Local authorities often use their own employees to run polling stations during election days and to count votes once the polls have closed. This is because they can be sure that the staff will be available for training and are guaranteed time off from their real jobs, and because it’s easier to pay them as they’re already on the payroll.

Consequently, I have worked as a polling clerk (at the polling station) once and as a vote counter numerous times. Take it from me, the idea that you need to vote in pen to prevent people tampering with pencil votes isn’t just offensive, it’s laughable. Staff take the integrity of the process very seriously and would not condone or collude with vote tampering. Take a pen if you want, but there’s really no need.


Falling Down Charges

I’ve just seen Charging old people for falling down in the Grauniad, by Jack Monroe.

I’m kind of surprised by it. Most councils, if not all,  provide some sort of telecare service. They differ by supplier, but they’re much of a muchness. The vulnerable person has an alarm pendant, bracelet or button-clipped-onto-their-waistband, and if they fall or have an emergency, they press the button to summon help through a radio-controlled unit linked into their phone line and connected to the control centre. The control centre might be part of council services, or it might be run by a private operator. Additional services can be added, such as falls detectors which trigger if the person falls without them having to press anything, heat/smoke/unburnt gas detectors, flood detectors, inactivity detectors (if the person hasn’t got out of bed by a set time, the alarm is triggered), or bed occupancy detectors (if the person gets out of bed in the night and doesn’t get back in within a set time, the alarm is triggered). There are also seizure detectors, intruder detectors, door sensors which trigger if the person goes out, and lots of other things, collectively known as telecare.

My own employer charges a basic charge for the unit and a bit more for every additional add-on. If all the control centre has to do is ring round the person’s nominated responders and notify them, the monthly charge is less. If the control centre has to send its own staff out to respond, the monthly charge is more. People on income support don’t pay.

Councils have charged for social care services for decades. Care in your own home, care home places, telecare – if you need it, you’re financially assessed and you make a contribution. I’m not sure why charging for an alarm & response service is so much morally worse than charging for help to get someone out of bed, or feed them, or change their stoma bag. If, as a society, we accept that it’s ok to charge for social care, then why would alarm services be exempt? If the people of Essex have had that service for free until now, they’ve been a lucky minority.

If you’re going to get angry about this, then get angry about the charges for all social care services. They’re not any better, or any more justifiable. And if you’re in Scotland, get angry about the free personal care for over 65s, which means that millionaires aged 65+ don’t pay, but ordinary people under 65 do pay.

And Jack, I think you’re great, but “Elderly people, save your pennies and buy a £10 mobile phone. Stick it in your pocket, and if you should find yourself needing to be picked up and nobody else can get into your home, 999 is – and will always be – free to call” is naive. If the emergency services get called out to pick the same person up over and over again, they eventually phone the social work office to request an assessment for an alarm service. And if the vulnerable person says they don’t want the alarm service, and continues to phone 999, the emergency services will continue to pressure social work, and depending how bolshie they’re feeling, they will even talk to the person about wasting emergency services’ time. Believe me, I’ve seen it.

ETA: of course, what we should be encouraging is more use of exercise and falls prevention classes. Edinburgh has seen great results with the Steady Steps programme.




When I  worked in Edinburgh, I referred many many people to Steady Steps. One woman was registered blind, diabetic and had serious mental health problems. She had gained a lot of weight and needed gall bladder surgery, but the surgeons didn’t want to operate because she was a poor anaesthetic risk. Within a few weeks of attending Steady Steps, she had regained so much confidence that she was walking up and down the stairs in her house several times a day, and going out and walking up and down the street. She lost so much weight and was so much healthier that she no longer required the gall bladder surgery, and because she was more confident in moving around the house, she was less dependent on her husband, who was coping much better as a result.

The first person I referred to Steady Steps had contacted us because she wanted a stairlift. She had been very independent, managing everything for herself and line-dancing a few times a week, but had a bad fall on ice one winter and completely lost her confidence. Rather than go straight to putting in a stairlift, she agreed to a Steady Steps referral. Within a few weeks she was completely confident and safe on the stairs, and by the end of the programme she was going out independently, was line-dancing again and had joined the gym.

