The frontline of social care “They say we’re all angels. Well, pay us then”

One of the public services most under pressure today is care. Here we look in depth at the problems facing the care sector and how they can be solved. And we hear from care workers on the frontline doing a job they love for so little financial reward. The support of UNISON is vital for this group of workers.

Dave Prentis, UNISON general secretary

Kicking off this special feature looking at the state of social care in the UK, Janey Starling talks to care workers and finds out what it's like on the frontline

Maria Jackman is a community care assistant for an agency in Essex. She spends long days – from 7am to 10pm – travelling between different homes to help people with personal care, medication, housework, food, dressing, and to offer social interaction.

She tells U what a working day looks like for her. “Generally speaking, I’ll get 20 calls a day, and I have around 30 minutes to complete each of those calls. Every call is different. It depends what you’re expected to do, but 30 minutes isn’t always enough. If you’re doing personal care, medication, food and nutrition, you’ll need another 15 minutes.

“It gets difficult when you have someone on medication that has to be taken half an hour before food, and you’ve only got half an hour from start to finish. It’s very easy to end up going over, and that just runs over into the next job. If your first visit of the day runs over, everything runs over. And there’s no paid overtime.”

Home carers provide a critical service to the communities they work in. Carers fill the gaps that families often can’t and help people to function independently in their everyday lives. But they’re hardly valued by society. Usually working on zero-hours contracts with no sick or holiday pay, and with travel time between jobs unpaid, the working conditions are merciless.

“Visits could be 10 miles apart, and you could get stuck in rush hour traffic,” says Maria. “It’s stressful enough when you’re late for a call, but it’s even worse when you’re going to someone with Parkinson’s whose medication needs to be taken at the same time each day. If their medication isn’t given on time, their condition worsens.”

Maria previously worked in a residential care home, but left after two months because of how distressing it was.

“For the amount of money that a resident is charged, they are being wholly fleeced. How can anyone justify £1,500 a week for three meals a day, laundry, and tea and coffee – that’s it. In the home I worked at, residents had very little interaction with carers, and I was told that I didn’t have enough time to engage with residents. So they were sat like robots and zombies around the TV. And if they’re not mobile enough to go to their own room, they just sit watching what someone else wants to watch. It’s phenomenally scandalous.”

“I remember there was a little old lady who understood where she was and knew it wasn’t home, and it threw her confidence totally. She was in this big building where she’s not allowed to come and go as she chooses, in a locked-down unit, with all these strangers saying to her ‘let’s give you breakfast, let’s get you washed, let’s get you dressed’. In a care home you can’t get dressed in your own time because you’ll miss breakfast. I would be told by my manager that I didn’t have time to talk to her. I just felt really bad for people like that.”

But in spite of the stressful conditions, Maria says that she wouldn’t change her job for anything else in the world.

“I enjoy all of it, and I’d like to think I’m making a difference. I’d like to think that I can make a person smile, even just for a couple of minutes. They’ll remember that. That particular person has nobody else coming to see them except their carer, and I want them to have a positive experience of it, not a negative. The thing that frustrates me, though, is that people refer to us as a fantastic service, they say we’re all angels. Well, pay us then.”

Stephen Hughes, a care training facilitator for a large residential care home in Merseyside, holds a similar view to Maria.

“Care assistants are the building blocks of a company, and they deserve more respect than they currently get,” he says. “They have the finger on the pulse in care homes and they know what’s needed, and what needs to be fixed. CEOs only see the homes every six months or so, and companies want to fill up all of the rooms to get the money, but they don’t take into consideration how it impacts the residents or staff.”

Like many care workers, Stephen is drawn to the work itself for the impact it can have on an individual’s life. “It’s all about the interaction with residents, the positive impact that you can have on their day. I worked Christmas Day and Boxing Day, and we had all the residents together with such a family feeling. It was an absolute delight.

“In a care home, you’re supporting people in the twilight of their life. It’s not a question of life being over, but ensuring that you’re enriching their lives. It’s all about treating people with respect and dignity. Some people only look at a person as a number of years – but what about their life up until now? If someone is 86, what have they experienced and achieved in those 86 years?”

The step between home care and residential care is live-in care. Dawn Astley is a live-in carer in Ipswich, who currently works from 8am-8pm with an elderly woman. For 12 hours, she’s constantly busy.

“In the morning I get up, prepare things for the personal care worker to come in, and together we roll the patient who is bedbound, change her clothes and wash her. As a live-in carer, I have to rinse all her clothes before putting them in the washing machine. So that means five washes a day, with my hands in cold water rinsing things. I also have to feed the person and get drinks into her three times a day. In the afternoon, she gets up for two hours, and another carer comes in to assist me so I can have a break.

“Then, I hoist her into bed and go through the same process as the morning: washing, dressing, changing her clothing, emptying her leg bag, measuring it up and fixing the tap to the night bag. Then I go to bed. It all starts again at 8am the following morning.”

