Home care commissioning practices by local authorities must protect older people’s human rights

9 Oct 2013 02:10 PM

Local authorities should change how they commission home care, and in particular ensure that workers are paid the minimum wage, according to a review of care published yesterday by the  Commission.

Local authorities should change how they commission home care, and in particular ensure that workers are paid the minimum wage, according to a review of care published yesterday by the Equality and Human Rights Commission (EHRC).

The report warns that the way care is currently commissioned is unsustainable, leading to inadequate pay, poor working conditions for care workers and increasing threats to older people's human rights.

While many of the activities care workers have to carry out require similar qualities to other professions such as nurses, their role is viewed as lower status. Very low pay, together with highly pressured working conditions and a lack of support are likely to exacerbate the high turnover of staff, making care recipients more vulnerable to neglectful or abusive treatment.

Although the EHRC recognises the severe financial pressures local authorities face, it found that the rates that some local authorities pay don't appear to cover the actual costs of delivering care. Many care workers are not paid for travel time or the time between visits, which means that they could be working for less than the legal minimum wage.

The Commission's review found that while budgets represent a constraint on improving contract values, some local authorities have been able to take innovative action in partnership with providers and older people to improve how they deliver care.

Today's report reviews the 25 recommendations the EHRC originally made in its 2011 formal Inquiry (1). This inquiry found although 50 per cent of older people were satisfied with their home care, many others had experienced poor treatment or neglect. The most worrying examples were rushed visits, older people not being helped to eat or drink, left without food or water, in soiled clothes and sheets, and being put to bed in the afternoon.

The EHRC is now calling for all contracts commissioning home care to include a requirement that care workers are paid at least the National Minimum Wage, including payment for travel time and costs. Local authorities should be transparent and set out how the rates they pay cover the costs of safe and legal care, with cost models published on their websites.

The Commission's original recommendations were aimed at local authorities, Government, the Care Quality Commission and the Local Government Ombudsman. As part of this review the EHRC commissioned an in-depth survey to assess how well local authorities had responded.

The analysis found that the majority of the 70 per cent of the 101 who did respond (2) had taken some action to implement the original recommendations. A few authorities showed impressive, well thought out approaches to commissioning care, ensuring the human rights of older people needing or receiving care were better protected.

As a minimum they were asked to review their complaints systems, the potential for age discrimination in care planning, whether commissioning practices met the diverse needs of older people and whether they supported a properly skilled and trained workforce.

This last area was the most commonly reviewed by local authorities and was the one where the highest number of authorities identified scope for improvement.

The Commission was also disappointed that given their earlier finding that older people were reluctant to complain even when faced with low standards of home care, only 34 of the 77 authorities had taken action to address this.

Today's review welcomes that Government and CQC will ensure that adult social care commissioning will now be independently monitored but the Commission is concerned that the scope of the Human Rights Act is still unclear, leaving home care users without redress for human rights breaches by providers.

EHRC Commissioner Sarah Veale said:

'The current system of commissioning and funding home care is increasingly unsustainable as the number of people requiring care grows every year.'

'Low status, low pay and poor working conditions are leading to high turnover of staff and putting older people's human rights at risk. Care workers perform a hugely valuable role in looking after some of the most vulnerable members of society and at the least should expect to be paid the legal minimum wage rather than being forced to fund transport costs and time spent between visits out of their own pockets.

'We recognise the extreme financial pressure local authorities are under. However, some authorities have taken innovative action in partnership with providers and older people to improve how they deliver care, without significant increases in expenditure. For example, closing the curtains when people are getting undressed or not talking over them does not cost anything and it makes a difference.

'The transparent use of carefully considered costing models that take account of all elements of the actual costs of care will make it clear to providers that local authorities expect care workers to be properly paid, trained and supported.'

Close to home recommendations review


For more press information contact the Commission’s media office on 0161 829 8102, out of hours 07767 272 818.

Notes to Editors

  1. The online survey carried out by IFF Research Limited was sent to 152 English local authorities that commission home care. In total 101 (66 per cent) responded. 40 submitted information subsequently and the 2 non-responders have been listed in the appendix. We will review their progress after publishing this report and decide on appropriate action if they fail to engage with us.