and increase local accountability. It is intended that Councils should produce ‘local accounts’ on the standard of services in their areas and be held to account by user-led groups and local people.

A conclusion - brave enough to confront some truths?

Bristol City Council plans to privatise what remains of its Homecare service in the eye of this 'perfect storm'. On average last year, Councils across the UK cut back on the number of Homecare Assistants they directly employed because they preferred to buy more cheaply from the private sector. The proportion of services provided directly by Councils fell to 16%.

Bristol currently has 15% of its homecare provision delivered by its own in-house team of Homecare Assistants. However, it is putting these women out of work, despite them being the most well qualified, experienced and necessary team of care workers in the City. Bristol City Council’s own homecare workers are either being forced to accept a supposedly ‘voluntary redundancy’ package (which may not even materialise) or they are being asked to accept other work in the Council. This 'other work' is often totally inappropriate for them or is with Council services which are facing imminent closure, like residential homes. Homecare Assistants since August have been facing up to the distress of going to out work, only to find their service users have been taken away.  The people they care for, in some cases for many years, are handed over to private agencies whilst the Council carers themselves are sent back home with no more work to do.

Right across the UK, Councils are putting pressure on private providers to continually reduce costs and Bristol is no different. This is achieved by reducing pay, watering down on regulation, turning a blind eye to poor quality provision, and expecting workers and service users to tolerate an ever higher risk of danger. Bristol certainly does not have a glorious reputation for regulating the private sector. The evidence speaks to the fact that it does not, and perhaps can never, ensure that only good quality private sector care is provided for taxpayers money.

It is perhaps unfortunate for Bristol to be singled out, but it is nevertheless a fact that Bristol has come under the national spotlight for care failure.

Lib Dem politicians at Bristol are woefully ignorant about the reasons why their own Homecare Service costs more than the private sector. They are also astonishingly naïve and out of date in their understandings of the employment terms and conditions of their own workforce. They are acting outside of the law in refusing to consult with trade unions about redundancies and not undertaking an Equalities Impact Assessment. They engage in warm words and platitudes when serious failures in care standards are uncovered.

This happens because it is precisely in their interests for the care companies to keep going, to keep on providing cheap care and for no-one to ask any awkward questions. Indeed when awkward questions were asked by Conservative Councillors at the Full Council meeting of 6th September, the Lib Dem response was to repeat falsehoods and misinformation. Who can blame them really? It worked. The Conservatives changed their minds about voting against the privatisation plans.

The idea that local people can hold private care providers to account is astonishing. Our elected Councillors rarely know what they are talking about on Adult Social Care. It is not in their interests for local people to be any the wiser.

One thing that ALL politicians in Bristol do know however is that people in our City do not want Homecare to be further privatised. All politicians know that with a certainty. They shudder at the prospect of being in the unfortunate position of having to carry the can for unpopular decisions.

The Lib Dems know they lost the 8th September by-election in Southmead over the privatisation issue. The Conservatives and Labour also know they picked up votes because both parties told voters they would fight to keep the in-house service. The Lib Dems leader herself has said as a result of the defeat that they ‘are listening to local people’.

Well if you are listening, listen to this. When looking into the eye of a storm in which older people are subjected to ever increasing risk and care workers are regarded as expendable fodder, nobody wants a coward to represent them. Privatising your own homecare service is far from a brave political decision. It is a decision taken in ignorance, irresponsibility, and with a cavalier disregard for what is actually taking place underneath your own noses.

If you do not have the courage to act as people who elect you require, if you do not have the courage to face up to hard truths which include your own ignorance, if you are simply not brave enough to confront the truth – you should stand aside.

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