Like many live-in carers, Dawn works alone and does not get paid for the hours she stays in the client’s home, which can be a lonely and even vulnerable experience. “I never know what’s going to happen. If I’m alone with someone, and if the person’s got some kind of dementia, they might get angry, they might attack me. I’m working in someone’s house, and it’s just that person and me.”

She also describes how precarious her employment conditions are. “The agency phones you up, and you do the job. There’s no contract involved, really. Some weeks I don’t have any work, some weeks I do. I never know what I’m going to get, unless I do live-in for a fortnight. Two weeks ago I didn’t have any work, and next week I don’t have any work either. For live-ins, you get around £500 a week. That sounds good, but in reality it works out at around £3 or £4 an hour.”

Dawn also does home care. Despite the uncertain working conditions and lower pay, since moving to work for a private agency she does feels that her home care clients are getting a better service. “With a private agency, I get longer time with patients than I did when with the local authority. The shortest time here is two hours with someone. Working with the county, I only had about 15 minutes minimum, at the most half an hour. You’re basically in and out, and you can never build a relationship with someone. This time you can.

“I love the job I do, and I love helping people. If it wasn’t for me, these people wouldn’t have anybody”.

Asked what needs to change, Dawn is quick to answer: “It’s a private industry and it really shouldn’t be. I’d like a national body. I’d like the service to be free for people – for everyone.” We agree.

The names in this article have been changed to protect the identities of the care workers.

The state of care

While money is desperately needed, there are some even bigger, structural problems. Guy Collis, UNISON's social care policy lead, gives some plain answers to our more pressing, care-related questions....

Guy, what are the main problems with social care in the UK?

Basically it’s a demographic timebomb. We have an ageing population, the demand for services is rising, the money is failing miserably to keep pace and politicians keep ducking the real issue of delivering change.

It’s a case of chronic underfunding. Public services like the NHS haven’t had the funding they needed for the last ten years, but social care has been cut really badly. Yet social care is never seen as the same kind of totemic issue as the NHS.

Why isn’t social care valued in the same way as the NHS?

It’s complicated. Partly because the health service has highly paid staff like doctors and surgeons, and you don’t find those in social care. It’s also because social care funding comes through councils and local authorities, who have particularly suffered in the last ten years of cuts. If councils increase money for social care spending, there’s less money for street lighting or leisure centres. Social care has had to compete with local government provided services in a way that the NHS hasn’t had to.

There’s also the traditional idea that care work is perceived as women’s work, and is therefore devalued. Traditionally, women have tended to take on the caring role in families, which is an unpaid role. And traditionally, a lot more women have been working part time, where pay rates have not been as good. As a result, our underpaid social care workforce is 90% female. Some care workers are not even being paid the national minimum wage because of travel time.

Who’s responsible for social care being so devalued?

Both the public and politicians. We all are to be honest. There’s a broad public misconception that social care is free, that it’s state funded. Every time there’s a white paper or green paper or anything else published, they should do an awareness raising exercise with the public that says if you want good quality services, you’ll have to pay for them.

Social care has been chronically underfunded for successive governments, but has become weaponised in elections. Politicians try to tackle social care, and then it gets too politically awkward and they bump it into the long grass. Andy Burnham tried to introduce inheritance tax rises to pay for social care in 2010, which was branded “Labour’s death tax”. Then Theresa May tried to introduce a cap on care costs in 2017, and it was labelled the “dementia tax”. Neither of these solutions would be the be all or end all, but either would have been better than what we have now, which is no action at all.

Privatisation plays a part too. The NHS is still largely publicly delivered so there’s a more immediate connection in the government’s mind between what actions they take, and the treatment that patients get. But with social care, the market is so dispersed and has so many different providers that there’s no sense of an all-encompassing body that is responsible in some ways. In some local areas there are hundreds of local operators, and because they can’t make money out of it, they have to make their money in nefarious ways like cutting call times or driving down wages.

What change is UNISON fighting for?

More investment in social care. Even if nothing else was changed, but we flooded the system with money, it would improve.

But we also acknowledge that money isn’t enough. We need regulation. Right now, too much bad practice is allowed. A lot of money in the care sector is bleeding away in profits and interest payments and all sorts of waste. It’s very hard to sustain any kind of support for a system that’s based on tax dodging. Funding needs to be accompanied by changing systems.

Ultimately we need to raise the status of care work. It’s seen as a bargain basement sector, when instead it should be seen as somewhere people are proud to work. Lots of members say how much they enjoy the work they do, how rewarding they find it, but at the same time they’re undertrained, underpaid and unregistered. They’re not getting the development they want. So a third of staff leave every year, which is higher than virtually any other sector. It’s demoralising.

As a union, we often talk about pay, and it’s connected to a slightly more amorphous idea of morale, status and public perception. If big, national decisions were taken to improve the sector it would become a virtuous circle where staff felt valued, were trained, turnover would be lower and standards of care higher.