My most recent Steady Steps success was an 84 year old lady who has a lifelong history of depression. She had recently moved to Edinburgh after being widowed, in order to be near her family, and the upheaval of the move had reduced her confidence. She and her family were worried that if she remained lacking in confidence, she would stop going out, become more isolated, develop depression and possibly attempt suicide again. She’s now attending Steady Steps, getting there independently, enjoying it very much, and at the age of 84, is now learning to swim.

Preventative and health promotion/maintenance services are incredibly important, but when money is tight they’re often the first to go. They generally pay for themselves many times over in terms of reduced dependency on other services.

So yes, complain that councils charge for important services. But don’t forget to complain that there aren’t enough preventative services too.



Another Private Care Agency Lets Us Down (And By Us I Mean the Tax-paying Public)

I refer you to my previous post on this subject.

For the last few years I have been working with a man who has a degenerative neurological condition. He now requires, and has received, a large care package including 2 workers 3x daily for hoisting and personal care, and one worker once a day for meal preparation. This has been provided to him for several years by one private agency. We’ve tweaked the package over the years but it’s stayed relatively stable. The man’s wife died a few weeks ago, after a long illness, and I had arranged to meet the agency at the house next week to see if we needed to make any further changes.

Yesterday morning the agency phoned me to say they had some concerns about their ability to provide the service and that they were planning on withdrawing from it, but said they would maintain the service until we found a replacement agency. We agreed they would visit the client the same day to tell him. at 1630 yesterday, they rang me to say they had decided to give us 12 hours notice that they were terminating their involvement, and that the man’s last visit would be this morning. When I pointed out that contractually they can’t do that, they said they only have to give 12 hours notice if their workers are at risk in the house. I asked what the risks were and the care manager couldn’t answer me – her response was “I’m the care manager and it’s my decision.”

Even worse, when I phoned the client to say “we will do our best to find another agency by tomorrow but it might be impossible”, he told me that they had told him (and his sister, who was present) that they were giving 28 days notice and would hand over once we had a replacement care provider. When he realised I was telling him that wasn’t the case, he was in tears. So I rang his son and asked him to go round, and the son said they had phoned him that afternoon and told him 28 days too.

Lying liars who lie.

Bad enough that they’ve left the man in the shit (literally), but to lie about it to him, to his family, and to me?

So today I phoned 21 different care agencies to see if any of them could take the package on, only to completely and utterly fail. The poor man has gone into a care home tonight, three weeks after losing his wife, and with absolutely no idea when we will be able to get a new care package and get him home.

This is the reality of private agencies providing public services.

Jeremy Clarkson did NOT call for striking public sector workers to be shot in front of their families

Look, I dislike Jeremy Clarkson as much as the next person. He’s an embarrassment to Yorkshire. He says horrible things, Top Gear is shit, and he’s just a crap old man in bad jeans who shouldn’t have a media platform. If he was muttering “eenie meenie minie moe, catch a nigger* by the toe,” then the BBC should sack him. But he didn’t call for striking public sector workers to be shot in front of their families.

Jeremy Clarkson on The One Show

I was a striking public sector worker that day. I got up at the crack of dawn, picketed my workplace, attended a radio debate, stewarded the Edinburgh march and went to the rally. I was as invested in, and supportive of, the strike and the campaign as any other public sector worker. And I came home, and I watched The One Show.

The One Show, that evening, had a fairly lengthy report about the strike and the reasons for it. If I remember correctly, they had vox pops with quite a few of the striking workers. Then they went back to the studio, and they let Clarkson talk. He had nothing sensible to say about the strike, but a) it’s The One Show – when do they ever say anything sensible? and b) it’s Clarkson. He might be a man who thinks and feels things very deeply, but his public persona doesn’t give that impression, unless you count his attention to motorised metal and glass boxes. So he muttered for a minute about how the strike was great because London was quieter and it was easier to drive about, which is not a comment on the rights or wrongs of the strike, or on the rights or wrongs of the government’s attacks on public sector workers. It’s just Clarkson doing his shtick of trivialising important events to promote his image as a petrol-headed fuckwit. And then he said “but this is the BBC so we have to have some balance” and then he went on to say that striking workers should be executed in front of their families.

