Our underfunded social care system cannot function by relying on the goodwill of underpaid and unsupported workers
An investigation by BBC Radio 4’s File on Four reveals more than 23,000 allegations of abuse made between 2013 and 2016 against homecare staff providing support to elderly and frail people in their own homes.
A freedom of information request submitted by the BBC to local councils uncovered 23,428 safeguarding alerts across the UK, but responses were made by only half the councils, suggesting this is a significant underestimate. The reasons for safeguarding concerns include allegations of neglect (12,300), psychological abuse (2,400), physical abuse (3,400) and sexual abuse (more than 400). Only 700 cases involved the police and there were just 15 prosecutions. The charity Action on Elder Abuse claims this seems to indicate a cultural ageism in our society, which manifests in the tacit acceptance of poor and degrading care and treatment.
The reasons why abuse takes place in any situation are complex, but fundamentally it is about power. Abusers have more power than those dependent on them, while at the same time they often operate in a system which makes them feel powerless, exploited or undervalued.
The vulnerability of people receiving homecare is self-evident; the rise in eligibility thresholds for social care means that people who get personal care and support to remain at home generally have high needs and complex care requirements. The majority are very elderly and many have dementia. Typically, they live alone. The care they receive, behind closed doors and out of sight of supervision, relies totally on trust. These are classic conditions in which abuse can thrive unseen.
There are two major issues that must be addressed. First, this is yet another indication of the crisis of funding in social care. The prevalence of short visits and cutbacks on contract prices with private agencies have contributed to a low-paid homecare sector riven with recruitment and retention issues. In such a culture, it is not hard to see how poor standards of care can result and become accepted as the norm.
This leads in to the second issue, which is about the regulation of care workers. Effectively, there is none. While social care services are inspected by the Care Quality Commission, people providing the hands-on care are not regulated. There is no register of care staff, as there is for doctors, nurses and other healthcare professionals registered by the Health and Care Professions Council (HCPC). This has been on the agenda for many years. Former regulator the General Social Care Council was moving towards setting up a register before its demise. The transfer of regulatory responsibilities to the HCPC was expected to lead to the inclusion of social care workers, but that has not happened.
Regulation of care workers would be an enormous undertaking – this is a very large workforce of about 1.5 million people. Any regulation needs to be risk-based and proportionate, but the risks are clear and underlined by the latest revelations on abuse allegations.
What is going wrong in social care has come under increased scrutiny in recent weeks, and the crisis in funding is widely recognised. The impact of this on the quality of care, on the morale of care workers and on the experience of those using services is becoming evident. Most care workers are not abusive or uncaring, and many provide a level of support and compassion that goes far beyond what might be expected. An underfunded social care system, however, cannot continue to function by relying on the goodwill of underpaid and unsupported care workers on the one hand, and covering up unacceptable and abusive care practices on the other.
Changing the culture of care takes more than money, but inadequate investment and a continued failure to regulate workers will ensure a downward spiral of falling standards, low expectations and a culture of complacency that is unsustainable.