Tag Archives: Elderly

Little Care, Little Quality and some Terrible Commissioning

(Part 2 of my story about the chaos that’s followed the awarding of a key public service contract to a private company and the impact that’s having on vulnerable people. You can read Part 1 here).

 

It’s about time Facebook designed a “jaw drop” button.

We Experts by Experience badly needed one when we watched the Care Quality Commission’s recent board meeting online.

We’d just been told that our jobs inspecting health and social care facilities were being transferred from a charity to Remploy, a private company majority-owned by a big US-based business. None of our previous terms and conditions would be honoured. We would be invited to re-apply for our roles – at around half the pay.

Bruised and confused, we tuned in to see what the CQC, which is responsible for the contracts, had to say.

“I think,” declared Chief Executive David Behan, “there’s been a very, very good piece of procurement activity undertaken.”

Thud. That’s when our collective jaws hit the ground.

This particular “piece of procurement activity,”  took two and a half years to complete.

As I predicted last week, it has resulted in a shortage of Experts capable of doing the job, and in a contractor that is clearly overwhelmed.

So much so that the charities which lost the contract for supplying Experts by Experience have now been called back in by the CQC to stop the scheme going off the rails.

Here’s why:

Remploy won the Experts by Experience contract in three out of four English regions. (In a curious fragmentation of the programme, Central England remains with the charities Choice Support and AgeUK who, incidentally, will continue paying a decent wage).

That was announced in early December 2015. Those of us affected (the majority of Experts) were told we would be transferred seamlessly to Remploy. It would likely be done under TUPE, a process designed to protect workers when the business that employs them changes hands.

But Remploy had other ideas. And on January 13th we were told there would be no TUPE transfer after all. Instead, we could all apply to the new contractor for the same Expert jobs – with a 51% pay cut.

Two days later, in response to my query, Remploy confirmed the new terms and conditions in a list of FAQs. Under the new contract, they would be paying us £8.25 per hour (£9.40 in London). Unpleasant, but perfectly clear.IMG_0133[1]

But then came that CQC board meeting.

“This contract is still in the process of being finalised,” said Chief Executive David Behan. “Detailed workings” would be discussed later that week he said. There were “issues that do need to be settled.” What’s more, there had been “inaccuracies” in what we had been told by AgeUK. He was clearly implying that we Experts had been misled.

We scooped our jaws off the floor and began scratching our heads.

The new contract was due to start in less than two weeks. Remploy had sent us their detailed terms and conditions – yet the CQC was still negotiating?

Two possibilities: Either they’d been unaware that Remploy intended to slash the wages of its Experts in half. Or the CQC had naively assumed we would simply accept the pay cut, ignore the implicit insult to the people we represent in care homes, and meekly hop aboard the private sector bandwagon charging through public services.

When we didn’t, a frantic backpedalling got underway.

Two days after the board meeting, the CQC announced that existing Experts who applied to Remploy would get £15.00 per hour for the first six months after they transferred.
An email from Remploy confirmed that temporary rate, helpfully adding that any decision to join them was entirely up to me.

I clearly wasn’t the only person un-wooed by the six month bribe.  At which point CQC backpedalling turned into blind panic.

Last Thursday, just four days before Remploy was due to take over the Experts by Experience programme, the CQC announced a further change.

If we signed up with Remploy we’d get £15.00 per hour for the first six months, and £12.50 per hour for the six months after that, with no decision yet on what the final level of pay would be. (I think we can guess. After all, new recruits are getting £8.25).

And still Remploy was struggling to get the programme fully up and running by the February 1st start date.

Some Experts by Experience who did express an interest in joining the private company have had no response. Others were immediately passed on to sub-contractors whose contact has been equally patchy.

A few were asked to do inspections . They were told to send in scanned copies of their criminal record checks. (Not the normal practice.) None were offered a contract, asked for their bank or National Insurance details, or given the reporting template needed to do the job properly. None have yet been issued with formal ID. I could go on…

Meanwhile a sub-contractor which ran an Experts by Experience recruitment day in January, has pulled out of the scheme. A spokesman wouldn’t say why, just that “the partnership [with Remploy] has ended.”

Not surprisingly then, the CQC desperately needs help. And who better to turn to than the charities that successfully ran the programme for years. The CQC has now asked Choice Support and AgeUK to supply Experts for inspections for the next two weeks – presumably at the Commission’s (that is, the taxpayers’) expense. The charities are by all accounts doing their best to oblige.

