It’s the biggest industry most people never give a thought to, until they find they need it

It’s the biggest industry most people never give a thought to – until they find they need it. Only when someone starts to require personal support that the family cannot provide do most of us begin to explore the scale and scope of UK adult social care, a sector that employs 6% of the entire labour force and makes an estimated contribution to the economy of at least £43bn.

However, that exploration typically happens under pressure and often in crisis, which is why the sector is making unprecedented efforts to raise its profile. It aims to demonstrate the full range of its services, so that people are more familiar with what is available before they hit crisis; to show the variety of rewarding jobs and careers available in delivering those services; and, not least, to reassure families that incidents of poor care exposed by recent high-profile scandals do not reflect the sector’s prevailing standards.

The social care world acknowledges there are issues of care quality to address: moves are under way to make a decisive improvement in staff training, to ensure services are organised around the needs and wishes of the individual, rather than to suit the system, and to tackle the low-pay image that blights the sector – though achieving a real breakthrough on that front will depend on significantly more funding.

People may never come to talk about “social care” as familiarly as they do about the NHS, but there is a real sense that this sleeping giant of a sector is stirring and starting to make itself heard.

We still know too little about the sheer size of the social care industry, which is overwhelmingly in the private and voluntary sectors, but still funded to a large extent by the taxpayer. An analysis published in early 2013 by Skills for Care, the sector skills agency, put the full direct and indirect contribution to the economy “conservatively” at £43bn a year, with a total 1.6m jobs in England alone being carried out by 1.5 million people. Given our ageing population, plus growing demand for support for young people with disabilities, those figures are certain to be rising.

In some communities, particularly popular retirement areas, social care is now likely to be the biggest single source of employment. But getting a full picture is difficult, especially as more people are arranging and paying for their own care and support (often with direct payments provided by the state through personal budgets), including perhaps 100,000 who are employing one or more personal assistants (PAs) to help them live independently.

Being a PA is only one of a growing spectrum of jobs on offer in the sector, the importance of which is often under-appreciated even by the people doing them. After she carried out a recent review of working conditions in social care, Labour peer Denise Kingsmill observed: “All too often during the course of this review, I’ve heard the words ‘I’m just a care worker.’” As she went on to comment: “It’s not a job for the faint-hearted – and it’s certainly not ‘just a job’.”

Skills for Care’s annual Accolades awards highlight some of the remarkable work being done by social care staff. And the rewards can be considerable, in terms of both job satisfaction and material benefits. Skills for Care’s own chief executive, Sharon Allen, is one of a growing list of sector achievers who have worked their way up from the entry-level role of care assistant.

Many workers like the flexibility of the job, which can often be tailored around childcare or other commitments, but there is no doubt that this flexibility can contribute to the sense that, as Kingsmill concluded, “care workers are undervalued, underpaid and under-trained”. Homecare workers talk of being paid as little as £1.70 for a 15-minute visit to someone’s house or flat.

A concerted drive is being made to eradicate such flying visits unless they are simply to check on a person’s welfare rather than carry out personal care tasks. Other moves to address concerns over the quality of care include the introduction next spring of the care certificate, a common minimum qualification for both social care and healthcare support workers, which will ensure that all new staff have instruction in basic issues such as ensuring the dignity of those receiving care – an issue that has featured strongly in scandals in both the social care sector and the NHS.

Meanwhile employers and workers are being encouraged to sign the Social Care Commitment, a pledge that people who have care needs will always be supported by skilled people who treat them with dignity and respect.

Some care needs will in future undoubtedly be met by means of assistive technology. Telecare and telehealth developments offer exciting opportunities for remote checking and self-monitoring of people living with long-term conditions. But in the end, personal care is a hands-on process and there can be no substitute for human interaction.

Because of this, and because of demographic trends, social care is one of the few sectors of the economy that is guaranteed to grow. The big question is where the money is going to come from to support that growth. The Care Act, to be implemented in 2015 and 2016, will start to inject extra funding into the system. But more, much more, is going to be needed to ensure an adequate supply of skilled and dignified care by well-rewarded workers.

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How to find good care

"Choosing care can be one of the most important decisions an individual ever makes"

Finding the right social care and support can appear overwhelming whether you are an older person realising you can no longer live independently in your home, or somebody younger learning to live with a disability or chronic mental illness.

It can be even more daunting when, as often happens, your search for care is triggered by a personal crisis. GPs can frequently be the first port of call for help and advice.

