Zero Hour Contracts, A Cautionary Approach

This week the Trade Union Congress will call for the outlawing of zero hours contacts (http://www.tuc.org.uk/the_tuc/tuc-22485-f0.pdf pg12) and while, personally, I dislike the practice there has to be caution in either outlawing the practice or, indeed, modifying it.

It is estimated that around 300,000 social care workers are on zero hours contracts (http://www.socialcareworker.co/2013/08/02/300000-social-care-workers-on-zero-hours-contracts/), around a third of the total workforce.

Before we puts jobs at jeopardy or social care services at risk by outlawing zero hours contracts there first needs to be a comprehensive look at why the use of zero hours contracts has risen in social care and, obviously, an understanding of the impact to services if those contracts are outlawed.

Is there, for example, a link between the increased use of zero hour contracts and the increased use of ’15 minute’ social care services being commissioned?

A survey last year by the UKHCA found that

·         Short homecare visits being commissioned by councils to undertake intimate personal care, with risks to the dignity and safety of people who use services;

·         Continued downward-pressure on the prices paid for care, where lowest price has overtaken quality of service in commissioning decisions;

·         Contracting arrangements which have resulted in visit times and the hourly rates paid for care as the decisive factors in the viability of the sector.

(http://www.ukhca.co.uk/pdfs/UKHCACommissioningSurvey2012.pdf)

If providers are fighting to compete on price then, from a business point of view, it means having staff on zero hours contracts makes sense if it helps reduce overall staffing costs. So the issue is not only about zero hour contracts but also about commissioning and funding in social care.

There also needs to be thought about the impact on services if zero hours contracts are outlawed or modified without any real thought of the implications.

Social care is, by its very nature, difficult to plan for. We cannot tell how many people will suddenly need social care services in the near future or, sadly, how many will no longer need care services. So there needs to be a degree of flexibility in social care staffing, particularly in home care where the greater use of zero hours contracts are found.

If zero hour contracts are removed without arrangements for dealing with this need for flexibility then care services could be affected. For example not enough staff would lead to people receiving care services only when people are available rather than when they need them or providers could have a surfeit of staff who would still need to be paid even when there was no work for them, putting pressure on the provider’s economic viability.

Within social care zero hour contracts are as much a symptom of the financial constraints as they are about employer exploitation. Yes let’s get rid of them but in a manner that ensures social care services are improved rather than put in jeopardy and a manner that improves the lives of social care workers rather than puts jobs at risk.

The Sense of Adventure

Do you like to think outside the box, push outside you comfort zone, expand your horizons or perhaps extend the frontiers of your knowledge?

It seems to be a naturally occurring part of human nature to seek out new experiences and find ways to enhance our lives by discovering new things. Obviously we all do this in completely different ways. The adrenalin junkie will take to extreme sports to conquer the elements by seeking outrageously dangerous thrills, excitedly relishing the physical and mental challenge they have set themselves. Others may take joy in food, the adventure of seeking out a new restaurant, savouring the ambience, sounds and aromas surrounding whilst eagerly anticipating the new tastes they are about to experience. Others could simply be avid readers who regularly and enthusiastically, seek out new authors to stimulate their imagination and mind.

Essentially, within all of us, to a greater or lesser degree, there is a need to have new experiences to keep us from become to stale and bored with life.

Yet, when it comes to providing social care, what do we do to stimulate and expand the experiences of social care workers to keep them interested in their work and to stimulate them to encourage them to expand their horizons when it comes to how they deliver care services?

Outside of social care, many businesses go beyond general training with such things as ‘team-bonding’ activities and whilst these may have become something of a joke or simply an excuse to have a good time the principle behind the idea is a sound one. It is something different in the workplace and should, if well planned and designed, give sensory experiences that go beyond those normally experienced in the workplace.

Unfortunately regular classroom training does not usually provide the extra sensory aspect, in fact much social care training is done simply to comply with regulations rather than truly benefit the care workers. Additionally training only forms a part of the learning process and without the other elements training becomes little more than a chore, especially if it is one of those courses that has been done year after year!

