Older people may be at increased risk of suffering human rights abuses as a result of local authority home care commissioning practices, according to a review published today by the Equality and Human Rights Commission (EHRC).
The report warns that the way home care is currently commissioned is unsustainable and leads to poor pay and working conditions for many care workers. This exacerbates the high turnover of staff, making care recipients more vulnerable to neglectful or abusive treatment.
The EHRC says it recognises the severe financial pressures local authorities face, but adds that the rates some local authorities pay do not appear to cover the actual costs of delivering care.
“Care workers perform a hugely valuable role in looking after some of the most vulnerable members of society and at the least should expect to be paid the legal minimum wage rather than being forced to fund transport costs and time spent between visits out of their own pockets,” said EHRC commissioner Sarah Veale.
Rushed visits
Today’s report reviews 25 recommendations the EHRC originally made in its year-long inquiry Close to home (2011). The inquiry found that around half of older people were satisfied with their home care, but many others had experienced poor treatment or neglect.
Examples included rushed visits, older people not being helped to eat or drink, left without food or water, in soiled clothes and sheets, and being put to bed in the afternoon.
The review finds that some progress has been made, but the EHRC is now calling for all local authority contracts commissioning home care to include a requirement that care workers are paid at least the National Minimum Wage, including payment for travel time and costs.
It also argues that local authorities should also be transparent and set out how the rates they pay cover the costs of safe and legal care, with cost models published on their websites.
The United Kingdom Homecare Association (UKHCA), which represents home care providers, said it “entirely endorsed” this recommendation. “Too often, cash-strapped councils dictate prices based on what they can afford to pay, rather than what the service costs to deliver safely and effectively,” said UKHCA chair Mike Padgham.
“They must only agree rates which enable employers to comply with at least the National Minimum Wage and their other legal obligations.”
However, Katie Hall, chair of the Local Government Association’s (LGA) community wellbeing board, refuted claims that local authorities contract services at rates that prevent providers from paying the minimum wage.
She said: “As the report acknowledges, the social care system is under enormous strain, with unprecedented cuts to council funding making it increasingly difficult to meet the escalating demand for care which is being caused by our ageing population. While this means councils have to seek greater levels of efficiency, the quality of care remains the primary concern.
“Care workers do a vitally important job and deserve fair pay, which is why local authorities do not contract services at rates costed below minimum wage.”
‘Dereliction of duty’
Heather Wakefield, Unison’s head of local government, said cuts to local authority budgets could not be used “as an excuse for the kind of reckless commissioning we continue to see in home care”.
She added: “We know that more than 150,000 home care workers are regularly paid below the National Minimum Wage and the EHRC has clearly demonstrated to councils that exploitative employment conditions for workers contribute to unsafe and humiliating care for clients.
“It is a dereliction of duty for councils to commission home care and pay no regard to whether providers are paying at least the legal minimum.”
Sandie Keene, president of the Association of Directors of Adult Social Services (Adass), said the good practice recommended in the EHRC’s report should be read by every local authority commissioner.
“The identification of potential threat to human rights is a serious one and requires further examination,” she said. “Our evidence is that quality and cost are not always directly correlated, but the issues raised in this report must be heeded and evaluated by local authorities and providers alike.”
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Why on earth is the ‘minimum wage’ being used as the appropriate benchmark? Surely vulnerable service users need a quality of service superior to that implied by a minimum wage. Do we have the right to expect an employee on minimum wage to demonstrate any more than minimal skill, minimal aptitude, and minimal motivation?
Unfortunately most, if not all, local authorities are having to make cut all across the board of the services they provide, either by payments or staffing resouces. Home care being only one of them.
While most home carers will be on the minimum wage and some, may be, up to the Living Wage, how can local authorites make savings. Many are just cuting the hours available to provide care to their disabled or elderly customers. If the assessed need was a set of hours to provide care under the critical criteria and these hours are reduced further, this creates care being given for provision of care below the critical criteria. So that, this is starting to set in motion the factors to enable safeguarding issues to occur.
We have already had the instituational safeguarding issues relating to Winterborne View and Mid-Staffs hospital, but now will come a time when similar safeguarding issues will be occuring in the home care sector. That is assuming that they are not already.
What is the answer? Well care is not being correctly funded and has not for many years in the past. While it is highly unlikely to happen, but all local authorities should speak with one voice to central government and tell them that the current level of funding, will not provide for a sustainable level of care to be provided for persons requiring personal care.
How can anyone not understand, that if the numbers of persons requiring care are increasing, how can care be maintained if the year on year budgets are reducing.
We are all amazed that the wonders of medical science,are allowing people to live longer.But it stands to reason, that within this increase the numbers of the elderly and the disbled will also be increasing and sowill their need needs. This can never be achieved on ever reducing social services care budgets. Rather than the critical care fit the budget, the budget should fit the critical care. For, if not the safeguarding issuess will come in abundance. Then will we hear the immortal phrase, which has been said in most of the children safeguading incidents, ‘Lessons will be learnt’.
But until care is placed on the correct financial footing, the lessons will not even be taught.