“Patients don’t know where to go because there is so much misinformation and gaps in information, and GPs are always there so they come to us for help and advice,” says Sheffield GP Prof Nigel Mathers, a spokesman for the Royal College of GPs: “People are desperate.”

So how can you remove the worry about finding care and when you do find it, what do you need to look for as a guarantee of quality?

A database of all social care providers in England, which can be searched according to postcode, can be found on the website of the Care Quality Commission (CQC) – the statutory body that regulates social care and health providers. Inspection reports are accessible to the public and rank services from outstanding to inadequate, allowing comparisons to be made. Service providers are expected to have a written summary of the inspection and its ranking for anybody interested in the service who does not have access to the internet.

From this October, the inspection team includes an expert by experience – a carer or somebody who has personal experience of care to “get under the skin” of what is on offer, according to Andrea Sutcliffe, the CQC’s chief inspector of adult social care. “But nothing beats going out and seeing it. People tend to make decisions about their care in a bit of a panic, the most important thing is for people to think in advance and ask themselves: ‘What are the things which are important to me?’”

Deborah Stone, co-founder of the website myageingparent.com advises visiting a care home or other service unannounced – especially at busy times of the day. She says: “Just turn up on the off-chance and if they are difficult about letting you see things then I think that says a lot about the place. Does it smell or are there cigarette butts outside the place which would indicate the home is run for the benefit of the staff and not the residents.”

Local authority social services departments are another traditional route for accessing care and support. As part of the health and social care reforms, each local council is expected to have a database of all care and support services in its district, although it can often be the same information available from the CQC website.

The first step towards potentially accessing statutory care services is to request a care needs assessment by social services. Everybody is entitled to ask for an assessment even if there is no intention of using statutory care or support services. People can self-refer or can choose to go through their GP or social worker if they already have one.

People with mental health problems who need social care could also ask their community mental health team for a referral; charity Mind also has a step-by-step guide on its website about how to go about finding social care support.

Other charities provide similar resources. Age UK, for example, has a factsheet about how to access social care on its website and Mencap – the charity for people with a learning disability – has a wealth of advice, all written in accessible English.

Phil Barrow, Mencap’s director of services, says choosing care can be one of the most important decisions an individual ever makes but the quality of information held by local authorities about what is available on their doorstep is variable. He says: “We are one of the few national organisations that provides specific information about learning disability care providers in different localities. Mencap Direct also offers background information about determining quality such as looking at whether a service is registered or not and the CQC ratings.”

The government’s NHS Choices website has a section devoted to care and support, which explains how to access services, funding options and make the right decisions.

The Find Me Good Care guide written by the Social Care Institute for Excellence (Scie) – the agency devoted to improving social work practice – is another handy resource. The section “care for different people”, where individuals can find out their options according to their own specific needs – such as dementia or drug or alcohol misuse – is especially useful and popular. Scie’s head of marketing and communications, Iris Steen explains “We don’t have a hard copy of the guide but what we have tried to do is make it easy to print out sections so that the information can be shared.”

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How to deliver good care

"is the service safe, effective, caring,
responsive to people’s needs and well-led?"

Stories highlighting abuse and neglect in Britain’s care homes regularly hit the headlines. They conjure up an image of a sector with a dark side employing sometimes violent or sadistic staff with no compassion for the vulnerable people they are meant to care for. Every scandal chisels away at public confidence in the quality of the social care workforce and the standards of services which people can expect of care providers.

The scandals present a constant challenge to the sector to produce the evidence that its 1.5 million workforce is well trained, highly skilled and committed to providing high-quality person-centred care. This month the Care Quality Commission (CQC), which regulates care providers, introduced a new regime, which it hopes will give it a broader deeper insight into the quality of services. Inspection teams, which will now include a former service user, will need to answer questions on five key points – is the service safe, effective, caring, responsive to people’s needs and properly led?

Andrea Sutcliffe, the CQC’s chief inspector of adult social care, expects the new system will allow inspectors to make “robust” judgments about the quality of services being offered.

The new inspection regime is just one of the steps being taken across the sector to address quality. The Social Care Commitment – a public declaration that an individual employee or care organisation is devoted to quality care and support – was launched last September by Skills for Care.

So far it has received 2,000 signatures; staff or providers who sign up to the commitment make seven promises, which include respecting an individual’s privacy and delivering care with dignity – a message reinforced via its national dignity campaign.

The commitment is triggering a culture change, according to Skills for Care’s chief executive, Sharon Allen: “It’s really helping people focus on the things that are needed in terms of investing in the workforce with the message that person-centred approaches have to be a two-way thing. You can’t expect support staff to provide person-centred care unless you as a provider provide person-centred investment in them.”