Add to this the increasing pressure in care services, to do as much as possible in ever decreasing time-slots, little time is left for workers to engage in personal growth through work and take the importantly essential opportunity to reflect on the work they are doing and what they could do to improve that work.

And now to completely flip the coin – what about those we provide social care services for?

There is this public perception of older peoples’ homes being rows of old-fashioned arm chairs filled with elderly people who just sit there between getting up and going to bed. While there a many homes where that may be the case there are many that provide excellently managed activities which stimulate and stretch the minds and senses of those they care for.

There is some great work around at the moment focussing on raising awareness of loneliness amongst older people who may have no family and only see carers for brief visits. But loneliness is not just about having no-one around you. You can be lonely in a crowded space, just like those people who are left to sit around all day in those poor care homes. Loneliness is not necessarily being alone but about being engaged or stimulated in some way. In social care we need to ensure that those we provide care and support are stimulated and engaged and given the chance to have new experiences or re-live the thrills of past exploits.

Cognitive decline does not necessarily mean a loss of all the senses!

We all have a sense of adventure laying somewhere within us and that naturally stimulates our need to seek out new experiences which in turn helps us keep fresh and stops us becoming bored. Social care must be about providing those who need services with a good quality of life and that sense of adventure is an important part of that quality. Similarly we need to keep social care workers engaged and stimulated as this obviously helps in retaining staff and encouraging them to fully immerse themselves in the quality of care they provide.

Calling for a Cabinet Minister for Social Care

I have set up an online petition calling for a Cabinet level Minister to be appointed for Social Care (click here) which I hope  you will sign  and which I hope  you will pass on  to friends and colleagues.

Why?

Around one in five of the population is affected by the decisions made by Government on Social Care and given that such a large portion of the country is involved it seems only right that they should have the appropriate representation at the highest level.

I say around 1 in 5 because the figure is hard to estimate and it could well be higher. Carers UK estimate that there are 6.4 million people in the UK providing unpaid care for loved ones (details here) and, naturally, there are a similar amount being cared for. The latest figures from the NHS Information Centre state that there are 1.4 million people in England receiving local authority funded care services, although this figure does not include those receiving continuing care funding from the NHS, additionally these figures are for England only, so the number is increased when the other countries are taken into account. They are then increased further by the unrecorded numbers who fund their own care services.

In addition, the latest figures from Skills for Care tell us that there are 1.6 million paid workers in adult social care. So, in a Nation that has a population of 62 million, one in five may well be a conservative estimate.

At present Social Care is presided over by a junior minister within the Department of Health and, whilst there is no doubt a strong link between health and social care, this fails to encompass the greater range of social care requirements of the people that need social care services.

Social Care is not a homogenous service. It includes services for the elderly, for those with learning disabilities, those with mental health issues or those with physical disabilities, yet, at present all these services are the responsibility of a junior minister.

Social care also encompasses much more than just health services, it includes housing issues, benefit payments, community issues, for those under the age of 65 employment services come into the equation.

As the population ages social care will be a greater part of life with even more people either using or providing services. It is time now for Government to fully recognise social care as a major part of social policy in this country and appoint a Minister to the Cabinet to take responsibility for it.

The e-petition link again - http://epetitions.direct.gov.uk/petitions/39701 I hope  you will  take the time to sign it and that  you will spread the word  to your colleagues and friends

Thank You

You Do Not Get Excellence On The Cheap

At a recent press conference Lord Coe said, "You can never spend too much on elite sport. It will always be the greatest driver of sporting participation and we should be unashamed about that.” He went on to say “Of course, you have to have the right structures in place to deal with that demand. Be under no illusion, you do not get excellence on the cheap”

While we are still in the grip of celebrating sporting achievement those words of Lord Coe could resonate throughout any aspect of society not just sport and particularly in social care.