Anyone who believes for a second that he was serious or that he meant it is, somehow, too stupid to watch The One Show without a carer to explain it to them. His remarks, hilarious as they weren’t, were “the balance,” the extreme opposing view to his previous “support” of the strike on the grounds it was easier to hoon it around London that day. His tone of voice was sarcastic (is it still sarcasm if it’s 90% of what you say?), it was hyperbole, and it was clearly not meant to be taken seriously. It was in bad taste, particularly when you consider that in some countries trade unionists are murdered for their activities, but Clarkson is bad taste.

If you’re going to get angry at Clarkson, get angry because he was reported as saying that the people working on the Hyundai stand at the Birmingham motor show had “eaten a dog” and that the designer of the Hyundai XG had probably eaten a spaniel for his lunch. Get angry at Clarkson because during an episode of Top Gear, he made a mock Nazi salute, and made references to the Hitler regime and the German invasion of Poland by setting the GPS system of the car he was looking at to Poland. Get angry at him for calling Gordon Brown a one-eyed Scottish idiot and a silly cunt. Get angry because he suggested the Welsh language should be abolished, or because of his remarks about how to deal with people who commit suicide by jumping in front of trains, or because of his mockery of India and Indian people, or because of his attitude to the Health and Safety laws which protect many people in the course of their jobs, or because of his attitude to climate change, or because he drove a car into a tree to see what would happen to the car, or because he punched Piers Morgan. No, wait, not that last one.

If you don’t like how Clarkson attempted to mock the BBC’s need for balance by going for the most extreme criticism of striking workers his brain could think of, fine. I didn’t like it either. But please stop perpetuating the myth that he called for the execution of workers. He didn’t, it’s obvious he didn’t, and when people say he did, it makes it all too easy for him to claim that all the really horrible stuff he says is being taken out of context too.





*I would not say the word, but I see no point in not typing it. Writing it as n*gger or n***** or “the n-word” doesn’t stop people knowing what the word is, doesn’t protect anyone from anything, doesn’t mean the word wasn’t used. The way to stop the hurt and anger caused by the use of the word is to not use it, rather than to blank some of the letters out.

The Clydebank ramp and professional reasoning

Many people will have seen the recent news stories about an access ramp installed outside a council property by West Dunbartonshire council. It’s been discussed and commented on in various newspapers, including The Grauniad, The Mirror, and The Clydebank Post, which gives a slightly different take on it.

Unsurprisingly, given the dimensions and appearance of the ramp, it’s attracted a lot of negative attention. I make no bones about it: the ramp is very very ugly. Comments have ranged from the well-meaning but misguided “there must have been another solution, it’s obvious” from people who know nothing about disability adaptations, to the downright nasty (as per the Express and the Daily Fail websites) which I’m not going to repeat here because – well, because why would you?

Given the complete lack of understanding of this issue displayed by so many people, I thought it might be helpful to go over the kinds of things OTs and technical officers have to consider when they’re looking at major adaptations like this.

Building regulations require gradients of no more than 1:12 for powered wheelchairs, 1:16 for attendant-propelled and 1:20 for self-propelled, plus there needs to be a 1400mm resting platform at the door and at the bottom, and more resting platforms every few metres. If they had relaxed building regs for this ramp, it would have been shorter, but much steeper, and possibly unsafe and/or too difficult to use. Remember that the small girl now will eventually be a heavier teenager, and will require a larger, heavier wheelchair. Look at the pictures of the property and the garden – there are three sets of four or five steps each from the pavement to the house, with longish platts between them, then a right-angled turn to the right, with a couple of steps up, and then a right-angled turn left to the front door with a step and probably a high threshold (uPVC doors have high thresholds) to get into the house. There’s a big height difference between the pavement and the door – it should be obvious that the ramp is going to have to be very long.

