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 angledI
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 purchasedor
what is being purchased, because it may not be care; it may be
a productis 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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