A new care certificate, which will set the minimum training standards required of care support staff before they can work unsupervised, is being piloted in different care settings across England and is expected to be introduced next year. It spells out the values, behaviours, competences and skills required to deliver quality and compassionate care.

Although not compulsory, it will be looked for as part of the regulation process. Nadra Ahmed, chair of the National Care Association, a membership organisation representing around 3,000 providers in England across different client groups, says: “It reiterates what good practice is and if it changes practice in 10% of care homes then it will be a good thing. The single most important thing which all care homes should be doing is looking after their staff to ensure from the outset that they understand the ethos of the service and that they are clear about the outcomes they expect so that staff are given the tools through their training to deliver that.”

Introducing registration for social care support staff linked to a professional code of conduct – first mooted by the government in 2011 and, according to Allen, has broad support from providers – has so far failed to move beyond a proposal by the Health and Care Professions Council.

Local authority employers are also working together to improve quality in care. The Association of Directors of Adult Social Services (Adass) is developing joint social care and health budgets in an initiative with the Local Government Association. Another joint project focuses on safeguarding adults.

“It’s about looking at safeguarding from the point of view of the service user and about what risks they want to take and to make the plan more focused on what they think the issues are,” says the Adass president, David Pearson. “Individual initiatives like the commitment and the dignity agenda are terrific and we have signed up to them but what we really need is a systematic approach to this.”

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Social care careers

Sian Brookes could have had the pick of any top graduate scheme. With a first in English and theology from Cambridge under her belt, friends and colleagues expected her to opt for a high-flying career in banking or financial services. But 26-year-old Brookes chose a different path and joined a graduate development programme run by the National Skills Academy for Social Care.

One year on she is now a project manager for Age UK and is convinced she made the right choice. “I wanted a career that I felt passionate about but I also wanted a career where I would be able to use my brain. I thought social care wouldn’t necessarily allow me to do that. But that’s not been the case and I feel passionately about wanting to promote social care as a career path for those who have come from a similar background to me because it’s not presented as an option.”

Lack of knowledge about the sector among potential high flyers such as Brookes illustrates one of the key challenges facing the sector, which already employs 1.5 million but needs to recruit for at least another one million job roles by 2025. Annette Baines, programme head of recruitment and retention at Skills for Care says: “The first priority for us is how can we attract people to the sector if they don’t know what the sector is about? People don’t understand the job roles available, there is still this image that if you come into social care you are going to do one of two jobs – be a social worker or a care worker working with an older person making them a cup of tea.”

But the reality of a career in adult social care paints a very different picture. There are around 27 different roles working with different client groups including older people, people with a learning disability or those with mental health issues. Jobs range from support worker, care coordinator or independent living adviser to care home manager. There is the chance to go on to train as a social worker or therapist and there is also a need for the expertise which applies to running any other business such as admin, human resources and finance.

While the sector still struggles with low pay at some entry-level roles, increasing demands are beginning to push up salaries. Earlier this year a survey by healthcare analysts LaingBuisson revealed that the days of a care home manager on a £100,000-a-year package were on the horizon. Report co-author James Rumfitt said at the time: “Groups want somebody who can run a business, not just someone who can tick boxes.”

Adult social care also has a strong tradition of investing in its staff and offering work-based learning. It is a culture that has paid dividends for Baines, who started her career as an unqualified care assistant on minimum wage. In the last two years, 133,401 adults began a social care apprenticeship with 76% staying in the sector once they completed the programme.

There is now the option to complete a higher level 5 apprenticeship in care leadership and management which has equal status to a foundation degree. And, uniquely, the qualification offers the opportunity to accrue higher education credit points which can count towards a future degree.

While the sector may be looking to fill a million more job roles in the next decade, it is crucial, says Baines, that it attracts the right kind of people with the right values to work in care. Towards that goal, the National Skills Academy for Social Care, Skills for Care and the charity MacIntyre have developed a values-based recruitment toolkit for employers. Resources include a model advertisement which promotes an organisation’s values and an online personality profiling questionnaire that prospective employees can complete to assess their individual values and behaviours.

The questionnaire builds on groundbreaking work by MacIntyre four years ago when it carried out research to find the personality profile of the perfect care worker. It found that ideally the individual should be an introvert who likes to work in a structured environment and takes a low-profile approach in the workplace, yet is a confident decision-maker with a genuine concern for others.