Excellence is always a driver for success, the concept of being a role model is hardly a new one and while the concept may have become something of cliché it remains a fact that we will always try to emulate our heroes or businesses will endeavour to emulate the success of rivals. Unfortunately, in social care, we do not see the success achieved in supporting people to live active and fruitful lives with the support of family or care workers, we do not outwardly demonstrate the excellence of so many care workers dedicated to enhancing the lives of those who can no longer fully participate in society on their own.

Obviously within the sector we do celebrate excellence, primarily through various awards schemes such as the Skills for Care Accolades, yet those celebrations do not extend outwards to the general population and the only view of social care that achieves mainstream coverage is when things go wrong such as the Winterbourne View case. Yet it is only through showing excellence on a wider scale that we can improve recruitment and retention in the sector and inspire people to work in social care.

The Daily Mirror has stated they have found 61,309 jobs in social care (Care for a Change) and, in the current economic climate it seems incredible that so many jobs are available and, let’s be honest, if that many vacancies exist there are some companies struggling to provide a full level of care and support.

To provide the best possible care services we need the best possible care workers and entice the best we need to demonstrate to the wider public the excellence that already exists to inspire people to see social care as a vocation that is rewarding and intensely satisfying. To achieve that we need investment in the social care workforce, we need to move it from the perception of an underpaid, poorly regulated job to a career that promises recognition and gives a sense of pride in working in a sector that is recognised for its contribution to society and the lives of individuals.

The fragmented nature of social care means that the only way this can be achieved on a national level is by the Government coordinating efforts across all of the Local Authorities and the myriad of care providers. The Government needs to invest in social care to ensure a high level of excellence in care provision that will inspire the public and restore faith in the social care system.

Naturally not everything can always be perfect and rogue careers will always enter the system (not unlike drugs cheats who enter sport) but we need to ensure that excellence is highlighted above all else. To achieve this the Government needs to invest in social care – you do not get excellence on the cheap.

The Voice of the Vulnerable

The Guardian’s Social Care Network has recently asked the question “How do we give service users a voice?” yet the fact that the question needs to be asked does, perhaps, highlight what is wrong with the current social care system and why we need wholesale reform to achieve social care that meets the needs of those who need it.

The most obvious answer to the question is, simply, that we ask those who use the services and, more importantly listen to what they say. But, unfortunately we have such a fragmented and somewhat territorialised system that any messages have to pass, in the manner of Chinese Whispers, upwards towards those who make policy decisions via the agendas of the various parties involved.

If we start with the individual the person who will listen to them the most and who probably has the best rapport with them is the frontline care worker. There may be occasional contact with a social worker but my general experience this will only happen once or twice a year at reviews, obviously families will probably also be involved in listening to what the individual thinks about their care package.

The route for the care worker is obviously their own line management but that would require the care worker be given the time (and be paid for it!) to sit down with the manager to outline their discussions with the care user, how things could be done differently to meet their needs and how the care service an improve their overall care delivery.

From there the route upwards means the care provider talking to the local authority funding the care to pass on the individual’s views and what they want from their care package. Yet there are probably very few opportunities to do this except where reviews take place and there is almost certainly not enough time to discuss everything the user may have said over the intervening period and be more focused on the care plan in place. It is also at this point the Chinese Whispers can begin with the agenda of the provider being set.

For example a care user might have said they would prefer to have their care at a particular time and the care worker would have passed this on, but if the care provider was unable to facilitate this because of staffing levels etc then would they necessarily pass this on to the local authority, especially if they feared the contract could be passed to another company who could accommodate that.

Once the care provider has passed on the views of the care user to the social worker then it will get passed along the upward line of the local authority where, to be brutally frank, it is likely to get lost or transform from the voice of an individual into a statistic aimed at proving why the authority should get more money from central Government. Of course the message may have to go through the NHS route and that is equally convoluted.

So by the time that the voice of the care service user gets to the Department of Health it has changed beyond recognition ceasing to be a voice and just one of many numbers that are processed by the bureaucracy of Westminster.

