Homecare – BBC report

Shocking levels of Homecare abuse reported to local authorities across the UK

Homecare neglect

Most care at home is safe and reports of abuse are relatively rare. However 23,500 allegations were made in the last 3 years.

We need carers to help older and vulnerable adults safely looked after at what is widely seen as the best place for them – at home. It is essential that such an intimate service is done sensitively in a professional and caring way.

However new figures the BBC have obtained show that over 23,500 allegations of abuse have been made to councils all over the UK in the last three years. But only a tiny number of perpetrators are held to account. The overwhelming majority of abuse is criminal in nature and never gets prosecuted.

Care is often arranged through the local authority using an external agency. So the care worker is working on behalf of local councils who are responsible for safeguarding. Experts say cuts to local authority care funding, unmanageable workloads and poor training are contributing to the toll of abuse. So how can families be assured that their family member is in safe hands?

Harrowing examples of abuse have been uncovered, one leading to criminal prosecution for ill treatment and wilful neglect resulting in the maximum available jail sentence.

A fragmented and underfunded system

Bridget Warr chief executive of the UK Homecare Association (UKHA), which represents 2,000 agencies has pointed out that “any incidents of abuse or neglect is awful… the vast majority of home care is good or excellent so we are talking about a…small minority.” “The whole… challenge of too little money in the system… absolutely needs to be investigated and put right.”

Types of abuse ranged from financial, physical and psychological, to even sexual abuse, but more than half of the alerts were about neglect, which is a very broad term. It can veer into violence and cruelty but the threshold at which it’s reported can vary widely between different local councils.

‘Conveyor belt care’ can lead to neglect

Why should allegations of neglect be so common? Pressure on carers may be a cause, and in 2016 NICE* issued guidelines intended to end Homecare visits of less than 30 minutes for such tasks as eating, washing and getting out of bed. But there is clear evidence that 15 minute calls are still taking place, this puts great pressure on the carer, old people are slow and it’s all too easy to lose patience and rush the old person. Unions also point out that many carers don’t even get the minimum wage as they aren’t paid for travel time between visits. All this can add up to great pressure on the carer to rush to get to the next appointment and not take the care needed or even grab their ward to hurry them up.

According to a survey carried out by UKHA show that a very large proportion of local authorities are still using 15 minute visits, 70% are commissioning visit of less than 30 minutes, one local authority admits that 40% of visits they commission are for 15 minutes or less.

50% of UKHA’s members stated they were worried that such short visits could compromise safety and dignity. Chief Executive Bridget Warr said “To maintain people’s dignity and safety you need much longer visits for people who need that sort of care”.

Extraordinary lack of prosecutions

Disciplinary action took place in only 8% of alerts raised across the UK. Police were involved in nearly 700 cases and out of the 23,500 alerts raised only 15 prosecutions were brought.

Gary Fitzgerald Chief Executive Action on Elder Abuse said that “The overwhelming majority of abuse is criminal in nature and never gets prosecuted… Even if it gets to court you’re more likely to see community service given or a suspended sentence given than actually sending those people to prison.”

The Local Government Ombudsman, Michael King, is the last resort for people complaining about Homecare. His service has seen the number of complaints rose by 25% last year and he is upholding two thirds of them. He sends a very strong message to councils

“You can outsource the care contract but you can’t outsource your responsibility to make sure people are cared for properly”.

But in complex outsourcing arrangements important messages and information can get lost resulting in poor or inappropriate care, such as wrong medication or missed visits.

“State neglect”

The BBC programme ‘File on Four’ commented “Local authorities and care agencies throughout the UK reckoned the roots of neglect are in diminishing resources from central government”. However the Department of Health counters that it is increasing funding for social care and has brought in tougher inspection of care services. The programme reported hearing that some Homecare agencies are closing and others are handing their contracts back to local councils, which leaves councils with little choice about what agencies they can use. Councillor Izzy Secom from the Local Government Association said  ‘we have to accept that if we squeeze the money so much people will stop providing care… it is a very difficult situation to be in”.

Funding will be even tighter in 2020 when central government withdraws all its central grant to councils. Whilst Health Secretary Jeremy Hunt says the government is looking at solutions to the funding of Social Care no details are forthcoming.

Bridget Warr of UKHA said “If the funding doesn’t improve I am deeply worried. We are already seeing in some rural areas that there is no Homecare provider covering that area… If we don’t do something led by government pretty soon we are going to see some very serious risks… We are talking about state neglect when we looking at what’s happening with the funding at the moment”.

This article is based on the BBC radio 4 programme File On Four ‘Neglect:The Story of UK Homecare’, first broadcast on Tuesday 28th February 2017.
*The National Institute for Health and Care Excellence