And after that? Who knows what’ll happen. The terms of the contract, and details of its execution and delivery have been changing almost by the day.

No, Mr Behan, this was not “a very very good piece of procurement activity,” at all.  

Calling time on my zero-hours job

I’m about to lose the zero-hours job I love.

Maybe “lose” isn’t the right word. But the contract under which I work has been taken from the charitable sector and awarded to a private company. The new bosses at the multi-million pound business taking over refuse to honour existing terms and conditions. They won’t even discuss them.

Instead, they’re offering exactly the same work with a 44 per cent cut in pay. (51 per cent for those living outside London).

So thanks, but no thanks. There’s austerity, and then there’s just plain insulting.

Let me explain. For the past two years I have worked as an “Expert by Experience” for the Care Quality Commission. I accompany CQC inspectors on unannounced visits to care homes for the elderly where I talk to residents and their relatives about their care. I visit people in their rooms, observe activities and meal times, assess the environment – from the state of the carpets to any bad smells – and then write a detailed report.

We’re called Experts by Experience because we’ve all had direct and extensive contact with health or social care services, usually as a result of caring for a family member. So we’re there to make sure the people using these services – and their families – are listened to.*

That requires patience, attention to detail, skilled interviewing and accurate note taking – sometimes in very difficult circumstances.

People in homes for the elderly typically have high levels of need. It could be serious physical ill health; it could be dementia – often both.

Conversations can be repetitive, fragmentary or non-existent. While the CQC inspectors wade through the minutiae of care plans and staff training files, check regulations and interview managers and carers, we sit and chat and observe how the residents actually live.

We wait patiently while they struggle to find their words. We watch interactions between staff and residents, listening for signs of disrespect and noting the many examples of genuinely warm and affectionate care.

Sometimes we pause, put the investigative work on one side and simply listen to life stories. A widow still grieving for a young husband lost in the war. A relative wracked with guilt because they can’t look after their loved ones in their own homes anymore.

Conversations can be unbearably intimate. Elderly women will tell you about the children they wished they’d had. Recovering alcoholics describe the families that fell apart in their drinking years.

Afterwards, we sift through it all, pulling out the important details. Our reports are woven into the inspectors’ final judgements of the standards of care, and include many direct quotes.

It’s interesting and rewarding work and, CQC colleagues tell us repeatedly, we are “unique and valuable” members of the inspection teams.

But evidently not valuable enough.

The CQC contracts out the Experts by Experience programme. It’s run by a number of “support organisations,” including AgeUK for whom I have worked on a zero-hours basis.

Now, after a protracted procurement process, AgeUK and a number of other charities have lost their contracts in three out of four English regions.

From February 1st, the programme will be run instead by Remploy – once a government agency, now a private company majority-owned by US health and human services business Maximus.

Remploy/Maximus have promised to deliver hundreds more Experts by Experience for the CQC. But the budget is tight and presumably they also have to deliver profits for their shareholders. Hence the big cut in our pay.

From £17.00 per hour, to £9.40 in London and £8.25 elsewhere.

In other words, people with considerable expertise and years of experience, selected through a rigorous interview process and then given specialist training, are being offered the Living Wage.

Less than my student nephew gets for a match-day shift at the pub.

True, few of us became Experts for the money. And we’ve always put in extra hours for free.

But some Experts are retired and living on modest pensions. Others have caring responsibilities or disabilities that make this kind of flexible work a lifeline. For them, the pay cut (announced just three weeks before the new contract was due to start) is a real blow.

But more than that, regardless of personal circumstances, the terms of the new contract are insulting. Not just to us but to the elderly and vulnerable people we’re there to represent. From next week, it seems, their opinions and feelings will be worth roughly half as much as they are now.

So not surprisingly, we’re protesting. Or at least trying to.

It’s not easy communicating with other Experts. Though we have Contracts of Employment, we’re not apparently employees. We’re merely “workers” and as few of us are members of the recognised work-place union, it has declined to get involved. Welcome to the zero-hours world.

But bit by bit we’re connecting with each other and discovering that very few of us are prepared to work for a private contractor for such low pay. (Oh, did I mention they’re shaving an hour off the already short time paid for report writing and a few pennies off the mileage allowance too? The shareholders will be pleased.)

The CQC says it’s aware of our concerns but that the new contract is a good one because there’ll be many more Experts by Experience over-all. But who will they get for such low pay? And when are they going to be recruited and trained?