They will have looked at

– the little girl’s needs, now and in the longer term, and her expected lifespan
– her type of wheelchair (pictures on one of the news websites, it’s a power chair which might not be suitable for a stairclimber attachment)
– family as a whole – siblings, parents, other carers, location of other family support – how physically able are they? how much care do they do? what are their lifestyles? how often will the little girl be going out? who takes her out? will it always be family or paid carers? Six years from now, does she want to go out independently with her friends? Will she need a bigger, heavier chair later that nobody could push up a shorter but steeper ramp? Is it better for the family to stay in that house because it’s close to family support than move to another part of town?
– proximity to hospital and school – good reasons not to move to another house
– adaptability of interior of the house
– access rights and needs of whoever lives in/owns the first floor flat above – if the shared access is jointly owned by the council and an owner occupier above, the o/o might have refused permission for a steplift
– availability of other suitable housing – houses in hilly areas will generally have steps at the door
– feasibility and cost of all possible solutions – stairclimbers, steplifts, vertical lifts.
– impact on the property. When no longer required, semi-permanent ramps can be removed in a couple of hours with minimal impact on the garden. Lifts require more structural work, before installation, and if it’s a vertical lift, after removal. Something’s holding that hill up, after all.

Stairclimbers require trained operators. Family members and/or paid carers would have to be trained to use it, if the girl has a wheelchair suitable for use with a stairclimber. This would restrict who could take her in and out, whereas most people would manage pushing a wheelchair up a ramp. And I really wouldn’t want to be taking someone up and down those steps using a stairclimber on an icy day.

Looking at the layout of those steps, it would need either four separate steplifts, or three and ramping from the door to the top of the path, or one steplift with a very very very long track plus ramping from the door to the top of the path. The last steplift I did was four years ago, covered 6 straight stairs and cost £12k. You’d be looking at at least £40k to do those steps. Steplifts and vertical lifts get stolen, get vandalised and break down. Do you want to be standing in Clydebank in the pissing rain in January in the dark with your daughter, unable to get into your house because the lift has broken/been nicked/been destroyed? And I don’t even want to think about the massive structural work that would have to be done to dig out the ground and shore up the hole to put in a vertical lift.

Having looked at the photos over and over, and drawing on my 14 years experience of doing major adaptations, I can’t think of anything else they could have done to that property that would have worked. Obviously we were talking about it at work today, and OTs and technical officers alike were in agreement that there was almost certainly nothing else that could be done to the property. But we all did wonder why the family hadn’t been rehoused. I think the Clydebank Post article sheds some light on that. It reads to me as if the family had been waiting to be rehoused to a ground floor property for a while and were offered this one on the understanding that they could manage the steps. It’s possible the little girl was mobile when they moved in and her use of a wheelchair has been a later development. It’s possible that they were offered and accepted the property on the understanding that rehousing or adapting the access would be offered if and when the little girl became unable to do the stairs. And it’s also possible that West Dunbartonshire’s housing policy says that if you refuse 3 properties they’ve offered you, you lose your priority and go to the back of the queue, so they felt they had to take it. I couldn’t find anything on their website which says so, but it’s pretty common in housing policies. But as mentioned above, there could be very good reasons for the family wishing to stay in that property.

What I don’t understand is why the woman is saying she didn’t realise what the ramp would be like. I accept that most people don’t know much about the building regulations applying to ramp installations, but surely it must have been discussed with her. Surely it was pointed out during the assessment and when they were looking at possible options. Mind you, I’ve done bathroom adaptations where I’ve taken plans out, gone over them at length, explained very clearly “this is where your bath is now, the bath will be removed, the floor will be relaid with a fall towards the drain, the shower will go in this area where the bath used to be, the floor will be a wet floor so there won’t be a step for you to worry about…” only to have people complaining at the end of the job that they wanted a shower cubicle and they’re pissed off we removed the bath. So it is possible that it was explained and the family just didn’t take it in, especially seeing as most people are not familiar with the drawings ramps.

But as for the nonsense about the gate – garden gates open inwards. There isn’t a housing developer in the land who would fit a gate so that it opened onto the public pavement.

Feminist bloggers love public services – unless it’s social workers, of course

This post contains references to behaviour sometimes exhibited in times of acute severe mental illlness, and enforced Caesarean sections, which most people might find distressing and some people might find triggering.

For months now, years now, feminist bloggers have talked about how important public services are, how valuable public sector workers are, how much they respect the workers who deliver the service, how much they value the services they provide, how much they recognise that public services are vitally important to women, and how much they detest and condemn government attacks on public services. That all goes out of the window though, the minute there’s a chance to have a go at social workers. No matter how much they purport to support public services, they can’t wait to condemn social workers, call for their heads on spikes, criticise their every move, pull apart their every decision, and portray them as callous, wicked, incompetent evil-doers, no matter how half-arsed the evidence. People who know that press reports aren’t always accurate or truthful, people who know that social workers are unable to report their side of a story because of confidentiality, people who know that perceptions of situations differ and aren’t always accurate, people, in short, who should know better, are lining up to say how the behaviour of the social worker is disgusting and there can’t possibly be any justification for what’s happened.

