Homecare - Channel 4 Dispatches - 4th April 2016

Channel 4 “Dispatches” presented a wide range of issues facing homecare services, including what appears to be care disappointingly below the standard that the public expect (note 1).

United Kingdom Homecare Association (UKHCA) makes the following considered response following the broadcast of the programme on Monday 4th April 2016 (notes 2 and 3).

Footage in the programme will have disturbed people and the public need to be reassured that each year almost one million people across the UK are enabled to live at home, supported by high quality care delivered by a dedicated workforce.

The homecare sector in context

The vast majority of people wish to retain their independence at home. High quality home-based care supports people’s wellbeing and enables them to remain in their local community.

There is increasing concern about social isolation of older people, and so careworkers who can deliver compassionate, dignified care are essential.

With 70% of homecare purchased by councils and the health service, UKHCA has repeatedly warned that the state-funded care system faces a crisis caused by sustained under-resourcing. This creates a pressurised system at significant risk of frequent and recurrent service breakdown.

In the face of constrained public spending, councils have continued to use their dominant purchasing power systematically to reduce the prices paid for care . The consequences can be seen in a range of interlinked symptoms in state-funded care:

• A low-paid workforce, increasingly close to the National Minimum Wage;
• Care purchased as a series of tasks, with insufficient time to meet people’s needs;
• Time and capacity pressures that leave services vulnerable to disruption from even minor unplanned events;
• Highly stressful working conditions which increase staff turnover amongst front-line staff and supervisors;
• Experienced and well-trained workers leaving the sector, creating additional pressures on training the workforce;
• Difficulty recruiting new workers from a shrinking working-age population.

The cumulative effect of these issues, presents significant challenges to embedding a positive organisational culture and workforce values, and are combined with financial pressures which increase the risk of rushed, undignified care.

These symptoms are a clear indication of the underlying lack of value that society places on the care of older and disabled people, and the social care workforce.

Issues posed by the programme

The organisations featured in the programme are best placed to comment on the individual circumstances featured in the filming and the actions that they have taken. Investigations will be in progress within the organisations concerned, which may involve internal disciplinary procedures (note 4).

UKHCA’s comments on the broader areas of concern raised by the programme are as follows:

1. Timing and duration of homecare visits

People who use services have a reasonable expectation that their visits will start at the agreed time. They should also expect to be informed if visits will be unavoidably delayed, particularly where the time of such visits is crucial for individual safety, comfort or the administration of medication.

While homecare visits are generally purchased for a specific length of time, social care services should be commissioned and delivered to enable people to achieve the agreed outcomes of their care.

There are occasions when a person may express a positive preference for an individual visit to end early. However, it is absolutely essential that careworkers spend sufficient time to meet people’s physical and social needs.

The scheduling of visits must allow sufficient travel time for careworkers to travel between people’s homes as a matter of safety for the worker and to ensure that subsequent visits take place at the planned time.

With rare exceptions, councils only pay for the time spent delivering care, at rates which do not adequately recognise careworkers’ travel time (which employers are obliged to cover). Providers must therefore minimise down-time between visits, while still providing sufficient time for workers to travel between people’s homes.

While not condoning inappropriate scheduling of care visits, we believe that the undesirable practice (referred to in the programme as ‘call clipping’) is a direct result of the way that homecare is commissioned by the public sector, particularly local authorities.

We are deeply concerned by the apparent lack of understanding in many councils that their contracting arrangements create a pressurised system which focuses on ‘time and tasks’, rather than people’s needs, preferences and outcomes.

2. Missed and late visits

Using unpublished data obtained under the Freedom of Information Act, Dispatches highlighted an apparent increase in the number of missed homecare visits recorded by councils.

Missed and late visits are a very real issue when they occur and can present a risk to the safety of individuals. It is important that careworkers report missed visits at the time, so that people can be contacted and remedial action taken, where needed.

UKHCA believes that missed and late visits are often a direct result of underfunding and the way that homecare services are commissioned by councils. However, unplanned events do occur. In a highly pressurised system this can result in service breakdowns which in turn cause distress to older and disabled people.

3. Careworkers’ pay

UKHCA believes that the skills and commitment of homecare workers should be rewarded well above the National Living Wage.

UKHCA calculates the minimum sustainable price for local authority care from 1st April 2016 to be £16.70 per hour to cover the costs of care, including careworkers’ pay, travel time, travel costs and providers’ requirement to operate a sustainable service (note 5).

We have repeatedly reported on the disparity between rates paid by local councils and the actual costs of care. In previous research, we have found that just one in seven councils paid the equivalent price at the time (note 6).

Whilst we welcome the introduction of the National Living Wage from Friday 1st April, it adds a further cost pressure on providers’ resources. We note the number of councils which have refused to increase rates paid for care, or which have not made a decision on increases, despite the increases already having taken effect.

