The care of older people in Scotland is a national disgrace. Fairly paid, well-trained staff on proper contracts with time to care is the very least older people in our communities have a right to expect.
Like others in the sector I have written reports highlighting staffing levels, budgets, structures and care strategies. Words have been written and numbers crunched – but that doesn’t tell the whole story. I participated in a couple of focus groups made up of care workers last year and the messages from the workers who provide care were deeply disturbing. They painted a picture of care in Scotland that nobody would want for their elderly relatives, including my own.
I summarised a key impact of poor employment standards when giving evidence to a Scottish Parliament Committee considering the Procurement Bill:
“The other day, I was doing a focus group with a group of care workers and I said to those who were on zero-hours or nominal-hours contracts, “Would you raise health and safety issues with your employer?” They said, “We’re on these contracts. If we raise health and safety issues, we will not be asked back.” That is exactly the position that colleagues were in with blacklisting. Sadly, when I then asked them, “What if you saw care abuse?”, they said, “We’d be pretty reluctant to raise that as well, to be honest, for the same reason.” People on zero-hours or nominal-hours contracts who raise difficult questions do not get asked back, and people are concerned about that.”
Having experienced those messages first hand I decided we would ask a much larger group of care workers and the outcome of that work is in UNISON’s ‘Scotland – It’s Time to Care’ report. This report gives staff at the front line of care delivery the chance to tell their story about care in Scotland and it doesn’t make comfortable reading.
The majority of workers believe the service is not sufficient to meet the needs of the elderly and vulnerable people they care for – both from the time they can spend and the quality of care they can provide. Almost half of carers (44%) said they were limited to specific times to spend with their clients. One in two workers are not reimbursed for travelling between client visits, while three in four said they expected the situation to get worse over the coming year. They also revealed that one in ten are on zero hours contracts.
Time to do more than just deliver a few manual tasks was important to staff and the people they care for. As one worker put it, “By doing the best that we can with the time given. I’ll admit I sometimes miss out a job so that I can sit for two minutes with the person receiving care. That means more to them than the dishes needing dried.”Adequate training is another concern, particularly for newly appointed younger staff. One said: “Staff are not receiving the training they need to carry out their roles, only the training which is low cost or has been identified as core.”
The isolating impact of personalisation was often mentioned and the threat of losing contracts if they make a fuss. One worker said: “Stop threatening charities indirectly that you will take the SDS contracts away from them and move to another provider if workers challenge decisions…Being told by management this is the case and we all must be quiet even though the workers sole concern is for the service user they care for and want the best for them.”
All of this adds up to staff stress and higher turnover that results in limited continuity of care. As another worker put it: “I feel the staff in our organisation are paid pretty poorly for the standard of work they are expected to provide. This means we often have difficulty in recruitment and cannot attract a quantity and more importantly a ‘quality’ of staff. It can be hard to keep experienced, well trained staff as staff shortages and low wages lead to overwork, stress and dissatisfaction to a point were employees resign.”
These are the stories of front line workers that illustrate, all too clearly, what we guessed from the hard evidence. This report should be a wake-up call for the Scottish Government and commissioning bodies to take action to end the race to the bottom in care provision.
Procurement action should include a requirement that all care provision should mandate:
- The Scottish Living Wage: this will help the recruitment and retention of staff and support continuity of care;
- Improved training: to ensure that care is delivered by properly qualified staff;
- Proper employment standards: ending the abuse of zero and nominal hour contracts;
- Adequate time to care in every care visit.
This year’s Scottish Labour Party conference will consider a motion from SHA Scotland on this issue. Shadow health minister Neil Findlay MSP has established a Quality Care Commission to look at the longer term policy aims and is promoting a campaign on the state of the care sector. The Leader of Labour led Renfrewshire Council has just this week committed his support for UNISON’s Ethical care Charter. This all demonstrates that Scottish Labour is showing real leadership on this issue.
Scotland’s older people and others, who rely on our care services, deserve nothing less.
Dave Watson is the Secretary of SHA Scotland and the Head of Bargaining and Campaigns at UNISON Scotland
This article first appeared in Healthier Scotland – The Journal Published by Socialist Health Association Scotland March 2014