Our shameful social care crisis
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“Extra Strong Mints are the best things to get rid of the smell of poo and sick,” I was told matter-of-factly by a fellow care worker. That afternoon, as I cleaned up diarrhea and changed a catheter it struck me just what an unrelenting job it is to be a social carer.

Most care workers simply get on with this sort of thing. It is a basic part of the job, a bit like turning on the computer is for me as a writer. And besides, you don’t have time to dwell on feelings of discomfort or even nausea: the next client is invariably waiting.

The reality of the social care sector was aptly summed up to me by a fellow carer, who told me she felt like a “glorified cleaner”. This was not meant to be disrespectful towards cleaners. Rather, it was a pithy judgement on the way in which care workers – on whom thousands of vulnerable people rely for their most basic and intimate needs – are rewarded and remunerated for the work they do.

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It is quite easy to get a job as a carer – something I did as part of the research for my book, Hired – because few people stick around in the job for long. The turnover rate in the social care sector is 25%, compared to a UK average for all jobs of 15%. The figure is even higher in the private care sector and among home care workers, where around 300,000 people leave their positions every year.

According to a new report by the IPPR think tank, England faces a stark shortage of 350,000 care workers by the year 2025. Should freedom of movement end after Brexit, that figure could reach 400,000.

Crucially, the report notes that “chronic underfunding” of care, together with a “dysfunctional” social care system, has resulted in outsourced providers competing to minimise wage costs in a race to the bottom. With council budgets being cut by as much as 50% since 2010, there is less money with which to fund the private companies that are contracted to provide care, meaning wages are kept low. The IPPR report estimates that increasing social care wages to a living wage could cost the public purse as much as half a billion a year.

A great deal of what is wrong in social care boils down to money – or a lack of it. According to a 2014 report by the Public Accounts Committee, local authorities have cut costs in recent years “partly by paying lower fees to providers of care, which has led to very low pay for care workers, low skill levels within the workforce, and inevitably poorer levels of service for users”.

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In Blackpool, where I worked as a carer and where large numbers of low-income families have the cost of their care subsidised, the lack of cash makes a big difference in the level of care people receive. For obvious reasons, it also discourages people from working in social care, which in turn reduces care quality yet further. It’s a vicious cycle.

The deficit in the number of people working in social care is also indicative of the lack of dignity and respect afforded to carers, which in turn affects the quality of care vulnerable people receive. Rochelle, a care worker at a company similar to the one I worked for, succinctly relayed the process to me: “the care workers [are] working for way less than the national minimum wage, no travel time, fifteen to twenty two-minute calls back-to-back, rushing in and out, and not actually having the knowledge and skills required to deal with particular situations because you were thrown into places”.

And care workers are “thrown into a place” because companies are usually short staffed. I received just four days of classroom training before I was sent out on calls. With this modest instruction under my belt – which resembled the cramming I did back in university prior to an exam – I was expected to do everything from change pads, stomas and catheters, to administer medication and move disabled service users in a hoist, as well as prepare meals and visit the shops for groceries. All of this typically had to be completed within a twenty-minute window.

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Even a perfunctory care visit like this was more than many people were getting. According to Unison, three-quarters of English councils commissioned care visits of just fifteen minutes in 2014, up from 69% the previous year. Put another way, many of the people under my charge were receiving what has been accurately dubbed ‘clockwatch care’.

Officially, of course, we were paid the minimum wage. In reality, however, as Rochelle pointed out, it worked out at less once the unpaid time spent travelling from house to house was factored in. And then there was the cost of the fuel to get there. The company I worked for paid fifteen pence per mile towards your petrol costs, and you were entitled to claim another thirty pence back out of your tax. The rest you had to cover yourself, along with the depreciated costs associated with using your car at work.

As with many of the jobs I did while researching my book, it wasn’t just the lack of money that made the job unappealing. The sheer insecurity of care work caused just as much unease among the care workers I interviewed as the material poverty. Around a quarter (23%) of care workers in Britain are employed on zero hours contracts, meaning they have no guaranteed hours.

Several care workers I spoke to relayed stories about how ‘difficult’ care workers, those who blew the whistle on wrongdoing or tried to join a trade union, had been driven out of jobs in the sector. They had not been fired – that would almost certainly have presented legal problems for the company – instead they had turned up for work and found that their hours had been abruptly reduced to nothing, which was effectively the same thing.

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The constant lack of time prevents you from developing any sort of bond with the ‘service user’ (itself a cold term for another human being). According to research carried out in 2016 by the charity Age UK, half a million over-sixties spend every day alone. When a carer enters an elderly person’s house, whizzing past photographs of children, grandchildren, and long-dead spouses, they bring a little bit of the outside world in with them. I remember being peppered with questions: what was weather like? Who had won the football? Was that Tony Blair fellow still the prime minister? Because above all, what they wanted was company.

This would probably fall under the heading ‘social value’ – an aspect of care work that is extraordinarily difficult to measure in monetary terms. Yet it is arguably just as important as the physical aspects of the job, such as ensuring clients are clean and comfortable. And loneliness costs money too. Last year researchers at the London School of Economics estimated that an “epidemic of loneliness” was costing £6,000 per person in costs to health and other local services. The report calculated that for every £1 spent on preventing loneliness there are likely to be around £3 of savings.

In order to solve Britain’s care crisis – and to ensure that older people are treated with dignity and respect – government must reform the sector from the bottom up. This means understanding the link between the way we treat care workers and the quality of care they provide.

This is a moral imperative – it is simply wrong to leave vulnerable people to the whims of the grossly substandard system of care provision we have in this country. But it is also something that should concern anyone who looks at public policy through the lens of self-interest. Those of us lucky enough to live into old age will need a carer too one day. One care worker described the current status of Britain’s elderly to me as “units parcelled up and sold to the highest bidder”. None of us want to be treated like that.