Where is the voice of the care workers?

“I want to know how we can expect our care workers to value the work they do if we put so little value on them,” said a care home owner in Wales asking “Where is the voice of the care workers?”

Anne Thomas, executive director of Linc Care, spoke at the Care Provider Summit held in Cardiff recently, after a report by the Older People’s Commissioner found too many older people living in care homes in Wales ‘quickly become institutionalised and have ‘a lack of choice and control’.

The first major review of residential care in Wales by Sarah Rochira, Older People's Commissioner for Wales, revealed a host of failings in the sector, including the use of de-humanising language such as ‘toileting’, ‘feeding’, ‘bed number’ and ‘unit’ and incontinence pads used inappropriately, with residents being told to use them, in spite of being quite capable of using the toilet, thus stripping them of their dignity.

Lack of funding and lack of nurses

Care homes in Wales have been quick to defend themselves saying they are struggling with a lack of funding and a lack of nurses which has forced many Welsh nursing homes to close.

Ms Thomas spelled out the challenges facing care homes in Wales. She said: “The Older People’s Commissioner called for care workers to be better trained but we have just heard that the money for NVQ training is going to be cut for people under 25. I want to know how we can expect our care workers to value the work they do if we put so little value on them. Where is the voice of the care workers?

“Recently it was announced that NHS staff will be paid the living wage. Yet because of lack of funding we can’t afford to do that. We seem to be keeping the NHS afloat.”

She has also found the lack of nurses for care homes to be a huge problem. “During our latest inspection, I discussed the lack of nurses and that we were being forced to use agency nurses. Then in our inspection report it said we were advised that we can’t use agency nurses as a long-term solution.

“All the leaders at Care and Social Services Inspectorate Wales (CSSIW) are obsessed with people running and working in care homes being accountable yet I don’t see anyone being accountable for there not being enough nurses.”

Mario Kreft, chair of Care Forum Wales, which represents care providers in Wales, echoed her sentiments calling for urgent reforms of the way services are commissioned and paid for.

He said the report had also highlighted the fact that it was less viable to run care homes in Wales than it was in England.

Growing number of Welsh care homes closing

As a result, an increasing number of homes are closing because they are not viable at a time when the need for them is growing because of the increase in the number of older people in Wales.

Care Forum Wales, he said, supported Ms Rochira's demand for a new approach which would see services being commissioned for quality rather than reinforcing a “culture of compliance to the bare minimum”. Mr Kreft said: “The report is an important piece of work but it does not fully recognise what is being achieved despite the system and does not give enough credit to the good quality care being provided by many good people across Wales.

“Yes, the standard of care can be inconsistent in places and where there is bad practice it should be rooted out, but the majority of providers are doing a remarkable job in the circumstances.

“Most care homes and nursing homes provide a very good standard of care while there are many examples of excellent, life-enhancing quality care taking place, often under difficult circumstances and with extremely limited resources because of the chronic underfunding of social care in Wales.”

He claims that the social care sector in Wales is “blighted by many years of chronic underfunding which causes a whole raft of problems, not least the fact that it suppresses pay levels for staff”.

"The commissioning process should be about quality and securing value for money and not about paying the lowest possible price."

"There are a total of more than 20,000 beds in the independent social care sector in Wales and of those 11,500 beds are for people who need nursing care - these beds are underpinning the ability of the NHS to function.”

High turnover of care home workers

Claudia Wood, chief executive of Demos, spoke at the Care Providers Summit about the challenges facing care homes generally. She believes one of the big problems is the fast turnover of care home workers that many care homes suffer from.

“People seem to move from job to job rather than seeing it as a vocation. One of the reasons for this is the pay. On average, care home workers receive £6.55 an hour. Compliance with the national minimum wage is worse in the care sector than any other sector. This suggests we are not valuing this sector. How can we support people properly in an ageing sector if you don’t value the care delivered by the care staff,” she said.

The summit was attended by Mark Drakeford, Minister for Health and Social Services for Wales, who agreed with Care Forum Wales that commissioning for quality is the key to providing better care in the future.

Dr Andrew Goodall, chief executive of NHS Wales, said he recognised “the challenges you are facing in the private sector. We don’t want the automatic default to be going to a hospital setting. We need to integrate our services around people not structures.

“People want more control over the care and the support they receive. A lot of people tell us they would rather not be in an acute hospital setting. They would rather be at home or in a residential care setting.” On a positive note, he added: “We have done something different this year by asking how many nurses you need instead of it being decided by the local health boards.”

Cymorth Cymru, which hosted the summit and represents organisations working with vulnerable people in Wales concluded that “the event demonstrated that a large amount of effort is being undertaken, as demonstrated by speakers on the day, to find ways of providing the very best services in these challenging times.

“Additionally it was clear that there is a commitment across all sectors – Welsh Government, local government, health, housing, social care, think tanks and researchers – to make a real difference to people’s lives.”