MacIntyre’s chief executive, Bill Mumford, says recruiting according to a personality profile is useful: “The more you know and the more knowledge you have the better decisions you will make.” But he stresses that it is equally important to ensure that the individual’s skills and experience match the characteristics of the role they are applying for.

Mumford admits that personality profiling is “not a silver bullet”. Indeed, MacIntyre has recently faced two separate sets of allegations of abusive practice. In a statement released earlier this year in response to the cases, it said: "We recruit and train all staff in ways that we believe enable them to be clear about what good support looks like and we focus in great detail on helping each and every employee to interact sensitively, respectfully and in a way that makes sense to everyone that they support."

Making a mistake in recruitment can be costly: the Chartered Institute of Personnel Development estimates that putting the wrong person in the wrong job can cost an organisation at least £8,200. But Baines says: “This isn’t just about the money, it’s about the reputation of the business and the damage it can cause to the service user.

"At the end of the day you could be sending an inappropriate person with the wrong values into somebody’s home. It’s so important to get this right.”

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Carers and community

Directors of adult social services this summer gave a stark warning about the pressure they were under as cuts continued to bite. Spending on social care, they said, had fallen by 12% in the last four years while the number of people needing care and support had risen by 14%. Levels of care were “unsustainable” if the axe continued to fall.

The pressure on town hall budgets has an impact beyond statutory services. Voluntary organisations are having to think differently about the way they design and deliver care and more providers are moving towards co-production – where service users, carers and the local community are helping to shape the services they need. Residential care homes are also changing – seeing themselves more as a local asset and feeling greater responsibility to reach out to a wider community beyond older people.

Jane Ashcroft is chief executive of Anchor, which runs 93 care homes in England looking after 4,000 people, and is also chair of Care England, which represents independent care providers. She says: “Homes have become a community hub – we have a facility and can make sure that it is part of the local community.”

In Anchor’s case this has meant some homes becoming meeting places for local Alzheimer’s groups or hosting a café for people with dementia. Others have been more creative, looking outside their core client group, and have become more like a traditional village hall. “In one home we’ve run a local mother and baby group and there were some fantastic relationships built with the older people. We have a physical asset for the benefit of the community and when services are being cut it’s about whether we can find a way of providing those services.”

The mental health charity Mind has also had to rethink how it supports people in the community. Its Bexley office in Kent has a joint contract from the local council and clinical commissioning group to provide community services for people with mental health problems. Steve Bynon, local innovation and development manager, says: “When we made the tender for the contract we knew that we couldn’t deliver on our own what they were asking for the money. We had to find new ways of doing this with less money and more output.

“That meant making more of other organisations and helping our service users to think about what the service is, what it would look like and how they can be involved in that.” That new way of thinking has led to some service users working behind the office reception while others have become involved in a peer-to-peer mentoring group – supporting other service users through recovery.

At care and support charity Look Ahead, service users sit on recruitment panels to appoint staff. They also help to design care packages and train support staff in how to deliver them. The culture of co-production has been driven by the personalisation agenda but cuts to services have also been a factor, according to its head of quality and customer services, Ceri Sheppard: “It’s highly significant at times of cuts as all providers are competing for contracts and there is less money around. If your approach is to just offer barebones support it’s not going to be so effective and people don’t have pride in it.”

Unpaid carers in the UK save statutory care and support services £119bn a year, according to Carers UK. The number of carers is on the rise, up 11% to 6.5 million in 10 years. It is an increase that far outstrips any demographic changes, says Emily Holzhausen, the charity’s director of policy and public affairs. “The only link I can suggest is that as the state pulls back, families are having to fill that gap.”

The impact of the cuts on carers has been varied. Some have seen fees introduced for what were free services, packages of support have been reduced because of changes to eligibility criteria and some services have disappeared altogether. These changes mean that the voice of the carer is even more crucial when services are being designed.

And their influence in co-production is already paying off. Action for Carers in Surrey was instrumental in pioneering a new system of direct payments for carers to cover the cost of their respite care. In Hertfordshire the carers’ voice was pivotal in a new hospital discharge system for stroke patients which is already helping to reduce readmissions.

Listening to the voice of carers, service users and the community is crucial during a time of cuts, according to Peter Fleischmann, head of co-production at the Social Care Institute for Excellence. He says: “The best way to find out what really matters is to talk to people and involve them in what you are doing. In the long run it’s going to result in an improvement in services by being more tailored to what people need in the community.”

