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TX: 24.01.08 - The Cost of Care

PRESENTER: LIZ BARCLAY

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THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.


BARCLAY
Imagine if you - if someone timed you while you got washed, dressed and handed breakfast this morning. Well some local councils are doing just that with care - paying care minutes for the carer they employ from an agency. If it takes 28 minutes to help someone get washed, dressed and have breakfast then that's what the local authority will pay for, there's no rounding it up. The authorities use telephones to monitor exactly how much care is being given so that they can buy it in minutes rather than blocks of time. So is that flexible thinking or cost cutting? Carolyn Atkinson is here. Carolyn?

ATKINSON
Well this comes on the day that the Local Government Association is warning that council tax bills are set to rise by an average of 4% in England in the next financial year and despite this rise they're saying at the same time services will either be cut or rationed and that will include services including help for elderly and disabled people. Now it's no secret that local authorities are under increasing financial pressures and as we've been reporting throughout our Care in the UK season they're already rationing who gets the care and they're only providing help to the most needy and they're leaving other people without any help. Well now we've discovered that a number of councils are bringing in a pay per minute system, so that they only pay agencies for the care that is actually given. Well I've been on the rounds with paid carer Angela Nyack [phon], as she arrived to visit her client, Alan, a former actor who had a stroke 11 years ago, he gets one hour's care in the morning to help him get up, showered, dressed, have breakfast and get ready for the day but that can only happen after Angela has clocked in.

ACTUALITY - CLOCKING IN
ANGELA
Morning Alan. How are you?

ALAN
There you are, ta.

ANGELA
I'm just going to log in.

ALAN
Okay thank you, right.

ANGELA
I'm logging in. It's a new system, so I have to log my pin number in, the time I'm entering the client's and now I'm logged in.

ATKINSON
So that means you start getting paid?

ANGELA
I start getting paid now from this minute.

ALAN
From that minute.

ANGELA
From this minute. I wasn't happy about it at all, you know, because I mean I've been doing this a long time, I don't think you should be timed by what you do, it's the service we give - it's not the time, it's what the quality of the care what the client gets.

ATKINSON
How do you feel that if Angela works less than the allocated hour slot she may not get all the money for helping you?

ALAN
It's dreadful and they call it Easy Tracker. And they can keep track of us. I think it's like they don't trust us and I think it's a dreadful system. I mean - cos I mean caring is a very dedicated job you know, I'm sure you know that, yes. And one feels that we're not trusted and it doesn't make - doesn't make for good working relations at all. Medication.

ANGELA
There you go. He's very good, Alan, he doesn't any water to take his tablets, he just pops them in and swallows them.

ATKINSON
Okay, well I'm going to let you get on, get up, and I'll come back to you in a little while. And we're now about 10 minutes into this one hour session.

ANGELA
Right, splint.

ATKINSON
So the clock is ticking and councils are keen to only pay for what they get. Almost £15 billion a year is spent on social care services in the UK. Mike Gillett is from Harrow Council, which has just introduced a pay per minute system.

GILLETT
The new contract for our home care services, which came into effect on the 1st December, we've moved to commissioning the service on an actual time delivered rather than in blocks of 10 minutes which we previously used.

ATKINSON
So when you say an actual time delivered, what do you actually mean by that?

GILLETT
Well it enables us to commission a specific amount of time to the minute from the care provider. We usually commission a minimum of 20 minutes but that can be flexible. Previously we would have allocated 10 minute blocks, so that meant if a task had taken 25 minutes we'd have commissioned 30 minutes of time which meant there was five minutes spare time. What it means is we can actually now commission to the minute, so if we think that a particular care plan needs 28 minutes we can commission 28 minutes, it's a more flexible system.

ATKINSON
People - some people would say flexible, some people would say that's just beyond sensible and is encroaching on the service user's needs. Why not just - if it was 28 minutes, why not just round it up to 30?

GILLETT
Because of what I've already said I think - that one of the models we're rolling out is about commissioning a period of time that the service user decides how that time is going to be spent. It's about efficient and effective use of the resources that we have.

ATKINSON
So it is to do with money then isn't it?

GILLETT
Well only in the sense of how we use the most effective - this isn't about cutting a service, it is about commissioning the time that is required rather than having a system which was inflexible.

ATKINSON
Angela Dyas, from the Harrow Association for Disabled People, welcomes the pay per minute system saying when time sheets were used to monitor care giving it was open to abuse.

