Need replaced by ability to pay
As statutory care provision is reduced to the barest minimum, private companies have stepped in. Quality of care, and working conditions for staff who provide it, are driven down as companies compete for contracts and maximise profits. Those who can pay for care are increasingly divided from those who cannot. The hundreds of thousands of working class people who rely on affordable care and those on the front-line of provision are caught up in a race to the bottom.
Home care is being hit hard by cuts and privatisation. Local authorities are reducing their spending by contracting with the cheapest company, while also cutting provision. 85% of councils now restrict provision to those with ‘critical’, or ‘substantial’ need. Others are left to find care elsewhere, either by paying for it or by relying on family. The sector is dominated by private interests, including private equity firms. 6,850 registered home care providers, voluntary and private, provide 89% of all care. Companies such as Care UK, Terra Firma and Saga drive down wages, conditions and the length of visits to provide the cheapest package, and then offer ‘top-up’ care at extra cost. The move to personal budgets, with ‘clients’ controlling a budget in order to buy packages of care, will reduce access and entrench a two-tier system based on who can pay rather than on need.
These attacks are already having a marked impact on working conditions. Unison found that over half of home care workers had seen pay cuts in the past year, with almost 60% having fewer hours. Conditions were considerably worse in private companies, with vastly increased use of zero-hour contracts, and while 99% of council home care workers receive sick pay, only 40% of private employees do.
Poverty pay and zero-hours contracts
Home care workers describe fragmented days where back-to-back 15-minute appointments have to be cut short for the worker to rush to the next one, only to be followed by long unpaid gaps, waiting for the next visit. Workers are increasingly paid only for the minutes they are actually in people’s homes, meaning an estimated 160,000 to 220,000 home care workers earn less than the minimum wage of £6.31 an hour. Almost 60% receive no pay for time spent travelling between visits and some workers have to pay for their own petrol costs. Additional pay for unsocial hours or enhanced care is being scrapped. Care-workers battle to meet the needs of the people they care for: ‘The terms of my employment would never dictate the level of care I provide although this means I am often breaking the rules or working unpaid.’
The problem is compounded by zero-hours contracts. 150,000, or 56%, of home care workers in England are on zero-hours contracts. Many have no option but to work weeks without a day off when hours are available in order to make up for the times when there is no work. The lack of a regular income and fluctuating hours is particularly punishing for those with children or personal caring responsibilities; 84% of carers are women. The turnover is high. The number of migrant workers more than doubled in the sector between 2001-09 and continues to rise. They are concentrated in the lowest paid jobs, the most exploited in an already underpaid and overworked workforce. In addition, apprentice care-workers are paid pitiful wages under the guise of training. While 58% of care managers are union members, only 24% of home- care workers and support staff are.
Both Islington and Southwark councils will require companies in the future to pay the London Living Wage, and Southwark also plans to ensure companies that win tenders phase out zero-hours contracts. These are positive but very limited steps, showing that pressure must be put on other councils to demand fair wages and working hours, and accessible quality care for all.
At the heart of the problem lies the commodification of care; vulnerable people becoming potential sources of profit. In order to maximise returns, both accessibility and quality of care, and workers’ pay and conditions are driven down. As one worker explains, ‘I am unable to provide full amounts of support time to the clients, yet they are still billed by the company for it.’ Free, accessible, dignified and compassionate care should be a right for all.
Rachel Francis
Fight Racism! Fight Imperialism! 236 December 2013/January 2014
