Select Committee on Work and Pensions Minutes of Evidence


Examination of Witness (Questions 268-279)

5 MAY 2004

MR BILL MCCLIMONT

  Q268 Chairman: We are covering a wide area of different interests and we now welcome from the UK Home Care Association Mr Bill McClimont who is a consultant there. Thank you very much for the written submission that you have made. We have particular interests that we would like to canvas with you from your own perspective, but could you spend a moment talking about what your experience is of the kind of resources that are available in this area, whether they are adequate for the purpose in terms of the modern workplace which you deal with in your professional life and then maybe we will go on to some more technical questions after that, if we may.

  Mr McClimont: I was particularly struck by a comment a moment ago about the shift of care from acute into residential care and from residential care into home care and so on, words that I have used myself over time. It is a particular issue that very often commissioners of services are expecting still to deliver care with the resources they had 20 years ago or equivalent, when the demands are so much greater; when also the level of regulation and expectation has rightly been increased. We are attempting to create a safer and better workplace and a better experience for the people who encounter services. The progress of that is not helped by the general absence of resources in the sector. For another purpose, I have just been doing an estimate of what it would take to achieve adequate levels of recruitment and retention in the sector and will be recommending to officials in the Department of Health that something of the order of an investment of £900 million in workforce pay and conditions alone is required. I have a meeting at their invitation to discuss that. That is an indication of the level of shortage that we are talking about. When that is on such a basic subject as pay and conditions, I have estimated training on top of that as being several hundred million pounds further. I am a board member of TOPSS (England) and over the next few years our estimate is that the requirement for training in the social care sector is of the order of £800 million but that is over a period of five to six years.

  Q269 Chairman: Do I understand you to say that that is a written document or a report of some kind?

  Mr McClimont: I have been involved in the preparation of it. The strategy has not yet been published, but it will be in the near future. It is part of the ongoing strategy of TOPSS England, which was the National Training Organisation for Social Care and will be the Sector Skills Council.

  Q270 Chairman: If it is available it might be of interest to colleagues, if it is in a form that you would be happy to share with us.

  Mr McClimont: That would be up to the organisation itself, I think, but certainly I can provide contacts for that.

  Q271 David Hamilton: I noticed you were sitting at the back of the room and agreeing with a number of things that were being said by the witnesses in the earlier evidence. Could I stick with the theme about the care plans that are being put into operation? I belong to that generation where I can remember a number of people who have moved into institutions in many cases and the Government, quite rightly, and the previous government also, took a decision to move back to care in the community. However, many people feel that the care in the community plan did not come up with the back-up information and resources that were required. As an ex-councillor, I am mindful of the fact that many people are under extreme pressure, looking after family members, whether it be the mother, the father, the daughter, the son or whatever. When we talk in terms of some of the issues about training and equipment that are not there at the coal face, if you like, there is virtually nothing like that when it gets to the home, especially when you look at a one bedroom flat or something like that, where the equipment basically is not any use. To what extent is health and safety legislation properly understood and applied within the home? How does that work?

  Mr McClimont: I think in the context of this it should be remembered that something like eight times as much care is delivered by those informal family members, neighbours and so on in the home as is provided by all of the formal services altogether. health and safety legislation leaves a vacant spot in relation to accidents occurring in that kind of care because it does not have the remit over that. It is not a workplace as such; it is what one person does for another. That context aside, home care has been the poor relation for a long time in relation to the way that health and safety thinking has developed. health and safety has not been addressed for the sector in the way that it should be. Indeed, there are some specific characteristics of the sector that appear to have been unaddressed and I have been trying for some years to persuade the Health and Safety Executive that they should be addressed. I have a letter, for example, which I discovered in developing this evidence that I wrote to the Health and Safety Executive in 1997 requesting that we got together to discuss these issues. Despite some degree of pestering, I was unable to get them to respond. Their view was that they were adequately dealing with the issue by talking to representatives in local government. This is one of those examples of being outdated in that 70% of home care is delivered by independent sector organisations; yet, the Health and Safety Executive is apparently considering that they are discharging their need to discuss things when they discuss then only with the minority provider.

  Q272 David Hamilton: You recognise the gains for health and safety at the workplace and in the private home. How would you change that? What needs to be done to make that fundamental change?

  Mr McClimont: There are a number of building blocks that we have managed to put into place. The new minimum standards for home care address this, in particular addressing the balance required between the interests of the user and those of the workers. We are particularly keen in UKHCA to identify that it is no good delivering a service which is not what the individual user needs. Moving and handling is one of the critical issues and one of the areas where we would acknowledge that far greater training is required, far greater knowledge of risk assessment and better practice on risk assessment is needed; but where this balance is starting to become too angled—I will not say in favour of the workers; it is in favour of over-caution. It is important that we keep workers safe, but it is not necessary for us to be over-cautious in doing so.

  Q273 David Hamilton: What support is given to the families? You say eight times the amount of support is given by family members personally. I know the Government made great strides to giving attendance allowances and putting a financial commitment in there, but what other things can be done to assist family members to get that support?

  Mr McClimont: There has been good progress in the provision of aids and adaptations, but it is still only addressing a small fraction of the issue. A great many of the people who are delivering this kind of care have not yet reached the attention of social care services; or indeed, once they have reached their attention, are not eligible for assistance because frankly they have too much money. The moment that you have resources, you tend to fall out of the remit of many of the services that are available statutorily. It is then a bit of a lottery whether you know of the existence of other services or potentially of aids and adaptations that might be available on the High Street.

