A day in the life of a Community Care Assistant

Today Karen’s timetable includes visiting and helping 7 people, all with multiple disabilities.  Most of the people she helps are elderly, some have dementia or other mental health problems, one with anorexia.  Two people need hoisting in and out of bed, and one person tends to be verbally aggressive. Today Karen’s tasks include: help with dressing, showering, and toileting, assisting with giving medicine and feeding, and most importantly for people who may be very isolated, the opportunity for a chat.

Her first visit is at 7.00 a.m, and her last visit finishes at 10.00 p.m. Most of her service users are allocated half hour slots. There are two gaps in the middle of the day – both unpaid.

This is work – often at unsocial hours – at the coalface of “care in the community”. Community Care Assistants are the foot soldiers of the health and social care system where it matters most – in people’s homes. When people don’t have family or a partner able to provide the unpaid care at home, it is Care Assistants who are helping them to stay where they want to be. And yet nationally 40% of Community Care Assistants are earning less than £7.00 per hour, just 50 p above national minimum wage!

The professional nurse, social worker or GP may arrange the care plan, but it is the non-“professional”, the Care Assistant, who has the important role. These personal care tasks that a District nurse carried out up to the 1980s are now undertaken by staff like Karen. This has become a skilled and demanding “professional” job.

The table below tells us something about the current status of the Community Care Assistant role.

National minimum wage	£6.50 per hour (over 21)
National living wage	£7.85 per hour
Median (average) wage of CCAs in UK	£7.90 per hour.

All the Community Care Assistants I have met have been very committed to their job and to the people they’re helping. But they are not getting the recognition or conditions of service they deserve. Weaknesses in home care services largely result from Local Authorities not being able to fund home care services of sufficient quality or volume. This in turn leads to home care staff being inadequately supported and rewarded.

It’s a vicious circle that needs to be broken if care at home is to be given the importance it deserves.

Prevention is better than cure – that is, when it’s available

87 year old Ben is living alone and he’s beginning to let things go. He needs help with his housework, the garden is growing wild and there’s little sign of safety or security about the house. There’s no family nearby, the neighbours are not very neighbourly and he’s not eligible for social care help yet because he can manage his own personal care.
But then Ben has a bad fall. From having no services at all from the State, suddenly Ben is pitched into high cost hospital admission followed by intensive social and health care support at home.

“Prevention is better than cure”. What this would mean for Ben is that if he’d had that little bit of help “upstream” the need for high dependency, and costly, help “downstream” might never have happened.

Last year’s NHS England report, “A Call to Action” agrees.  It says that the NHS must place greater emphasis on keeping people healthy and in “preventing rather than treating illness”. The government is saying the same about social care.  The 2014 Care Act includes a new prevention duty for local authorities.

This is looking optimistic for thousands of people who are in Ben’s situation, but how realistic is it? Across the country grant aid to voluntary groups, for example, to help with housework, befriending, keeping the garden orderly and making the house safer, is under pressure. These service do cost some money, though miniscule amounts as compared to “downstream” health and social care.  It seems likely that this bit of the Care Act may remain as well-intentioned but ultimately hot air.

One alternative scenario to this bleak picture of insufficient funding is in the development of self-help and self-care. Examples of this would be Ben helped to learn how to lead a more healthy lifestyle, or relatives or neighbours popping in to prevent him neglecting himself. This is all well and good if you actually have any family living nearby, or if you have the financial means or strength of mind to take some control of your life. But people like Ben are not so fortunate.

In the absence of any new government money coming in to Ben’s world, another route we might follow lies in encouraging people to take on more active roles in their neighbourhoods as volunteers. Sometimes called “the Big Society”, this looks like a good idea.

But the question Ben’s neighbours ask is, why them? What they see is the voluntary sector struggling to maintain such services whilst the bigger picture is one of growing inequality. This can undermine the motivation to be helpful to others and, without that motivation, the “Big Society” idea will continue to struggle to get off the ground. With Britain’s top executives now being paid 130 times as much as their average employee the Big Society solution right now feels like a non-starter. I fear we will continue to be pulling people like Ben out of the river “downstream”.

Health and Wellbeing Board 17th April

Health and Wellbeing Board: 17^th April 2013

As Healthwatch Nottinghamshire (HWN) Chair I took our seat at the first ‘live’ Health and Wellbeing Board on 17^th April. All the papers presented I thought had implications for Healthwatch work.  To summarise: The first paper concerned the work of the Transformation Board of the Sherwood Forest Hospitals NHS Foundation Trust. By the end of April a “blueprint” of options for future configuration of the component hospitals and their functions and associated community services, including social care, is to be presented to stakeholders. I proposed that HWN should support the local Community and Voluntary Services and Patient and Public Involvement leads of Health services in the public and patient engagement that will now be required across central Nottinghamshire.

A wide-ranging paper from Public Health (which now sits within Nottinghamshire County Council) was a comprehensive attempt to describe the 20 or so factors that are key in leading many children and young people to becoming vulnerable. It was suggested by HWN that future work is required to better establish the actual numbers of young people in contact with those Nottinghamshire services. Knowing this would make it possible to begin to weight the effectiveness of programmes across and between those many factors.

A third paper from the Adult Social Care “Living at Home” programme concerned the impact on social care of the rising number of frail elderly population requiring either long term residential care or more intensive home care. The paper points out that there has to be “organisational cultural change” in the way hospital doctors, GPs, and social care staff tend to take risk averse decisions on behalf of dependent older people. This leads to over use of residential care rather than enabling more integrated home based care. I was interested to know the sorts of approaches that were being taken to begin to address such a major “cultural” change in the routine practice of care professionals, taken together with the natural concerns of carers.

There seems to be a new energy around the County on joint working initiatives between health and social care.  This is being triggered by the issue described above of the impact of an ageing population leading to greater demand on care – but perhaps different kinds of care as the baby boomer generation starts to need help – and all on reducing or static social and healthcare budgets.

HWN will be engaged in this new thinking and action on social and health care integration which is sensible and effective for consumers, action which is long overdue.