The Telegraph reported that a pregnant Italian woman came to Britain last July to attend a training course. She then suffered a panic attack and called the police, who became concerned for her well-being and took her to a hospital that she soon realized was a psychiatric facility (the woman’s family believes that her panic attack was caused by her failure to take medication for her bipolar condition). The woman has told her lawyers that when she expressed a desire to return to her hotel, she was restrained and sectioned under the Mental Health Act. Essex County Council social workers obtained a High Court order in August for the woman’s birth to “to be enforced by way of caesarean section.” The woman claims that in the 5 weeks between being sectioned and the enforced C-section, she was given no information about the legal proceedings relating to her pregnancy.

And then the internet kicked off.

I read “social workers can now remove children on a whim if the mother has a mental illness.” Ha bloody ha. A local authority not far from here appointed a new chief social work officer a few years ago. The first thing one of the social work managers did was take a huge pile of files to the CSWO’s office and say “here are all the children we have assessed as needing to be removed from their homes to a place of safety because they are in immediate danger, who we can’t remove because we have nowhere else for them to go.” Do you really think social workers who don’t have anywhere to put children who are definitely at risk are going to go round snatching children just because the mother has a mental health problem? How would they even know the mother has a mental illness? They don’t have time (or permission) to read the medical notes of every woman in the area looking for mothers with mental illness. Children are referred to social workers because there are concerns for them. Social workers don’t go out looking for business.

I’ve read “social workers are paid for every child they remove.” Bollocks. That’s not just a misunderstanding, it’s an outright lie.

I’ve read that social workers will snatch the children of every sex worker, because social workers are all devotees of radfem theory, which is so ridiculous it’s actually laughable. Unless my colleagues wait until I’ve gone out for the day before they start discussing radfem theory.

I’ve read that this is “socialized medicine at its best,” to which I can only say “fuck off, teabagger.”

I’ve read that the social workers got the court order for the C-section to avoid having to pay for several weeks of care for the woman in question, which again is nonsense. A person who is so ill that they have been detained in hospital does not need social care, they need hospital care, which is why they have been detained in hospital. A person in hospital is not coming out of social work’s budget, for want of a better way of putting it. I cannot imagine any social worker trying to go to court to get an order for a C-section because it would save the NHS money. It just wouldn’t happen. And if it did, I don’t believe there’s a judge in the country who would make that order. Contrary to popular internet belief, judges and sheriffs take this kind of thing seriously, and they will not deprive someone of their liberty unless they have been convinced that it is absolutely necessary.

Very few people bothered to make the point that the press reports might not be accurate, and certainly were not the whole story. A few people tried to point out that the source of the story was Christopher Brooker, who has form for making up shit about social workers, but they were shouted down in the general outrage. Christopher Brooker distorts facts and tells outright lies about social workers and social work departments. This post has quite a lot of detail about it. This High Court judgement, paragraph 185, criticises Mr Brooker for reporting that social workers stole a child from its parents on the flimsiest evidence of “faint bruising.” The child had fractures of its left ulna, right femur, right tibia, left fibula, and two in the left tibia. That’s one broken arm, two fractures in the right leg and three fractures in the left leg, and experts agreed none of them could have been accidental injuries.

Mr Brooker is not a reliable source and I cannot understand why so many people were willing to believe his take on events when it’s obvious he is not a reliable reporter of matters relating to child protection. And I cannot understand why so many people were willing to accept that the Telegraph report was a full and accurate picture of the facts, when they know fine well that it was only half a story.

