If we don’t care for carers they can’t care for the old
Old people just grow lonesome / Waiting for someone to say, ‘Hello in there, hello.'” So wrote the poet and singer John Prine. He might have had the levels of homecare provision in mind.
People dependent on homecare anywhere in the UK have good reason to feel anxious about the future. Here, however, anxiety might well be shading into panic.
The old, and others in need of help in the home, fare worse in the north than in any other part of the UK. And this isn’t about to get better.
A survey published by the UK Homecare Association (UKHCA) estimates that just more than 640,000 people in England, Scotland, Wales and Northern Ireland are currently entitled to publicly-funded homecare.
It finds, too, that, by every available measure, the 23,500 of these who live in the north are significantly less-well looked after than their counterparts across the water.
The fact that there seems to be no plan on the part of the Executive to set this anomaly to rights will be considered by many to be a sad fact of political life that no one can do much about.
But there’s nothing stopping them raising blue murder about it – in the way they did over funding for policing a few years back. Matter of priorities, I suppose. The UKHCA isn’t a radical group. It is the professional association of homecare providers from a range of sectors – private companies, voluntary groups, not-for-profit organisations and statutory agencies.
The survey is the most comprehensive conducted in the area. Seven hundred and thirty-nine homecare providers furnished detailed responses to a series of questions on the constraints and impediments encountered in supplying services to 189 of the 211 local authorities in Britain and the health and social care trusts here.
“The commissioning of these services is becoming increasingly commoditised and poses considerable risks,” the report concludes. “Lowest price has overtaken quality of service in commissioning decisions.”
Slashing the time carers spend on each visit is the main means of saving money. Somebody who has had an hour’s help, or more, a day might find their entitlement cut to 30 minutes. Or from 30 minutes to 15.
Which means drastically reducing the element of human exchange. Stopping for a chat before rushing out the door becomes a practical impossibility. Making a cup of tea is out of the question. This is more than a matter of comfort and convenience. A bit of time over and above changing a dressing, or helping in the bathroom, isn’t an extraneous extra. Loneliness, a sense of being partially abandoned, can make well people ill and ill people worse.
It seems that 73% of homecare visits in England are of 30 minutes, or less. Scotland and Wales do better, at 42%.
To be compared with a “staggering” 87% here.
There is evidence of visits of 15 minutes, or less, in all UK jurisdictions, with the north again topping the table (28%).
Overall, 34% of providers expressed concern that such short visits “put the dignity of service users … at risk”. The figure for Northern Ireland was a “particularly striking” 87%.
Not only are visits shorter; care levels are further compromised by trusts in the north – in company with councils in Wales, the West Midlands and the North West – offering providers significantly less-per-hour (£9.55 to £10.04) than the UK average of £12.87 – itself a shockingly low figure, given that councils and trusts generally expect providers to cover care-workers’ travel time and expenses from this allocation. Moreover, a quarter of providers say that most payments are late, “with particularly poor payment rates reported in Northern Ireland”. Of all the regions around us, this is no place to be old.
There is no estimate in the report of how much it would take to bring the north up to the (inadequate) UK average.
It would come to a pretty penny, no doubt. But the Barnett formula means that the money should be there.
And, anyway, the fact that equality doesn’t come cheap is no reason not to set equal treatment for older citizens as a priority.
It is unfortunate, as far as funding is concerned, that older people in need of care are not disproportionately concentrated in one of the ‘two communities’. Inequality of that sort would rocket the issue to the top of the agenda in our ramshackle, irrational, sectarian, doomed-to-fail system of governance.
But if you are the sort who “once had a carefree mind of your own and a devilish look in your eye”, but who now faces a dull existence and a need for help from society around you to sustain a decent degree of comfort and self-respect, forget it.