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Living wage is just the start in valuing home care workers

James Archer, 11 May 2015

Increasing numbers of Adult Social Care Commissioners acknowledge their role in driving down the cost of home care contracts, and that by doing so they became “part of the problem”.

The result is staff turnover often over 30% per annum and around 200,000 home care workers paid under the minimum wage, if unpaid travel time between visits is taken into account.

There are welcome signs that growing numbers of new home care contracts with local authorities require providers to pay the living wage.

However, raising pay is easy in comparison with a shift away from ‘time and task’ towards a holistic approach in which home care workers play a key role in the integration of health and social care systems.

Such an approach helps people receiving support to remain as independent as possible, able to achieve their maximum potential and to be treated with dignity, compassion and respect.

This vision transforms the role of home care workers into one in which they will be trusted, listened to, supported and treated with dignity, compassion and respect by their own managers and by health and social care professionals.

Some hope to achieve this through well-crafted specifications, but what is actually required is Systems Leadership, which has been described as a way of working that shares the leadership load to achieve large-scale change across communities.

Systems Leadership goes beyond organisational boundaries and traditional ways of working and extends across staff at all levels, professions and sectors. It involves people using services, and carers, in the design and delivery of those services.

Local authorities will need to develop genuine partnerships with home care providers, recognising that home care workers are often the person in most contact with the person needing support, and with the most knowledge of their changing needs.

Genuine partnerships can start to build the trust that is so sorely lacking between home care workers, their employers, commissioners, social workers, district nurses and GPs.

Research by Jill Maben, Director National Nursing Research Unit, et al has shown that compassion only grows where staff feel safe, and that lack of trust erodes nurses' professional values and desire to do good.

Maben cites the following prerequisites for compassionate care to be delivered:

  • motivated and receptive colleagues;
  • adequate staff and good skill mix;
  • ideas welcomed and change encouraged;
  • support for staff through mentorship; and
  • a support period for new staff.

That all needs to be underpinned by a philosophy of care that supports compassionate care.

If it is hard for qualified nurses to feel trusted it is far worse for care workers! Too often, they have been ignored in the creation of new models of care for people living at home, but they need to be seen as central participants in any new service design.

The first step is to start building a shared understanding of the new role between the councils and the providers.

This new understanding must be used the create the conditions where compassion can flourish or else the onslaught of five more years austerity will overwhelm and undermine attempts to transform care at home.

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