Don’t mind the monkeys

A still from the BBC's Winterbourne View Panorama documentary, showing a male care worker standing over a male patient who is stuck under a chair, while another man sits on the chair.Carers and care workers are the best kind of people. So why are they treated so disgracefully?

Yesterday the Guardian published the above article by Rhiannon Lucy Cosslett, best known for co-founding Vagenda magazine and for a column in the New Statesman, which romanticised the role of carers both paid and unpaid. She has a brother who is autistic and has learning disabilities, and recently one of his carers had to resign because her relationship ended and she could not afford to live by herself on a carer’s wages, so had to go and live with her parents a long way away. She called carers “the best kind of people”, doing an often unpleasant job for little money or a small sum in benefits. This provoked quite a bit of debate on Twitter among people who had both been carers and those who needed their care. The general consensus was that calling them “the best people” was not only far too simplistic but also patronising, serving to cover up low pay and stress among the carers themselves and abuse of the people who receive care.

The only care workers I have ever had to deal with personally were at my boarding school, Kesgrave Hall in Suffolk, when I was between ages 12 and 16. They were a variety of ages, a few (mostly older) genuinely caring ones who realised that we needed adults to step in for the parents we had been separated from, and a number of (mostly younger) men who were clearly trying to “get down with the lads”, and some of these were dire, often showing outright favouritism towards their “lads” and openly despising those of us who weren’t the type of boys they thought they had signed up to work with. There was no criminal record vetting then, but worse, none of them received any training from the school and we were told that the pay wasn’t great, despite the reportedly high fees the school charged. And it appears that care work which is unspecialised (unlike, say, nursing) remains a low status job with poor pay and training, and while no other residential care facility is known to be as dreadful as Winterbourne View, the kind of care you get, whether at home or in a nursing or care home, remains a lottery.

I know a few disabled people who do need personal care on a daily basis; things like washing, dressing, toileting, and cooking. One woman I know has severe ME and is both bedridden and incontinent, and has agency carers visit twice daily although her husband cares for her the rest of the time (day and night). She lives in a part of the country where there is more recognition and sympathy for ME in the medical field than elsewhere in the UK, but many of her visiting care workers only know how to care for elderly people, many of whom are hard of hearing, while my friend is often acutely sound-sensitive. Despite frequent complaints, they sometimes turn up as much as 45 minutes early, and forget very basic rules of hygiene. There are, of course, also excellent paid care workers - I’ve seen her and another Twitter acquaintance refer to “Lovely Carer” - but like Megan in Cosslett’s article, even lovely carers often leave, sometimes because their circumstances change or because they are offered a better-paid or more secure job.

Why do we have such poor standards for paid care work? Perhaps because it’s seen as a low-skill job that some people just know how to do, that is generally done for free, and that mostly women do. There is no particular qualification, and I have heard members of “higher” caring professions, like teachers, say that their job is “not just looking after them”, as if that job is unimportant and beneath them. However, we do have certain standards for parenting and whole departments that enforce them, and if you can’t look after a child well enough (or you are seen as not being able to), you risk losing them. Standards for couples seeking to adopt a child are notoriously stringent, with it often being remarked that most parents would not be allowed to adopt their own children. Not every disabled adult is as vulnerable as a child, with many being perfectly competent to decide things for themselves, but some are and those that can speak for themselves do not always have their demands, or needs, met.

The “people do it for free” excuse doesn’t hold up when you take into account that there are plenty of tasks people do for themselves or for their friends and families for free which are a lot less unpleasant than washing and toileting another adult but which pay a lot more if you do them for money, like driving and decorating. If I was asked to work on a Sunday or major holiday like Christmas Day (I’m an agency van driver), I would get a special rate, likely time-and-a-half or double time. This does not always happen for care and support workers. Last Sunday, Mark Neary (best known for fighting his local authority to get his autistic son, Stephen, out of residential care) told us that Stephen’s support worker had not shown up for some reason, and I asked him if the worker would have got a special Sunday rate. “Of course not,” he replied; “that would eat into the agency’s 100% profits”. I would jump at the chance to work at unusual times for better money unless it clashed with an important family occasion; for them it’s just worse work. Filling the Sunday morning shift has always been a problem for him.

Another aspect of why care workers are underpaid and standards are poor is that social care generally is underfunded and funds go towards glamorous or high-profile services. Even before the cuts began after the 2010 election, councils had been cutting their social care costs by refusing services to families whose needs they assessed as less than essential or critical. There has been a long trend towards downward pressure on taxes and hidden services are more likely to be singled out for funding cuts. People simply do not want to pay more tax than they absolutely have to and would rather pay none; it has been known for councils to canvass opinion on what people want to pay a little extra tax for, and for the result to be “nothing”, so they resort to cutting services and selling off assets, such as staff car parks, school playing fields, entire facilities such as disabled people’s day centres and so on. Paying more money to existing workers is simply out of the question.

If we are to attach a greater status and need for training to those who do care work, we should of course do the same for those who hire care workers, including agencies, care homes, boarding schools and anyone else other than competent adults hiring their own carers (and even they should have the right to access vetted and trained carers, but also to hire trusted personal friends if they wish). Besides the agencies that just have poor training and pay, there are some who are actually abusive to their clients, as this blogger found out when using the “services” of an un-named care agency in Portsmouth a year or so ago. She also found that the Care Quality Commission were slow to investigate them once she had been taken off that agency’s books. They must be expected to perform record checks and ensure that they know how to deal with different types of service user appropriately and attend to different types of needs, as well as ensure that they are aware of best hygiene practices, and they must be required to pay carers for all the time they put in, including travelling time between jobs, which many carers are currently not paid for, resulting in pay that is below minimum wage, let alone any idea of a living wage. After all, these are not low-skilled minimum wage workers but people running a business for profit, often at the expense of their disabled clients or their families, or the public,. They should be held to the highest standards.

It is often said that if you pay peanuts, you get monkeys. This is really quite insulting to those who do a good job for little money (though I’ve also heard it said that it’s insulting to monkeys), but it’s also a fact that some of those who dish out the peanuts don’t mind the monkeys. Certain types of service user are not seen as important enough to merit decent care (the impression I got from being called a “little sh*t” repeatedly by certain members of Kesgrave’s care staff). There are people whose attitudes to some disabled people are barely above that level, judging by the abuse they receive in the streets in some places; there is no doubt that society has too low a view of the job, the workers and many of those they serve to fund proper training and a living wage for care workers. What they do is an important job - it’s not a poor cousin to nursing or teaching - and if it’s not done properly, people suffer and some people die.

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