How do we stop this? Well the simply way is to ensure that all user comments about their care service are written down. This may seem a little old fashioned but it achieves one thing – the original message retains its value, unadulterated, on the way to the top. Yes it would generate a lot of paperwork (or e-paperwork!) but at least in Westminster they would have access to the qualitative data in addition to just the quantitative stuff!

In reality the problem is a fundamental one, the distance between the person using a service and the policy makers deciding what is best for individuals is an immense chasm with a rickety bridge connecting the two. The change in social care needs to address this, it needs to ensure there is a smoother, undistorted route for the users of care service to move up the line towards those who make the policy and hold the cash.

Not easy by any means but worthwhile it we are to achieve the best social care for those who need it.

Why I Am Supporting #Twobby - End the Care Crisis

Back in 2008 I sat in the press conference where then Health Minister, Alan Johnson, announced that the Labour Government was launching a consultation on a social care Green Paper. Now a Green Paper is, in itself, a consultation document – so it was the announcement of a consultation on a consultation! This, effectively, meant that the then Labour Government would not have to tackle the issue of social care before a General Election, something that was raised by numerous journalists at the time.

Since May 2010 we have had a Conservative/LibDem  Government whose only action, so far, has been to launch yet another consultation – Dilnot – with the promise of a White Paper which appears to be delayed yet again, although reports last week suggested we will get a draft version which will be open for consultation!

Apart from the blatant prevarication by all parties there is also the issue of what the constant consultations involve and that is the issue of who pays what for social care.

Yet the issues go deeper than that, social care has been facing cuts since well before the recession actually kicked in with issues over less than inflation fee increases by local authorities going back to at least 2007.

So it is not only a case of who pays but also is enough actually being paid?

Principle in this question of how much is being paid is what we are paying social care staff. At the end of last year the BBC revealed that many care workers are actually getting less than the minimum wage http://news.bbc.co.uk/panorama/hi/front_page/newsid_9604000/9604221.stm

If we want to provide the best possible quality of care for the most vulnerable in society then we need the best possible workers to provide that care and support. Yet care workers have been described as ‘vulnerable workers’ by the TUC and there seems to be little political action on improving the image of care work to encourage more people into the sector.

In 2010/2011 there were around 1.5 million adults accessing Local Authority funded social care services and this does not include those ineligible for funding and who are having to pay for their own care. And the issue of social care will only become more pressing over time, more people will need care and support services as the population continues to live longer and WE WILL NEED more workers to provide that support.

Government should be about leadership yet ALL political parties seem to prefer to run and hide when it comes to dealing with social care.

I am supporting #Twobby because those who sit in Westminster need to STAND UP and take action on social care NOW rather than endlessly prevaricate in the hope that it will go away

62% of Care Users Extremely or Very Satisfied

           The recently published final report from the Health & Social Care Information Centre, entitled “Personal Social Services Adult Social Care Survey, England 2010-2011” actually paints a fairly good picture of social care and is perhaps worth highlighting to counter the general negative reporting we usually see.

            The survey, which had 61,115 respondents, found that 62% of those who responded were extremely or very satisfied with the care and support services they received, 28% were fairly satisfied, 7% neither satisfied or dissatisfied and just 3% said they were dissatisfied.

            Given that we are trying to achieve a person centred culture it seems odd that the constant criticism of the care system does not seem to be wholly reflected in the views of those who use care services.

            The survey also asked about individual’s quality of life. In this just over a quarter of the people who responded (26%) stated that their quality of life was so good it could not be bettered, 31% responded as it being good and 33% as alright with only 7% responding their quality of life was bad and 3% so bad that it could not be worse.

            We should also be singing the praises of social care workers. The survey asked “How happy are you with the way the staff help you?” A staggering 69.2% responded “I am very happy with the way the staff help me, it’s really good”.

            The overall picture of social care service delivery in England is a positive one.