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Twelve voices
on social care

David Pearson, president, Association of Directors of Adult Social Services

“What we need to do is build a system fit for the 21st century. We have the right principles in the Care Act and we need to implement it and make sure we are joined up with health in a way that [allows us] to continue the journey of personalisation and also first class commissioning. But that system has to be funded in accordance with the aspirations of the MPs who voted for it. For the first time we have got the first bit of legislation for 60 years which has widespread support across the sector. I think we are all ambassadors for care, all of the people working in the sector. Maybe we are a bit diffident about that. We are quite a diverse and a very rich sector, but perhaps not galvanised with colleagues enough to really speak with one voice to say how important this is.”

Andrea Sutcliffe, chief inspector of adult social care, Care Quality Commission

“People should look at our website where they can search for a home or care according to a postcode and find the information about a service report and the judgment we have made. Our new inspection regime will provide a much broader view about what it is like to use that service either in the home or to use a domiciliary service in your own home. We will be doing that by asking five questions – is it safe, effective, caring, responsive to people’s needs and is it well led. We have also expanded our inspection teams to include an expert – someone who has personal experience of care or has cared for somebody. We will also have access to specialist advisers, including pharmacists or medics, who will be able to tell us what they think. When we do the inspection we want to find out what the provider is telling us but the most important aspect will be talking to the manager, the staff, service users and the visitors to enable us to get under the skin of the experience of using that service.”

Sharon Allen, chief executive officer, Skills for Care

“Dreadful things do happen in care but they are the minority. There is so much fantastic stuff that goes on in the sector that is unheard and unsung. There are people who are totally committed to the care and support they provide for people – ask those they care for who can’t sing their praises enough. It would be good to collectively put some emphasis back on the good stories that happen. Under the new Care Quality Commission inspection regime, as well as notifying us when they find services which are inadequate, they also want to tell us about those services which are outstanding and I hope that these will be newsworthy stories. What needs to happen is recognition that social care is a skilled role, it’s not something that anybody can do, and we should be thankful that there are people who can do that.”

Nadra Ahmed, chairman of the National Care Association, representing around 3,000 independent care home providers in England looking after a variety of service users

“There are a plethora of good intentions and initiatives, such as the Social Care Commitment and the Dignity Challenge, and of course as an organisation we are committed and support all of these things. But for me it’s always been about how does that make a difference for somebody running a care home? If I had to have one campaign, it would be about going back to basics in terms of social care – how do you measure that somebody is delivering good quality care? It’s not about signing up to a bit of paper – it’s about demonstrating how you meet those conditions. A gentlemen in my mother’s care home visits her daily and I asked him one time why he was there and he said it’s because he feels safe, he eats well and he doesn’t have to worry about being warm. Of course he said there are times when things go wrong but we sort it out because we are a family and that is what families do. There are all these really good services out there and this is one of many.”

Zoë Hallam (24) is a charity procurement officer in London. She has degenerative muscular dystrophy, is a wheelchair user and has 24-hour care and support

“I’ve worked in procurement for three years after leaving university and for the last year with a charity. I manage all the contracts it has with suppliers and third parties. I live with my boyfriend in south London and have a live-in personal assistant (PA). I am able to manage my own affairs but I have an electric wheelchair and I need a lot of physical support with things such as washing, preparing meals, laundry, cleaning and going to the shops. My PA helps me get up in the morning and get ready for work and during the day will help with chores at home or run errands for me such as going to the bank or the post office. If I need her at work I just have to call and she will come in. I employ a couple of PAs – both women in their mid-20s. They are self-employed so pay their own national insurance and tax; I’m quite familiar with contracts so that wasn’t a problem for me. I have been able to tailor the support to my individual needs. I couldn’t live without my PA as she allows me to be as independent as I possibly can be – it means I can be flexible and if I want to go out for a drink after work I can.”

Caryl Kelly (72), retired pharmacist and full-time unpaid carer for her husband Tom (80) a former physics teacher from Ruddington, Nottinghamshire, who has dementia. Caryl is a Carers UK ambassador:

“All the carers [care workers] we have had are very pleasant and kind, some are more outstanding in the way that they help Tom than others – that is just their natural personality as well as their training and experience. They are just exceptionally kind. Tom has mixed dementia as well as other medical problems. For me what I am not getting is any joined-up thinking about Tom’s care – I see a carer in the morning and in the evening but they don’t have any input into his medical needs which I find quite difficult to manage. Nobody joins up the thinking between health and social care. Once the social care package is in place you are signed off; you can go back to social services but then you have to start all over again and you won’t get the same person. It’s almost impossible for me to say what would make things better, but what would make a difference would be the availability of just more care. My desire is to keep Tom at home – I don’t think I could bear the thought of him in a home. They won’t love him in a home the way that I love him. They just can’t.”

