Millions of elderly or impaired people rely on the social care system to carry out personal care or domestic routines.
It’s a system under extreme pressure, as cuts bite hard and privatisation drives down standards at the same time as demand soars.
The BBC’s Panorama last week revealed horrific new examples of abuse and neglect.
Just as they did with hospital staff after the Mid Staffs scandal, the Tories and much of the media have been quick to demonise workers.
But the scandal should really be a warning of how private companies and government policies are undermining quality care and making abuse more likely.
“Social care is in a mess,” said Sam, who works in an elderly people’s home in Neath Port Talbot, South Wales. “It’s overloaded, under funded, and understaffed.
“It’s supposed to be a support system for those that need it, for the vulnerable in society who need support. Something that people can rely on. But I don’t feel like it is that right now—it’s a second-hand system that’s struggling, at best.”
In a society that only values people for how productive they can be, many people worry about the care they will receive when they stop working.
A 2011 poll showed that over 80 percent of people agreed that the government needs to do more to meet the care and support needs of older people. Over 60 percent were worried about what would happen when they got older.
But funding stagnated under New Labour and dropped sharply under the Tories. At the same time the population has been ageing.
The number of people aged 85 and over—the group most likely to need care—has increased by 30 percent in a decade. And cuts to community support services such as day care centres or home care have led to a huge shift towards relying on residential and nursing homes.
By 2011, it was estimated that of two million older people with care needs, nearly 800,000 received no formal support. The following year council spending on adult social care decreased on average by 20 percent—a total of £2.8 billion.
Sam explained what this means for residents.
“They used to have things like a dedicated entertainment officer, which meant staff were free to focus on personal care, but now that’s gone,” she said.
“Budgets for organising outings or trips for each unit have been cut severely. So residents aren’t getting out in the community as much anymore.”
Sam works for Gwalia Group in Neath Port Talbot, south Wales. The private firm took over the running of residential care homes from the local authority two years ago.
In England around 80 percent of publicly funded homecare is now provided by private firms that are reshaping the delivery of care to slash costs.
Sam says managers expect staff to plug the gaps and do their normal job. But they are already overloaded.
“There’s no acknowledgement that we’re under pressure and more staff are needed—they just expect you to take on more,” she said.
“But it gets to the point where you’ve got no more to give.”
The anger this is fuelling has led to industrial disputes from care workers in the Unison union. Sam and her colleagues are fighting attacks on conditions and a pay cut of up to 16 percent.
And in a long-running dispute, support workers in a service for people with learning disabilities in Doncaster have struck against new contracts that could see some lose up to £7,000 a year.
Doncaster council handed their service to leading NHS privatisers Care UK last year.
“Most of the time I’ve worked in the NHS I’ve just got on with the job,” said Dave, a worker there. “But now we’re with Care UK you notice a lot more that market forces are involved.”
Workers are angry that the vital work they do is so undervalued.
“We work five days out of seven and probably average about two 24-hour shifts in a week with sleepovers,” said Dave. “You can work ten days straight before your next day off.
“It can be a physically demanding job assisting people with physical disabilities.
“It’s also quite mentally tiring, not only because of the hours but because dealing with their behaviour can be draining.”
Dave described his duties as “very much hands on”.
“I help people straight from when they get up in terms of personal care from bathing, dealing with incontinency, changing their pads and cleaning them up front and back,” he explained.
“Once they’re up I sort their medication, assist them with breakfast and try to help them enjoy their day. We might go out for a bit of shopping, or just be out and about, or days out like trips to the seaside or something.
“We have to order their medicines from the doctor, which are then organised into dosages and there can be four or five sets of medication to dispense. We have to check and make sure the medicines are correct, and deal with people’s finances.”
This is complex work that needs well-trained and motivated staff—something that the private firms’ race to the bottom is threatening.
“The concern is that people we’ve cared for all our lives could face neglect, malpractice and possibly even fatalities,” said Roger, another Care UK worker. “They’ll be very much at risk.”
Between them Roger, Dave and Sam have a lifetime’s experience. But bosses prefer to cut costs with a pool of temporary workers on low wages, with less training and little incentive to stay on and build up experience.
“There are more and more new staff coming in now maybe not from a care background,” said Dave.
“The day-to-day care stuff people can pick up. But understanding the service users’ needs—how someone thinks and behaves—only comes with experience.”
He warned that Care UK has outsourced training to other parts of the company. The “good fundamental training” that they got under the NHS has been replaced with “a little bit of induction training”.
The low paid contracts will likely lead to a high turnover of staff, leaving service users to be passed from one worker to another. “You need continuity of care, that’s where the quality comes from,” said Sam.
“In private care we’re seeing a lot more of this generic role where you do care, kitchen and domestic work,” she added. “That’s a disaster as far as I’m concerned.
“Care workers should be doing care work because it’s a chosen vocation. The demands on care are so high now that if you don’t want to do it then you shouldn’t be doing it.”
Instead, she said, we’re getting “conveyor belt care”. All this adds up to create a dangerous situation. Environments that are supposed to be a haven for those in need are turned into pressure cookers of stress, driven by managers who put profit before care.
Extreme examples of abuse are still rare, but things go wrong all the time. Service users can face long waits, petty humiliations and worse as workers struggle under the strain.
Sam thinks it’s wrong to blame individual workers for this atmosphere.
“The blame starts at the top,” she said. “If you’re a manager, you have a responsibility to know what’s going on.”
The situation is made worse “because of a lack of support, supervision and training”.
“I don’t defend anyone abusing someone, but I understand the level of stress a lot of staff are working under,” she continued. “Some are ready to pop themselves because of the pressure.
“What you should be doing is taking time out when you feel like that. But it’s becoming less possible, and often people could be working on their own without that guidance from an experienced member of staff.”
The drive to profit also makes it harder to expose real abuse.
“Whistleblowing can be hard because sometimes you feel like management are against you,” said Sam. “They don’t want to admit there’s a problem in their homes.
“If they’re running a business they don’t want the bad publicity.”
The absurdity of putting the market in control of care was exposed in 2011 when the largest care homes firm, Southern Cross, was plunged into crisis. Speculators attacked the firm on the stock exchange.
In the financial mess that followed, workers and residents took the hit while bosses made millions selling their shares just in time.
At the time Justin Bowden of the GMB union warned, “If you want to see what the NHS will look like in two years look no further than Southern Cross.”
Now Sam is furious at the politicians who have voted through cuts and allowed private companies to leech off public services.
“I don’t think they have any idea of the impact of these cuts,” she said.
“They should try walking in my shoes, doing my job, before making these decisions. They’re cushioned with private health care and have got nothing to worry about.”
Care workers are regularly demonised if they take industrial action. But their strikes are the best way of stopping the drive to cut corners.
Every working class person risks being reliant on social care one day. And if we want it to put our needs before profit, we must back the workers who are taking on the greedy bosses.
“I won’t let anyone say I’m wrong to strike because I’m a carer, or that I don’t care for people,” said Sam.
“It’s because we are so worried about the deteriorating quality of the service that we have to strike—and we are right to do so.”