Calderdale Council’s Director of Adult Services and Wellbeing has told Calderdale GPs and NHS commissioners about “feeling guilty and ashamed at the demands I put on carers”.
Iain Baines, who is responsible for commissioning social care services in Calderdale, made the admission at the 23rd January meeting of Calderdale Clinical Commissioning Group Governing Body, during discussion of Calderdale Council’s Public Health Report 2019-20.
The Report, “Working Well”, is about health and work. A section of an accompanying film, screened by the Director of Public Health at the Clinical Commissioning Group Governing Body meeting, could more aptly have been called “ Precarious Work Makes You Sick.”
Paul Butcher, who wrote the Report, said the film is aimed at Calderdale employers and Trade Unions, in order to encourage better mental health support for staff.
The section screened at the NHS Commissioners’ meeting features an account by an exhausted, seriously overworked home care worker, about how she reached the point of having to quit her job in order to save her own health, after being rota’d for 12 days work without a break.
The film cuts to an interview with Mark Coup, her boss at the Upper Calder Valley social care company, Welcome Independent Living Ltd. He explains that the company’s precarious finances are the root cause of the care worker’s predicament.
I caught up with him after the meeting to find out more. He explained that when Councils deliver care themselves (eg in a crisis and in the reablement team after hospital discharge), it costs them about £50/hour.
But on the basis of Calderdale Council’s fee calculation – similar to the the UK Homecare Association model – Welcome Independent Living is paid £16.74/hour of care, contact time only. Since Welcome Independent Living pays travel time as work, the average wage based on Calderdale Council’s fee calculation is £7.90/hour.
Mark Coup explained,
“Because of the split shift pattern of care work, a Welcome Independent Living care worker could work 10 hours a day out of 15 hours.
“But usually they work an early shift or a late shift. The early shift is 7.30-10am and then 11.30am-2pm. The late shift is 4-6pm and then 7-10pm.
“This amounts to 30 hours/week on minimum wage, which is not enough to live on. So they have to work two or three jobs.
“But for District Nurses, the early shift is 7am-2.30pm – seven and a half hours. They get paid for the full shift.”
Mark Coup added,
“There are many 40-50 year old women working with Welcome Independent Living who have to do other jobs too in pubs, supermarkets or betting shops, just to stay afloat.”
No amount of mental health support for staff is going to help, until the broken, privatised social care model is fixed
The Governing Body’s Clinical Vice Chair Dr Majid Azeb observed that the care worker examples showed the effect of low wage employment and contracts.
Until this problem is solved, in the view of Calderdale and Kirklees 999 Call for the NHS, the film’s aim of promoting better workplace mental health support seems beside the point.
Low wage jobs and contracts is not a newly recognised problem – but it seems to have been swept under the carpet for years. As long ago as 2014, Calderdale Council recognised that social care workers need a living wage and manageable working hours – not rotas of 12 days work without a break.
The then-Director of Adult Health and Social Care, Bev Maybury, told the first meeting of the Calderdale People’s Commission on Health and Social Care that Calderdale Council was trying draw up Social Care contracts to improve working conditions. They planned to ban zero hours contracts, pay the living wage, and pay travel costs. She added that paying a little more is essential to get a better service
So why has this not happened?
I emailed Iain Baines to ask, but he didn’t reply.
Governing Body barks up wrong tree
The NHS Commissioners’ Governing Body seemed to think the solution is better commissioning. Penny Woodhead, the Clinical Commissioning Group’s Chief Quality and Nursing Officer, asked,
“How do you commission for compassion?”
She went on,
“The NHS People Plan emphasises employee Health and Wellbeing. But commissioners put all sorts of things in place that limit that.”
The Governing Body Chair, Dr Steven Cleasby, invited Iain Baines’ input. Calderdale Council’s Director of Adult Services and Wellbeing replied,
“It’s about how we commission things.
“For example, Welcome Independent Living is one of our contractors and they can’t really afford to pay a decent wage.