Rounding up the cowboy care providers

What makes a bad situation worse? Try private companies taking profits out of a system already short of cash. Janey Starling explains more

Research published at the end of last year by the Centre for Health and Public Interest shows what UNISON members have been saying for decades: residential care homes are being run irresponsibly.

The financial structure of our overstretched and underfunded care sector has been revealed, with an estimated 10% of income suspiciously “leaking out” each year.

UNISON assistant general secretary Christina McAnea said: “Every year millions of pounds are lost from the sector, which could have been spent on care.

“There are rich pickings for the shadowy businesses operating UK care homes from tropical tax havens, siphoning off their haul while residents go short.

“Fixing the broken care system must be the number one priority for the next government.

“But with so much cash being sucked from the sector, simply flinging more resources at it is not the answer. Nothing short of a fundamental review of how care is structured, financed and provided will suffice.”

The care home industry and the wider social care sector is desperately short of cash, but extra funding must not be wasted on extra profit for directors and investors. Significant government investment, as well as regulation, is needed to ensure the money goes where it should.

Across the 26 largest care home providers in the UK, a total of £261m of the money they receive to provide care goes towards repaying debt. Out of this, £117m is payments to related companies – a known way of dodging tax and hiding profits.

The money that is funnelled out of care businesses and into rental and debt repayments detracts from the money available to pay for frontline care such as food, staff and facilities.

UNISON is fighting for change for care workers and the people they care for.

Care to act

In response to the care crisis, UNISON has embarked on an ambitious campaign to win fair funding, decent jobs and quality services. And you can get involved, explains Rachael Henry

“One of the things to remember is that for all the things that are wrong with the care system in this country, we have a workforce that are passionate and committed. They care desperately about the people they look after. That’s a fantastic place to start in trying to build a care system that works”, explains Christina McAnea, UNISON’s assistant general secretary, on why everyone in UNISON needs to get behind the campaign, Care Workers for Change.

“In the course of any year almost 100% of the population will use the NHS. But with care, it’s only when a parent gets older, a relative is in an accident, or if you have a child with a disability, that suddenly you’re thrown in and discover what the care system is really like. Eventually though, care touches all of us.”

“A big problem is that care is so often about the ability to pay, rather than need. Families can suddenly find themselves in awful situations. Let’s say your mother gets cancer, everything would be provided free. But if she gets dementia, you have to pay. It’s not right.”

“People need care that responds to their needs. And to be supported by a properly trained, properly paid workforce. It’s not low-skilled, low-pay work - there are different levels of skills required for different types of care jobs. We need a national framework that reflects that, with a proper structure, and decent levels of pay, linked to training and standards.”

Christina makes a passionate case about the link between the outcome for care users and the condition of work for care workers. Quality services and decent jobs go hand in hand.

People need care that responds to their needs. And to be supported by a properly trained, properly paid workforce

“In some cities, there’s 40% turnover rates. That means, an elderly relative might see 10 different care workers in a year. There’s no consistency. Companies come and go because they go bust. People are providing intimate care in people’s homes, yet we don’t even have minimum standards of training in place.

“We need commitment from government and employers that care won’t be done on the cheap.”

She adds: “There a business case but also a moral case for organising care workers. These workers do an essential job for society, for the most vulnerable in our society. They need the protection of a union and that union should be UNISON.”

Leading the way in the north west

The Care Workers for Change campaign started in the North West and has brought power and protection to thousands of care workers, while also building political alliances and winning community support. This has provided a formidable foundation to take the campaign UK-wide in 2020.

Kevin Lucas, the lead organiser for the North West’s campaign shared some insights;

“Hostile employers, combined with low trade union membership, makes care an extremely challenging environment. But with hundreds of thousands of low paid women, employed on precarious contracts, we saw the duty to help them build real power.

“In the last three years our members have recruited thousands of their colleagues. Seven new employers have agreed to negotiate and consult with UNISON. Five councils have signed our Ethical Care Charter, committing them to contract companies with higher standards and pay the real living wage to thousands of care workers.

“We’ve achieved so much. But we must continue to bring care workers confidence and representation. We’re so pleased the union is taking this national.”

Significant legal battles in the supreme court, to defend fair pay for care workers has also put UNISON at the forefront of the fight for decent care.

So, what can you do?

In 2020 Care Workers for Change will build on our success and fight for:

  1. Decent jobs – care workers need to be organised and protected by a union
  2. Quality standards – a national framework for care, with pay and training linked to standards
  3. Fair funding – build political alliances and public support

UNISON members can support the campaign by using our online action to influence your council to sign the Ethical Care Charter. This will improve the quality of care in your area AND deliver a pay rise and better conditions for care workers.

Words: Janey Starling, Rachael Henry

Images: Mark Pinder

Design: Demetrios Matheou