Employers must comply with the National Minimum Wage Regulations, which, from the 1st April 2016, includes the National Living Wage. UKHCA provides a comprehensive National Minimum Wage Toolkit to assist employers in their obligations (note 7).

4. Appropriate and compassionate care

Homecare plays a vital role in supporting people, who often live on their own and/or have cognitive impairment. Care that helps people to maintain their personal hygiene, to remain properly nourished and hydrated and to take their medication at the right time is vital. Failure to provide such care is not acceptable.

It is vital that careworkers understand and implement the training they receive from their employers to provide appropriate and compassionate care.

Careworkers regularly provide a vital role in reducing isolation for people supported at home. It is absolutely essential that careworkers spend time in people’s homes in ways which respond to people’s needs and their preference for social engagement.

5. Accurate record keeping and care plans

Written records of care must be accurate, particularly as they contribute to people’s safety and demonstrate that the planned support has been delivered.

Accurate written records also form part of contractual compliance, quality assurance and regulatory oversight. In some cases they are also examined in legal proceedings.

Inaccurate record keeping undermines confidence and trust between people and their care service.

Providers must have control measures in place to ensure the accuracy of records, and that agreed plans of care are available to careworkers and followed. Employers will issue clear guidance to their workers on accurate record keeping and emphasise that falsifying records is a disciplinary matter.

6. Undercover filming and use of closed-circuit television

The use of covert filming in the Dispatches programme raises issues around the use of concealed cameras by journalists, people who use services and their families.

The Ofcom Broadcasting Code governs the standards with which programme makers are expected to comply. The purpose of covert filming in the public interest should be to protect people from harm. We are extremely disappointed that ITN failed to convey concerns about care received directly to the employer and the statutory regulator immediately after the footage subsequently used in the programme was obtained.

It is essential that older and disabled people are completely confident in the careworkers who visit them. The equipment to film in the home has become significantly easier and cheaper to install and covert filming may have a place in providing reassurance for some people who use care services and their families.

However, CCTV will only ever provide evidence of inappropriate standards of care after it has happened. We strongly encourage people to raise concerns with their care agency immediately, rather than just rely on filmed evidence. People who don’t wish to talk to their agency directly could also contact their local council, who coordinate adult safeguarding investigations and who will provide advice. If there is any immediate risk to individuals, or suspicion of crime, then the police should be contacted. The Statutory Regulator for England has produced advice for members of the public on the use of covert filming in care settings (note 8).

Conclusion

As a professional association, we are committed to working with providers, commissioners and local and central government to support dignified, compassionate and effective support to people at home.

With an ageing population and increasing demands on social care, this needs to be underpinned by a shared understanding of the value that homecare services bring to individuals and society.

Ends.

Notes for Editors

1. Dispatches “Britain's Pensioner Care Scandal” was produced by ITN for Channel 4 and broadcast at 20:00 hrs on Monday 4th April 2016. The programme is available for a limited period on catch-up services from http://www.channel4.com/programmes/dispatches/episode-guide.

2. United Kingdom Homecare Association (UKHCA) is the professional association for over 2,000 domiciliary care providers in Great Britain and Northern Ireland.

3. UKHCA’s mission, as a member-led professional association, is to promote high quality, sustainable care services so that people can continue to live at home and in their local community. We do this by campaigning, and through leadership and support to social care providers.

4. Please see www.careoutlook.co.uk. 

5. UKHCA produces a detailed calculation of the minimum price for local authority care, based on assumptions that workers are paid for all working time at the prevailing rate of the National Minimum Wage (including the National Living Wage), that contributions are made for travel costs, statutory paid holiday and pensions. From 1st April 2016, the minimum price is £16.70 per hour. See: www.ukhca.co.uk/downloads.aspx?ID=434.

6. UKHCA submitted Freedom of Information enquiries to every council in Great Britain and the Health and Social Care Trusts during a sample week in 2014, and found that the average price of care was £13.66 per hour, compared to UKHCA’s Minimum Price for Care (at the time) of £15.74 per hour. See: UKHCA (2015) The Homecare Deficit at www.ukhca.co.uk/downloads.aspx?ID=458.

7. UKHCA’s National Minimum Wage Toolkit is designed to assist employers remain compliant with the National Minimum Wage Regulations and is regularly updated. See: UKHCA (2016) National Minimum Wage Toolkit at www.ukhca.co.uk/nmwtoolkit.

8. Care Quality Commission (2015) Thinking about using a hidden camera or other equipment to monitor someone's care? www.cqc.org.uk/content/using-hidden-cameras-monitor-care

9. For further information please contact:

Colin Angel, Policy and Campaigns Director
United Kingdom Homecare Association Ltd
Sutton Business Centre, Restmor Way, Wallington, SM6 7AH

Telephone: 020 8661 8188
Mobile: 07920 788993
E-mail: [email protected]
Website: www.ukhca.co.uk