“We rely on care work a lot. How do we commission at a fair price so that staff have a decent working life? I’m thinking ethically about how we commission.
“I end up feeling guilty and ashamed at the demands I put on carers.”
Paul Butcher, Calderdale Council’s Director of Public Health and author of the “Working Well” report, added that its “Anchor Organisations” section noted the Health and Wellbeing Board’s statement that there is scope to review how to tender and award contracts and services.
Penny Woodhead agreed,
“There’s a requirement in the NHS Standard Contract around some of these things – we need to think more about how to use this.”
However, the NHS Standard Contract doesn’t apply to Calderdale Council contracts. So how is that going to help with with Council’s privatised social care contracts?
And even if it did, in Ck999’s view, solving the problem of social care work that makes social carers mentally and physically ill is not about “how we commission things”.
Director of Welcome Independent Living Ltd: “I don’t want private companies providing social care.”
Surprisingly, this was the first thing Mark Coup said to me. So I asked him what he did want.
“In an ideal world, health and social care would be merged and delivered by a statutory workforce, but in a way that could be more efficient than current methods.
“For example, the NHS and Local Authority could subcontract these hours of care to a non-profit organisation aligned to the Council/NHS. But this would not be like the Wholly Owned Subsidiaries set up by NHS Foundation Trusts as a way to save or make money.
“The economics would allow the non-profit organisation to make an 8% surplus to reinvest in better wages and conditions. Compared with the current model that gives Welcome Independent Living a 3% surplus. Which amounts to £24K which pays my and my wife’s £12k/year wages.
“Social care in my world would be driven by the NHS, because it’s good value and good for the taxpayer. And it’s the clinically right thing to do because it’s down to hospital consultants and other clinical staff to decide which patients need care packages and what they need. So social care needs to be driven by people whose interests are clinical interests, which means NHS-led.
“The NHS and Council are working together a bit – for instance the last few weeks Welcome Independent Living have been helped to provide care for customers stuck in hospital who are medically fit for discharge but who don’t have a care package so they can go home. This means Welcome Independent Living can now provide care for the first 8 weeks after discharge, before the NHS and Council can get them into regular care.”
I asked if Welcome Independent Living are involved in the Upper Calder Valley Primary Care Network. Primary Care Networks are supposed to have multidisciplinary teams to care for frail elderly patients in so-called “virtual wards” that use so-called telehealth digital monitoring, to keep an eye on their health. The aim is to identify any deterioration in health in time to prevent unplanned hospital attendance and admission.
It turns out Welcome Independent Living are not involved in anything like this but Mark thinks they should be located in the GP practice, to enable joined up NHS and social care.
It’s not about how to tender and award contracts and services
In the view of Calderdale and Kirklees 999 Call for the NHS, it’s about the urgent need for government to end the privatisation and fragmentation of social care, and to restore responsibility to the NHS for the long term care of the elderly and those with chronic illnesses and disabilities. With an appropriate funding increase.
Last summer, the NHS Detectives Think Paddling Pool reviewed how Thatcher CREATED the split between the NHS, social care and mental health services.
They came up with these recommendations:
- Return responsibility for the long term care of the elderly to the NHS and increase NHS funding accordingly
- Abolish the market in care homes
- Return responsibility for the long term care of the mentally ill to the NHS and increasing NHS funding accordingly
- Restore the caring arts to professionalised nursing and end the split in nurses’ roles between “personal care” and “health care”
(Declaration of interest: NHS Detectives Think Paddling Pool includes members of Calderdale and Kirklees 999 Call for the NHS. It’s not grand enough to be a Think Tank.)
We’re interested in the experiences and views of both social care staff, employers, people who receive social care and their families and friends
For years successive governments have been kicking a long-overdue review of social care funding and provision into long grass.
What do you want from social care services, and how should this be provided and funded?
Please let us know, we will anonymise all info we receive and handle it in line with Data Protection law. We will then communicate it to Councillors, Council Officers, local NHS organisations and MPs.
The Working Well film is on You Tube, here.