Our parents are our world when we are growing up. They clothe us and feed us, look after us when we are poorly and listen to our hopes, worries and fears. Later in life, it can be distressing when this situation is turned on its head as our loved ones grow old, especially if they become frail and suffer from ill health. We want to do everything we can to ensure they are well cared for and as happy as they can be.
So the conclusion of a report published today – that those who care for our families are undervalued by society – challenges us all to make a real change.
Denise Kingsmill was commissioned by Labour to review working conditions in the care sector as the party seeks to develop its policies in this important area. Her report, Exploitation in the Care Sector, says the sector is in ‘crisis’ and highlights real shortcomings in the employment of care workers in both home and residential care. As many as 220,000 care workers are paid below the national minimum wage and more than 300,000 are employed on zero-hours contracts, with no stable hours and no recompense for being on standby. Some carers are expected to carry out home visits in just 15 minutes, resulting in a rushed, poor quality service. A significant proportion does not receive adequate training and there is a lack of oversight, both by regulators and local council commissioners hit by funding cuts. There is a real mismatch between our instinct to do everything we can to look after our parents and this worrying situation.
Sadly Baroness Kingsmill’s findings will not come as a shock to many families who have come into contact with the care sector. I speak from personal experience. My mum Dorothy, now 79, was diagnosed with Alzheimer’s eight years ago. At first, she was forgetting little things, like what time of day it was, but her condition has deteriorated significantly and she is now physically very frail. Mum still lives at home with my dad Arthur, but as you can imagine, this places a huge burden on him.
We have relied upon carers coming three times a day to help to look after all mum’s needs. They are decent, caring people and my mum and dad have been fortunate in that their visits are not rushed and for the most part they have had the same carers who have got to know them both well. But I have known our carers have daily lists of 17 calls, which can include 15-20-minute slots in which to wash and change someone, give them their breakfast and administer medication. They are on zero-hours contracts and earn just above the national minimum wage, but they do not get paid for any gaps between calls or travelling between visits. They work seven days a week. They have had to buy their own uniforms and do training in their own time and they do not receive any sick pay, although I understand some of these terms and conditions are about to be improved as they move to a new company.
When you take all these things together, that is a really tough working environment – and according to Kingsmill it will be familiar to a significant number of the 1.8 million carers in England. With the best will in the world it can only make it harder for them to deliver the kind of care we all want our loved ones to receive.
Then there is residential care. When my dad was unwell my mum entered respite care able to walk and feed herself. She came out six weeks later having lost 9lb, and unable to walk and feed herself. During her time in respite she had become dehydrated and had to be admitted to A&E. I did have some sympathy with the staff because they did not appear to be well supported. But no son or daughter ever wants to see one of their parents in this situation and there have been a number of high profile cases at other homes in which residents have been abused by staff.
I have already campaigned around some of Kingsmill’s recommendations in a broader context – like enforcing the national minimum wage and calling on public authorities to commission services based upon quality and social value rather than a race to the bottom on price. But her other ideas, like ending 15-minute care slots, licensing care workers and providers and improving regulation of working conditions, are well worthy of consideration. Some of these recommendations could be achieved within existing budgets, while others will require investment.
At a time when public funding is scarce it is more important than ever to take a ‘whole system’ view of care. For instance, the Alzheimer’s Society has estimated that by reducing the length of stay of people with dementia in hospital by a week, the NHS could save £80m a year for just four common conditions – across all conditions this could run into hundreds of millions.
My mum’s respite care cost around £400 a week rather than the £200 cost of her home care but she was unable to leave the care home until my dad had had an operation on his leg and could care for her again. So why not fast-track NHS treatment for full-time carers like my dad? There are clear financial benefits to improving the quality of care in the home and community and keeping people out of hospital in the long run. Doing so requires us to care more for our care workers and ensure caring becomes a universally respected profession.
To attract the most talented, caring people to the profession – and then retain them – we need to improve pay, terms and conditions. Caring for someone vulnerable is one of the hardest, most important jobs anyone could ever do, yet working conditions do not reflect this. We need to decide as a country – do we really want to make sure our mums and dads are looked after with the care and compassion they showed us when we were growing up? And when the time comes, how do we want society to care for us?
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Hazel Blears MP is a former secretary of state for communities and local government. She is vice-chair of the all-party parliamentary group on dementia and an Alzheimer’s Society ambassador
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Photo: Catherine Smith