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.
Today’s report reviews 25 recommendations the EHRC originally made in its year-long inquiry Close to home (2011).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.”