Calls to Remploy go unanswered. (The receptionist has no extension for the Experts by Experience programme). It has therefore been difficult to discover more about the contract discussions that the CQC says are continuing. So far, our protests have produced what the CQC clearly thinks is a sweetener: existing Experts who join Remploy will get “up to” £15.00 per hour for the first six months of the new regime.

A small pay cut to help a big company get its new business up and running so that it can then take an even bigger slice of our pay?

No thanks.

Unlike the vast majority of people on zero-hours contracts (cleaners, carers, food industry workers… admittedly a growing list), I’m a well educated stroppy middle class professional and I can afford to just walk away.

But I’m sad that an inspection this week was my last. Sad also that there are unlikely to be many (if any) experienced and qualified Experts available for inspections come February 1st.    

And mostly I’m sad – and angry – that the same free market, get-the-rock-bottom-price-whatever ideology that encourages faceless corporations to squeeze money out of public services has now swallowed up a socially valuable job I loved.

Once again, it’s the powerless and vulnerable who’ll suffer as a result.

(UPDATE: Thirty-six hours after this blog was published, the CQC acknowledged the concerns of Experts by Experience and announced an update on its contract negotiations with Remploy. Now, in addition to the offer of six months work at £15.00 per hour, there’ll be an additional six months at £12.50. After that, pay will be set at an as yet undecided rate. (That’s despite Remploy having sent us all details of the very much decided £9.40/£8.25 pay). A sliding scale of insult and uncertainty then. They can still count me out.)

(*While I do mostly elderly care, other Experts focus on homes for people with mental health problems or learning disabilities. We also join inspections of hospitals, GP surgeries and domiciliary care. All are affected by the change in contract)

 

Letter from Spain

If, as Mahatma Ghandi said, “A nation’s greatness is measured by how it treats its weakest members,” then I might move to Spain.

 True, Spain is going through unprecedented economic turmoil. The $36bn in spending cuts planned this year probably won’t be enough to get its budget deficit under control. Unemployment is at a record high 24.4% (twice that rate amongst the young), public sector salaries are being frozen and taxes are going up. It’s tough for everyone certainly. But there’s something about the language of austerity – and the values that reflects – that gives one hope. Neither unemployment benefits nor public pensions are being cut, value added tax is left unchanged while taxes on the wealthy have already been raised.  Plenty of critics of Spain’s bloated public sector and generous welfare state would quibble with the economics of that, but what about the values it reflects? Aiming for healthy public finances is all very well, the deputy Prime Minister Soraya Saenz de Santamaria explained at the time of the budget “but not at any price.” And (bear in mind it’s a centre-right government in Spain) she added that “we have to support those who are in most need and not slow down the necessary recovery.” Quite a contrast to George Osborne’s “tough but fair” welfare cutting, VAT raising budgets in the UK.

I was reminded of this on a warm June evening in Barcelona, as several hundred elderly people gathered around a band on the sea-front. Most sat watching and listening but in a large space at the front, many others danced. There was a waltz, a paso doble, a bolero, every conceivable style – all announced by one of the young women on the stage. The couples (a shortage of men meant some women danced together) launched into steps learned decades earlier but still remembered and executed perfectly. Young carers spun and slid the wheelchair users around. Volunteers stood ready to hand out sandwiches and drinks. All of it was organised by the City government. And why not said one volunteer: “There are so many things for young people, it’s only fair to provide something for the elderly too.”  

 

That fits with the Mayor of Barcelona’s plans for getting through the tough times. Xavier Trias, who’s from a liberal regional party, wants to make Barcelona a centre of economic innovation and growth for the whole of Catalonia. But he says his priority is “improving the well being and quality of life of the people.” It’s probably easier for him than most other mayors to increase spending on social services as he’s done. Tourist heaven Barcelona is doing better than many other cities. In Spain’s patchwork of autonomous regions, the economic pain is not evenly spread. 

I’m no expert on the Spanish economy and I know many of its people are struggling every day – and preparing for worse still to come.  As in many countries, the elderly are having to support children they’d seen off into the world years ago while at the same time, paying higher prices for electricity and food. But at least they’re not blamed for their predicament as the vulnerable so often are in austerity Britain. At least they’re not patronised with the “we’re all in this together” mantra while cuts and tax rises fall disproportionately on the poor. Instead, dignity intact, they’re invited to dance as the sun sets on the waterfront.