  Q274 David Hamilton: Who would be the organisation that would deliver that service?

  Mr McClimont: If not the social services, there would be some support potentially from housing departments, but very large numbers of people in this situation are not eligible for those kinds of support.

  Q275 Mrs Humble: You mentioned earlier that the bulk of home care is provided by the private sector and a proliferation of organisations. We also have many people who purchase care themselves privately, if they have the resources and increasingly people are employing private home helps without any assessment of need and indeed sometimes private nursing care. Secondly, there are also more and more people now receiving direct payments from social services departments, so they are the employer, even though it is public funding that is going into their home. How can health and safety regulations get into those people's homes? I know that with direct payments obviously there has to be a plan with social services so there is an involvement there but nevertheless it is the person receiving care who is the employer, who is paying out the payments.

  Mr McClimont: I would not over-specify the plan with the local authority. Once they have decided how much money a direct payments recipient is entitled to, they are not entitled to make any statement as to how the care is delivered, whatever. They may regularly check that the care being purchased—or what is being purchased, because it may not be care; it may be a product—is meeting the needs that they have assessed, but that is the limit of their powers in that respect. How do we get health and safety regulations into the home? I think the sad thing is that they are already there. Effectively, they apply to an individual as an employer in exactly the same way as they would apply to ICI. The trouble is that that individual as an employer does not know that and has a lack of knowledge. I was particularly struck by the evidence of NCIL who were emphasising the need for training and support for individuals as employers because, in the absence of that, they may well be creating very, very severe problems. We have an issue also in home care particularly that those private individuals, still unknowing and uneducated on the subject, have a joint responsibility for health and safety even with formal services when they are purchased. When a care worker, be it from a statutory organisation or from a private organisation, comes into their home, the individual has a legal responsibility under current health and safety regulations for the condition of the home and for part of the way of safe working. This is not something that is very widely publicised. It is certainly not something that is adequately insured and I think the level of information is important. Direct payment support schemes ought to assist that. Whether they are going to be adequate or not, remains to be seen.

  Q276 Miss Begg: A lot of the pressure for direct payments and allowing someone to purchase their own care has come from younger people rather than elderly people with disabilities because if you go through the social care system of the local authority they have to take what they get. Very often they feel that that person does not fulfil their needs so they are very attracted to being able to purchase their own care. One of the reasons that they often do not get what they want from a social work department is because of the constraints of the health and safety legislation which is enforced; whereas, when they act as their own employer and can get someone else in, they will change the light bulb and change the curtains and do the bits of housework that the home help employed by the local authority simply will not do because of the health and safety constraints. Is that a pattern that you have picked up? To what extent is that going to be a problem and, given what you have just said in your answer to Joan Humble, is there a disaster waiting to happen where a privately purchased home care assistant falls off a step ladder and then sues the person who is their employer?

  Mr McClimont: To answer that last question first, yes, it will happen. health and safety accidents happen in every workplace. When we are talking about tens of thousands, as we will be very soon, of these kinds of employer relationships, accidents will happen. The chance of that accident happening is aggravated severely by the absence of proper information and support for the individuals as employers. I think the disaster will be rendered even more acute by the absence, in most cases, of insurance held by those individuals to cover their liabilities. Speaking from my own particular perspective inevitably as a representative of formal providers, one of the concerns that we have is that because of that void of recourse, even when formal services are purchased, there is a tendency for the legal liabilities of the individual to be underplayed and for the formal provider, as the only insured person in the triangle, to be engaged by the courts as the person liable.

  Q277 Miss Begg: Is one of the answers to this that we really need the public sector to be much more flexible in what it can offer individuals so that it is the public sector they buy their care from rather than from somebody they have advertised for off the street who may not even be trained?

  Mr McClimont: I think it is important that flexibility is there. I would put it slightly differently and say that I think it is important for those who are aiming to deliver services of this sort to remember what the service is they are trying to deliver. In social care particularly, it is very different from an acute setting, where procedures are done to people.

  Q278 Miss Begg: You take what you get.

  Mr McClimont: In social care, we are attempting to encourage the independence of the individual, encourage their empowerment, to get them to take risks. It is an oddity that the standards for care in home care are specific: that you must encourage a user to take risks. That sits very uneasily with a health and safety approach which says you must minimise risks. I feel that health and safety ought to be a balance. I think the legislation probably is a balance. Unfortunately, many people who interpret that legislation balance that far too far on the precautionary side.

  Q279 Chairman: Do you have anything else for us? We are grateful for the written evidence. It is very helpful and you have been very clear this morning in your oral evidence. Is there anything else that you think our attention should be drawn to?

  Mr McClimont: I would like to draw your attention to a modest piece of work that I led for TOPSS England, the training organisation, in conjunction with the Recruitment and Employment Confederation who represent agency workers. This is a set of guidance which is intended to help people who provide agency workers to statutorily regulated services to see their way through the maze of regulation. It includes some work on health and safety, particularly in relation to agency workers and in relation to home care, which I created in conjunction with HSE and which hopefully would take that issue further forward.

  Chairman: That would be very helpful. Thank you very much for your appearance this morning and for your help with the written submission.





 
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