            Yet more work needs to be done. The survey does not, unfortunately, fully identify where any differences in care delivery may occur. The responses are broadly uniform across the country and in terms of demographics the level of dissatisfaction with care services appears age related with younger people more likely to be dissatisfied and, I suspect, more detailed research would be needed to discover if this is because services are that much poorer for younger adults or whether it is purely because of age.

            We also need to be able to pick out what is the best practice that can be disseminated. What is being provided to the 62% who are extremely or very satisfied with their care package that can be translated into the care packages of the remaining 38% of care service users.

            We need to be able to identify what it is that makes care users happy with the way care workers help and support them, so we can disseminate this good practice throughout the social care workforce.

            Perhaps more importantly we need to raise the profile of this survey to show that the social care delivered in England is good, that the people who count – i.e. those who use the care and support services – are broadly happy with the service being received.

            Yes we do need a fundamental review of social care in the UK but we must be careful not to throw the baby out with the bath water and we should take the time to recognise that the bulk of care and support provision is good.

It's not just about who pays for Social Care but How We Talk About It

                Politicians of all parties have a tendency to view social care as a matter of cost. The endless consultations we have had over the past few years have focused on how social care is paid for and who should pay for it.

Yet it is not just a matter of cost but of how society views its provision care and support for those who need it.

To really improve the social care system society first needs to start changing the discourse of social care. Public views and opinions are always based on the way politicians and the media talk about different issues and social care is no exception. Those who have no contact with the social care system could be forgiven for thinking that social care is delivered in a completely haphazard manner, leaving all those who need it at risk and that care and support is delivered by individuals who are completely incompetent or, worse, evil people who prey on the vulnerable.

This view is very far from the truth yet it is a persistent cloud that covers the areas where social care shines and it is this cloud which needs to be blown away before we can make any real progress in improving social care.

Firstly we need to tackle the image of working in social care.

Social care workers are low paid, work unsociable hours and receive little reward for the work they do – yet they do it. But the entire workforce is often told it needs to ‘professionalise’.

Imagine the effect on any workforce that is constantly bombarded with the implication that they are unprofessional. Think of the impact on staff morale and performance. If you were to hear that phrase used about you, how would you feel?

To add to that there is the constant comparison of social care workers to the retail sector in terms of wages and conditions. Yet how can the two types of work be realistically compared? In truth the closet comparison would be to that of Healthcare Assistants in the NHS but that, perhaps, would raise to many questions in relation to pay and conditions.

The portrayal of social care workers as unprofessional and low paid naturally has an impact on recruitment and retention in the sector. What incentive do younger people have to enter social care other than as a last resort job?

Pay and conditions are not going to change overnight, the way the system works at present means that many care providers are small businesses who do not have the funds to improve wages without making cuts in other areas of care provision or, and lets be blunt, cuts in their profits but it is time to really start talking up social care workers and making realistic comparisons about the work they do.

Politicians also need to tackle the perception of haphazardly delivered care, yes there is a postcode lottery where care and support provision depends on the Local Authority that delivers it but are those services so significantly different from one area to another? If so, then surely we need Government intervention, to discover why and to take action to rectify this and to be seen to do so publicly. Too often, in recent years, there has been a tendency for Government to brush of social care delivery as the responsibility of local authorities yet, in truth, social care is still funded by central government and they should take responsibility for it.

Perhaps the hardest issue to tackle is that of the risk of abuse. We need to be constantly vigilant in the fight against adult abuse but the public also needs to be informed of the reality of vulnerable adults and abuse. Abuse is not limited to social care workers, in fact in home care abuse is far more likely to be committed by family members than by care workers but it is where a care worker has committed abuse that is far more likely to hit the headlines.  In many cases it is the social care worker who identifies and reports abuse committed by others yet such work goes unreported.

How social care is viewed depends on how social care is talked about and it should now be time to start talking about social care openly and honestly, identifying the real issues, talking about them and taking action to deal with them.