Social workers are generally forbidden from speaking to the press, and they can never give full details of their cases or the reasoning behind the decisions that they make, because of strict rules about confidentiality. This means that any person or family can go to the press and say “the social workers stole my children/abucted my granny/refused me a new house” and give a completely one-sided view of events, calling the social workers incompetent and dishonest, and the social workers can’t give their version of the facts. One of my colleagues was involved in a very distressing situation a few years ago when she had to get a court order to remove an elderly person from their family’s care in their own home. The family could easily have gone to the paper and made accusations of institutional incompetence and malice, and the social worker would not have been able to respond with the facts, which were that the family had neglected the elderly person to the point that they had a bone-deep pressure sore on their body and weren’t given so much as a paracetamol to relieve the pain, let alone appropriate wound care.

So, to the very sad and distressing case of the pregnant Italian woman who underwent an enforced C-section. The woman has bi-polar disorder, and her family believe she hadn’t been taking her medication. We don’t know if she was in the depressive phase or the mania phase of her illness. We don’t know how ill she was. We do know that she was so ill that she needed to be detained in hospital, and we know that social workers were able to convince a judge that an enforced C-section was the best option, and that the professionals who performed the section were also willing to go ahead.

So many people seem to think that despite knowing any of the facts, they know better than the many professionals, including a high court judge, and that there can be no possible justification for this course of action.

What if the woman was so severely depressed that she had become psychotic and believed the baby was a demon who was killing her and she was trying to hack it out of her body with implements or her own hands? What if she was determined to kill herself in order to kill the demon within her? It’s happened before. What if she believed that she and the baby were super-human, possibly divine, and she had to get the baby out of her by any means in order for it to begin its divine work? People with severe, acute, florid mental illness can hold extremely powerful, bizarre delusional beliefs, and very often feel compelled to act on them. Anti-psychotics and anti-depressants can take weeks before they begin to work, and they can be very harmful to foetuses. I can see any number of scenarios whereby health and social work professionals might come to the conclusion that the best thing for the woman and for her baby was to get the baby out of her as quickly and as safely as possible, and that other options would not be adequate or sufficient.

It’s not pleasant. It’s upsetting, it’s distressing, it’s something that nobody wants to happen. Nobody wants it to happen to them, nobody wants it to happen to other people. I understand that if you’ve never worked in the field, or never experienced that type of mental illness to that degree of severity, it might seem farfetched and unbelievable that someone could be so unwell that the best option for her care is to compel her to have a C-section. But it can happen. And instead of rushing to condemn it based on nothing but one interpretation of some of the facts, shouldn’t all those people who claim to respect and value public services and the workers who deliver them show a little bit of that respect by holding back on the condemnation and accepting that the people who knew the full facts made the decision they thought was best at the time?

Miscarriages of justice happen. Of course they do. Nobody gets it right all the time. Professionals try hard to get it right, and that’s why they don’t take decisions in isolation. They discuss things with their colleagues, with their managers, with their employer’s legal people, with the other agencies involved, and they agree plans of action together – and then they present their evidence to the court, and the court decides. It could be, that in this case, they all got it terribly terribly wrong. But we don’t know the full facts, we only know the report from Brooker, who is not a reliable source, and the bare minimum of information released by Essex County Council. So, instead of shouting about how appalling it is, why don’t the bloggers accept that they don’t know the full facts and stop indulging in such irresponsible, hateful criticism? Or even better, if they’re such experts, why don’t they go and train as social workers and show us all what a better job they’d make of it?

Because every time someone who doesn’t know the facts and doesn’t know the law starts shouting about how terrible social workers are, somebody somewhere sees it and believes it, and decides not to ask for help that they need.

Union members’ right to privacy‏

You might have seen news reports over the past year or so about construction companies blacklisting workers who were union members – refusing to employ workers or whole workforces because they were union members. The government is now attempting to pass a law which makes it legal for the government and appointed third parties to inspect union membership lists to see which workers are members and which are not. I don’t see why it’s any of the government’s business. Given this government’s other attacks on workplace rights (increasing the fees for lodging tribunals, for example, and trying to dismantle health and safety legislation) and their links with big business, I can’t see that any good will come of this for ordinary working people. I see it being a particular problem for people working in the private sector where union membership is not as strong and employers are often quite vocal about breaking unions (see numerous posts about “ethical” company Lush), but it could easily become a problem in the public sector too. And you could argue that employers wanting to get rid of people could use the lists to start with getting the non-members out first because they have nobody to support them. So this Bill is bad for everyone who is an employee.