DYAS
I would say it was quite common for people to turn up at someone's house and be contracted to stay for an hour and stay half an hour. Now I don't actually think that anybody gained from that really because the person who was cared for generally got sub-standard care because of it. The council still ends up paying the full hour because the person presents a time sheet which said they had been there for an hour. There are some carers who would never have abused the time sheet system because it just was - because it wasn't within their ethics but it did allow people who were willing to do that. And the worst example I can think of - and I have come across many - but the worst thing I can think of is a woman who was left for nearly a week and she was meant to have visits by a carer every single day, she was dying and she had no care and she was incontinent and she couldn't feed herself, she couldn't provide herself with food or drinks and as far as the agency was concerned that carer had been - a signed time sheet had been provided for the amount of hours that she was meant to be there for.

ATKINSON
But Mike Padgham from the UK Home Care Association, which represents the agencies which provide carers to councils, disagrees.

PADGHAM
The vast majority of carers are very responsible and we would refute very much that people are sort of forging time sheets if you like to actually make sure that they get paid. Very often people will perhaps they might arrive a little bit late because the last client needed extra attention and then they might have to leave a bit earlier sometimes to get to the next client on time. We're asked to do more and more tasks in shorter and shorter time and that can't be right for the clients, it can't be right for the carers and I just reflect on what the Commission for Social Care Inspection recently said about 15 minute visits, that they don't like them, we don't like them.

ATKINSON
The chairman of the Commission for Social Care Inspection, Dame Denise Platt, is worried at this new trend.

PLATT
We know that people already feel that they're just a list of a tasks, they really resent time being allocated to them in smaller and smaller slots of time, like 15 minutes or less. And unless people have asked for that we really do feel that allocating time by such a small amount moves against all the current policy direction for individualised care. It flies in the face of providing care that respects people's rights, dignity and their needs. Now if people receiving care and those giving it are watching the minute hand on their wristwatch, to see whether they can either afford to have a conversation or whether the care worker is thinking about the next person they go to, then that really is not a good supportive quality experience for either worker or the person in receipt of care.

ATKINSON
But for Sarah Pickup from the Association of Directors of Adult Social Services, ADASS, this is the way forward. She says another 35 English councils will have brought in some form of electronic monitoring by March.

PICKUP
I don't think any of us expect to pay really in life for what we don't get. Now it's been difficult to do that precisely in the past but this system is one way of doing it. It is our job, as councils, using public money, to make absolute best use of every penny that we've got. And if we're paying for services that aren't being delivered we are not serving our clients well. So this is not about cutting services to clients, this is about using our resources efficiently to make sure that the pennies we have got are spent effectively on clients.

ATKINSON
And next month Harrow Council will consider whether elderly and disabled people who have to contribute towards their care should also pay for that care by the minute. Back at Alan's house carer Angela is getting ready to log out after doing her one hour but she thinks this is a system which will deter people from joining a profession that's already facing high turnover, low pay and low morale.

ACTUALITY
ANGELA
Nice and clean. Ready to face the world, it's very nice.

ALAN
Looking nice. It's raining like hell out there isn't it.

ANGELA
It is. I'll go and prepare your breakfast, what would you like for breakfast, you want crumpets this morning yes? You don't want cereal, do you, or do you want both?

ALAN
No I'll just have crumpets.

ANGELA
Just crumpets, yeah.

ALAN
Two crumpets and a coffee.

ANGELA
Lovely okay. Yeah and you'll be down.

ATKINSON
What affect has this being paid per minute having on carers like yourself?

ANGELA
Well carers are leaving or they're not just taking on jobs where they're given - well you can't do it because you haven't got the time.

ATKINSON
So some carers are refusing to do the 15 minute slots maybe?

ANGELA
Well yes, oh yes correct. I don't - I won't do 15 minute slots, it's not worth my while.

ATKINSON
So why do you keep doing it?

ANGELA
Because I love my job, I love caring for people and I just enjoy my job.

ATKINSON
So coffee and crumpets.

ALAN
Coffee and crumpets - that's breakfast yes.

ATKINSON
So Angela's about to clock off. So Angela, time now, exactly an hour.

ANGELA
Yeah, so I'm logging off. Give us a kiss. We always do this. We're lovers really - not really. Right Alan so I'll see you later.

ALAN
See you later darling, yes.

ANGELA
Okay have a nice day.

ALAN
Bye love, bye darling.

BARCLAY
Angela Nyack and her client Alan ending that report by Carolyn Atkinson.

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