Council Attacked Over Whistle-Stop Care

Edinburgh City Council has defended its record on caring for elderly and disabled residents at home after a critical report highlighted a series of failings.

The council responded to the study which it had initially dismissed, when its chief of social care described it as “fundamentally flawed”.

The report, by a team from the Strathclyde Centre for Disability Research at Glasgow University, claimed that interviews with clients, voluntary organisations and social work staff in the city had uncovered problems caused by cutbacks and external tendering.

Carried out on behalf of the Edinburgh disability charity ECAS, the study painted a worrying picture of services being delivered by third-party organisations which had reduced costs in order to win contracts, but which had delivered those savings by reducing what they offer to people with a disability.

In particular, the report’s three authors claim lengths of visits by support staff have been reduced, often from an hour to half an hour, with the introduction of 15-minute “pop-ins”.

They express concern about the withdrawal of help with shopping from some clients and say some service users who need emergency help with using the toilet are being told to wait until their next visit if it is less than an hour away.

The report queries the time allocated for provision of meals, claiming some contracts allocate only half an hour for meal preparation, where it was previously an hour. The report says this does not allow sufficient time to prepare a meal from fresh ingredients, leaving disabled recipients of care living on microwave meals. Care providers told researchers they had “grave concerns” about the nutrition of those relying on such food as their main meal of the day on a long-term basis.

A spokeswoman for Edinburgh City Council told the Herald that the council still had reservations about the report’s methodology, and said researchers had not contacted the social work department to request research access. Many of the statements in the report were the opinions of individuals and not backed by statistical or quantitative analysis, she said.

Officials dispute suggestions in the report that people are having to wait for toileting assistance, and the department have asked researchers for concrete examples. “This is a very important part of many care packages and specific cases of problems should be reported to us immediately,” the spokeswoman said.

While some recipients of domiciliary care are receiving shorter visits, overall expenditure has increased as have the hours provided overall, she said. “Under last year’s budget, although some people had their hours cut some went up at the same time, so it is not true to say we are cutting the length of all visits,” she added.

Regarding provision of meals, officials also say the report is incorrect. “Many people still get an hour for meal preparation, and there are up to four visits a day to some people, although some of those visits may be fairly short,” she explained.

The council responded to the Herald’s enquiries to head off a war of words which had been developing between Edinburgh and the report’s authors.

Last week, Peter Gabbitas, the council’s director of health and social care described it as “so-called research” and “fundamentally flawed”.

The study’s lead author Professor Nick Watson told The Herald that he stood by the findings. “We feel it is a very thorough piece of research,” he said. “We were under no obligation to contact the council and they don’t have a right of veto over what we say.” He added that he would rather see a debate over the report’s contents.

He said all claims made about services had been “triangulated”, ensuring that nothing was included unless it was corroborated by two additional sources.

“We talked to 14 providers of care, five representatives of disabled people’s organisations and three senior members of the social work department.”

Prof Watson said it was normal to offer participants anonymity in a study such as this.

“I fully understand that Edinburgh like every other city in Britain is having trouble balancing their care budgets.

“We have massively increasing older populations and it is a real problem.”

Prof Watson said there was a need to look at whether vital social elements of care were being lost through cost pressures.

“What really concerned us was that things have become focused on tasks rather than processes. You might be able to do the necessary tasks in 15 minutes but what about the very important process of social interaction that goes with the care? The introduction of 15 minute pop-in visits was detailed using the council’s figures. They are rare but on the increase.”

He also called into question the job satisfaction of care staff under some of the contracts currently being imposed by councils. “Care staff are often rushed and continuously clock-watching. This is very poorly paid work with low status. There is a danger that you make that job unbearable and untenable to do with any pleasure.”

Ian McInnes, a service user in Edinburgh and vice-chair of ECAS, said his home help service from the council had been cut back and at one stage had been completely stopped.

Living in supported accommodation means that he has staff on call if there is a crisis, he said, and they have picked up on some of the tasks previously provided to him by the council. However that option is not available to many others, he said. “At least I’ve got that back up. There will be people at home without any other support who are having visits cut – but it’s a lifeline for them,” he said.

David Griffiths, of ECAS said the report highlighted a need for a debate about the level of care provided by local authorities. “I don’t think it is just Edinburgh where this is happening. I think we need an urgent debate about what standard of care a civilised society should be providing.”

The spokeswoman at Edinburgh said plans were advanced for the introduction of a “re-ablement” programme providing intensive support packages to help people relearn skills and regain a degree of self-sufficiency. “We have got limited resources and do have to be clear about the purpose and focus of any work we do provide.”

In response to the claim that staff were too task-focused to provide social interaction along with care, she said surveys regularly showed high levels of satisfaction among clients.