The Bill in question is going through the House of Lords so the time for contacting your MP is past – now it’s time to contact a peer. http://action.goingtowork.org.uk/lobbyingbillpart3 has all the information you need and a handy email form to contact the peer of your choice online. Unions already have a vested interest in keeping their membership records up to date so this Bill isn’t anything to do with making records more accurate for our sake, it’s about giving the government the right to breach our privacy and pass that info to their corporate fat-cat chums. I’m a bit cross about it. Contact a peer today – do it now!

The trouble with the private sector is it gets to walk away (and it operates within the patriarchy)

Local authority social work departments have a legal duty to assess the needs of people with disabilities, and to provide services to meet assessed needs (in line with their eligibility criteria). They have no obligation to provide all of the required services internally; it’s acceptable to contract with external agencies to provide services on behalf of the local authority. Over the past few years, the free market has been invited in to social care services, under the mistaken belief that agencies would be falling over themselves to provide good quality care at reasonable prices.

Agency care workers regularly report not being given travel time to get between clients and not being paid for travel time, although travelling between visits is obviously part of their working day. Add to this the low wages, shift work, early starts, late finishes, weekend and public holiday work (yes, people still need help to get to the toilet on Sunday mornings and Christmas Days), the physical demands of the work, the psychological demands of remaining pleasant, polite and professional while a confused person rants at you or a family member yells at you because you’re ten minutes late having had to travel from your last visit on the other side of town, and the general dealing with pee, puke and poo, and you can see why many people decide it’s not for them and go off to other forms of employment. Care work is not easy work. Not everyone can do it or do it well. But it’s always been viewed as women’s work and therefore  it is under-valued (although not always under-appreciated) and underpaid.

This article states that

Turnover for domiciliary care staff working with older people has reached 28%, up from the previous year’s [2011] figure of 24%. Turnover for care home workers is slightly lower at 20%, but still represents an increase from 18% in 2011. The National Care Forum released the figures in their annual staffing survey, based on data from 40 organisations employing a combined total of more than 55,000 staff.

The most common reasons for people leaving their jobs were personal reasons (14%), dismissal (9%), and ill health (5%). The report showed the overall care workforce is ageing, with 46% of staff aged 46 and above. The NCF said this represented “a steady increase over the last three years”, while the proportion of the workforce aged 16-35 stands at 33%, compared to 34% in 201.

In 2011, Skills for Care published a report called Workforce Insight 2 –
Understanding Turnover and Retention in the Social Care – Research Report Findings 2011. This report states

Separating social care providers by ownership type, as in figure 3, we see that third sector providers exhibit turnover rates slightly below the regional average, private providers exhibit rates slightly above the regional average and statutory providers and other providers exhibit turnover rates which are markedly below the regional average; some 8% points lower, a difference of more than 50% in real terms.

Whilst exploring the differences between service types, we
discovered that whilst care homes with and without nursing were seen to have turnover rates slightly below the regional average, domiciliary care services were seen, on average to exhibit markedly higher levels of turnover than other forms of social care provider.

Whilst this insight accords with the prevailing wisdom, that domiciliary care providers have exaggerated levels of turnover, it is worth noting that in the case of the West Midlands sample there were a higher percentage of domiciliary care services which experienced no turnover incidents compared to other service types. Specifically, 33% of all services reported experiencing no turnover, whereas 36% of domiciliary care services experienced no turnover. This suggests that the high turnover ‘problem’ experienced by domiciliary care providers is actually experienced most acutely by a small number of providers.

Identifying these providers and supporting them to address their difficulties should be an important objective for Skills for Care and its local partners.

The report goes on to say that care workers have double the staff turnover than managers, and senior care workers have a slightly slower turnover than managers. They suggest that the high turnover among care workers could be linked to limited opportunities to progress from care worker to senior care worker, and new employees taking entry level care worker posts and leaving after realising the work is not for them.

Skills for Care also compared turnover in rural and urban areas, and found that (unsurprisingly) care workers tend to stay in their jobs when there are few other jobs to go to, but turnover is higher where other jobs exist. They say

This is significant not only because it helps to highlight the relationship between local labour market conditions but also because it suggests that social care remains something of a second choice occupation in those labour market areas where there is a choice of alternative occupations.
Having observed greater levels of job shifting behavior (and so higher turnover) in areas with higher job densities we can further hypothesize that mean wages of social care workers in these areas will also be higher as employers seek to encourage their employee not to seek work elsewhere, this would be particularly marked in lower-status
social care roles where the ties to a role may be weaker.

