Who cares about the care workers?

The pay and working conditions of our predominantly female care workforce is already a national scandal. Cuts to council budgets can only make matters worse. By Heather Wakefield.
The crisis in our care services is widely acknowledged and uncontested. White after green paper, royal commission after law commission, select committee after academic reports have all highlighted the looming funding and human crises in adult social care.
Alongside concern over future funding there is rightly a growing demand for more personalised, quality care, while essential, publicly-funded support services like meals-on-wheels and day centres are disappearing.

The Local Government Association’s ‘Funding Outlook for Councils 2010/11 – 2018/20′  said that expenditure on social care would exceed 45% of council spending by 2020 ‘eating up other budgets as it does so’. Since the number of those receiving funded care has already dropped by 40% since 2009, many more will slip out of the safety net by the end of the decade.

The service has been fragmented and privatised too. 85% of councils in England now only provide care when need is ‘substantial’. Two thirds of domiciliary care comes from myriad private and voluntary sector organisations, 4% by the NHS, 21% by personal assistants and just 9% by councils.

Amidst the genuine angst and policy twists and turns surrounding social care, carers themselves rarely get much of a mention. UNISON asked our members employed in home care what had happened to pay and conditions over the last year and how cuts have impacted on the service.

Their responses and personal testimonies in our ‘Time to Care’ survey released on 6 October paint a shocking picture of an exploited, underpaid and unrewarded workforce and a service creaking at the seams. Without the underpaid and unpaid goodwill of women, many of our elderly would receive just the bare essentials of care, stripped of those human touches that often make life bearable.

An important 2011 study by Dr Shereen Hussein of the Social Care Workforce Research Unit  highlighted the problem of poverty pay.  It showed that between 150,0000 and 200,000 people in the social care workforce were earning below the National Minimum Wage. In essence employers are breaking the law which requires them to pay a minimum wage of £6.20 pence an hour from this month, up from £6.08 pence last year.

UNISON’s  survey shows that for 56% of respondents pay has continued to decline over the last year,  with the same percentage earning between just £6.08 and £8 an hour for complex and demanding work.  60% had had their hours cut and 52% had been given additional duties within the same working hours.

Nowhere is the exploitation of the homecare workforce clearer than in the failure of many employers to pay for travel time between visits or adequate fuel allowances. A shocking 58% of our members surveyed are not paid for travel time, with a marked distinction between local authorities and external providers: just 19% of the latter paid compared to 89% of councils paying up. 25%  spend over 6 hours each week in unpaid travel time.

This puts many employers are in breach of National Minimum Wage regulations – a fact confirmed by HMRC in response to a complaint by UNISON. Travel time between visits should be considered as working time, so failure to pay for it frequently tips the hourly rate below the legal minimum. Add to this cuts in fuel allowances and this is what you get:

• ‘ Petrol not enough to cover mileage. 10 minute calls for meds normally should be 15 minutes. Not paid for travelling from client to client…every hour a carer works on average (she) will lose 15 mins pay with travelling’
• ‘Currently proposing to drop mileage allowance from 40p per mile to 30p per mile and also want to stop paying travel time’
• ‘No travel time between clients and no lunch time’

Casualisation of a predominantly outsourced workforce is also evident in our survey. 56% of those working for private or voluntary sector employers are on zero-hours contracts, as are 22% of  local authority employees. 61% of all respondents have varying amounts of monthly pay, making it difficult to budget or make expenditure plans. This inability to plan or seek other work makes life stressful. It also means frequent changes in carers for clients – a deeply unpopular aspect of the service:

‘ A zero hours contract means that in practice I may receive my rota for the week just one day in advance, and sometimes less. This makes it impossible to plan my week and leaves me feeling anxious and stressed. The low pay and unpredictable hours also means I have to be  continuously in search for other work, although it is very difficult to commit to a regular second job due to the unpredictability of the weekly hours offered.’

‘Time to Care’ also reveals other shocking findings: only 40% of those employed by external providers receive sick pay, compared to 91% in councils. Although 71% of our members received some ongoing training, 41% received no training to deal with specialist needs such as dementia, strokes or stoma care. 24% have to administer medicines or carry out medical procedures such as changing colostomy bags without specialist training too.

But while declining pay and conditions and lack of training are very serious problems faced by homecare workers, our survey also throws a spotlight on the impact that ‘austerity’ is having on the the time they have to care and hence the quality of service. Carers rarely spoke just about themselves, but also about the impact that cuts and under-funded commissioning are having on the service they can provide. This was frequently a cause of stress and great concern. Most carers do the job because they want to make a positive difference to clients’ lives. Take just one comment:

‘Homecare is very task orientated and the amount of tasks we are expected to perform in half an hour is ludicrous. I have an 86-year old lady with slight dementia, arthritis, mobility and continence problems. The morning visit means first getting the lady out of bed- which can take quite a while as she is stiff and disorientated. I escort her to the bathroom and on to the toilet, assist with a full body wash and dressing, clean her teeth, brush her hair and leave her to use the toilet while I make the bed, changing soiled sheets. I escort my client downstairs to the lounge or kitchen, make her breakfast and drink. I put soiled bedding into the washing machine after hand sluicing. I prompt medication, observe my client taking her meds and leave drinks for the morning.’

‘Call cramming’ is now endemic in domiciliary care, with 15-minute visits becoming the norm for many providers. The UK Home Care Association  says that 73% of visits in England are now below 30 and 28% below 15 minutes. 79% of our members surveyed have to rush to clients or leave them early in order to get to the next one. Almost half have to do this ‘a lot’.The consequence is that 52% of those working for private providers and 38% employed by local authorities work in their own time to provide a service they consider nearing acceptable.

These unpaid acts of love are keeping an underfunded, fragmented and outsourced care system ticking over, but time is running out.

‘Time to Care’ is available from UNISON. Contact [email protected] for details.

By Heather Wakefield
Heather Wakefield is head of the Local Government Service Group of the UK’s largest public service trade union Unison, representing over 700,000 of the union’s 1.4 million members. She was previously a researcher and regional official for the union, and a women’s rights officer for NCCL (Liberty). Heather is a regular commentator on local government and women’s issues.