Returning … to our rural/urban categorisation we can see that average wages for care worker roles and senior care worker roles are indeed higher in rural areas than in urban areas. Registered manager roles are marginally more in urban areas; a likely reflection of the fact that managerial skills are more readily transferable and therefore more highly valued in the urban labour market than the rural labour market.

This report says that in England, 19% of homecare workers’ time was spent travelling. It also says that across the UK, roughly 80% of the care at home workers are female. And if they’re not being paid for travelling time, and travelling time make up 19% of their working time, they’re losing out on a fifth of what they should be earning.

No wonder the turnover is so high.

And when the turnover gets high, care agencies can’t meet their commitments. In my part of the world, I had been aware for a couple of months that one agency appeared to be having difficulties. Service users and their families were complaining that their allocated care workers were being chopped and changed. One woman told me her mother (who has dementia) received 29 different carers in the past two weeks. The agency acknowledged they were having difficulties providing staff, and we heard rumours of precautionary suspensions to investigate disciplinary allegations contributing to the staff shortages, a manager walking out without notice, and a management team being flown in from another part of the UK to take control. One of my service users asked me to reduce their care package from 2 workers for an hour morning and evening to one worker for 30 minutes morning and evening (because of an improvement in function and reduction in disability). That information was passed to the agency in early October, by phone and electronically. A month later, they were still sending in two workers for an hour, and said they had no idea they’d been asked to reduce the service. Disorganised doesn’t seem to be adequately descriptive.

And then on Monday, late in the afternoon, the agency in question emailed my employer with a list of people they are supposed to provide a service to, saying they were unable to cover the visits for the foreseeable future, and asking the council’s own homecare department to step in and cover, immediately. How on earth is a homecare department, reduced over the years as work has been outsourced to private agencies, supposed to cover several hundred hours of visits with only an hour’s notice before the first workers were due?

The home care managers and others have been working flat-out this week to find cover for the people abandoned by the agency, from within their own resources and from alternative private providers. Obviously, it hasn’t been possible to provide care to everyone at the times they usually get, or with workers they know, or in some case, to provide care at all. Families have been asked to help where they can, and I’m not aware of anyone who has been left with no care at all, but if everyone has been covered, by workers or by family, it’s been through good fortune and a lot of very hard work. It’s entirely possible that if this happened again, vulnerable people could be left with no care, because when you’re asked to provide 500 care hours, and you can only find the workers to do 350, something’s gotta give.

I’m astounded by how understanding the service users and their families have been. Yes, there have been grumbles, but on the whole even the grumblers have been reasonable and understanding in a situation where rants and shrieks and formal complaints would be understandable. One family member said to me “but the agency have just put the council in the same position the agency were in – trying to cover care with no workers to do it.” Really, they should be bellowing from the rafters their outrage that such a thing could happen.

Councils shouldn’t be outsourcing huge amounts of care provision. Of course there will always be people whose needs are best met by specialist agencies, such as specialist mental health providers, but the bulk of bread-and-butter home care should be kept in house, where the staff can be trained, paid and treated properly, and the service and staffing levels can be managed properly.

Where councils insist on contracting out their responsibilities, they should be specifying that the workers must be paid at least living wage, must be paid for travel time, must have access to a decent pension scheme, must have regular, good quality training and must have regular supervision – and the contract price should be one that allows for that. And if councils say they can’t or won’t do that, the whole of society should be asking why not? If we truly value the vulnerable people we have responsibilities to care for, shouldn’t we be doing everything we can to minimise the chances of their care provider walking away and leaving them without care? Shouldn’t we be doing everything we can to ensure that people with dementia have continuity of carers? Shouldn’t we be making sure that the people who look after our most vulnerable people aren’t driven out of their jobs because they just can’t afford to live on what they’re paid? Shouldn’t the men who go to work and make decisions rather than stay at home and care for their dependent relatives decide to value the work the women do to care for those relatives, rather than paying lip service to how much they appreciate it?