Norman Lamb, Liberal Democrat MP and care minister

“We should all be able to get good care when we need it. Many of you reading this will be getting or providing excellent, compassionate care, day in, day out. But there have been pockets of terrible abuse that has shaken the public’s confidence. I have made it my priority to rebuild that trust and to take a tough approach with those who provide poor care. In the wake of Winterbourne View and, following my appointment as care minister, I was horrified to discover that provider companies and their directors could not, in most circumstances, be prosecuted for serious failings of care. I was determined to change the law on this.

The Care Quality Commission has just begun inspecting and rating homes against new, tougher fundamental standards of care which we have introduced. And, in the future, it will have the power to prosecute companies and their directors that allow poor care to happen. But I’ve also been determined to make sure we recruit staff with the right skills and values, that they are properly paid and are supported by honest and knowledgeable leaders. I’m proud that we are introducing a ‘fit and proper person’ test for senior managers and a new care certificate for frontline staff to make sure this is the case. In effect, this will mean compulsory minimum training standards for care workers. And I’m proud of the tough action we are taking on employers who break the law by failing to pay the minimum wage. We’ve helped care staff recover large sums of money in pay owed to them. We have also made it easier to name and shame these companies that flout the national minimum wage law.

We’ve made great progress but my commitment to stamping out poor care remains as strong as ever. We must do this for the people who have entrusted us with their care and for the staff who have made caring for others their life’s work.”

Deborah Stone, co-founder of the website myageingparent.com

“My father had dementia and we struggled to get good care, it was very difficult. Myself and co-founder Alex Ingram thought we needed to do something about it in terms of information – there is so much out there and it’s difficult to get your head around it. The website is a signpost for anybody needing elderly care. It’s really important that people plan ahead when they are thinking about a care home or how to choose care but people don’t like to do that – it’s so much easier if you understand the issues before you become ill or have a care need. My advice for anybody who thinks they need care and support is to go to their GP because if they refer you it’s stronger than if you were to go straight to the council. I would also recommend that you go and visit a home without an appointment. Talk to them about how open they are in terms of having relatives on their committee. If you were choosing a nursery for your child you would want to go and see what the staff are like – it’s the same approach looking after older people because they are equally vulnerable. I would never put somebody in a home just on the back of a Care Quality Commission inspection report.”

Risa Bridgeman (83) lives at home in Grayshott, Hampshire with her husband Edward (87). She has Parkinson’s disease and has four care worker visits a day

“I’ve been here at home now for about 10 months. I was in a care home before for about a year but I didn’t like it. I missed my husband and I was really miserable. How can I put it? I couldn’t find friends there. At the home the carers did as well as they could but there were a lot of us and not enough carers. At home I have two carers who come four times a day – at breakfast, lunchtime, at 5.30pm when I go to bed and again at 9pm. They come and make sure I am comfortable and take me to the bathroom. The shortest visit is 20 minutes at lunch time. At breakfast it’s about 45 minutes and half an hour at night time. It’s the same group of carers and I have got to know most of them. I get on very well with them they are very friendly. They do extra jobs like get my husband a paper if he wants one. They see me as a real person. To be realistic I probably will need more care before I go, I am pretty disabled and can only walk with a frame and somebody to hang onto. I will probably have to spend more time in bed but I want to stay here for the rest of my life.”

Lynn Day, manager of Anchor’s Cranlea care home in Newcastle upon Tyne which cares for 39 older people; 15 have a dementia diagnosis

“It’s lovely the way care is changing in England. We are beginning to realise the value of the older generation and that they still have a lot of things that they can share with the community. In the last 10 years the manager role has changed. The business side of things is more at the forefront, it’s more about marketing and PR and making sure you know what your competitors are doing. I’ve had to learn new skills looking at budgets and spreadsheets. I think you still need a grounding in care, you should have that perspective. I do think it’s a role for young people – it’s a really interesting world to be in. You are looking after these people who have been given to you in trust by their families – they are their most prized possession. I’m quite a confident person and there have been meetings where people in the room think that a person in residential care doesn’t know what I would know. I think attitude is changing – they realise that people working in homes are professional and they have as much information and value to give to a person’s care as somebody else who is looking after them in hospital, especially when it’s people with dementia.”

Maddy Moll-Harrach, domiciliary care worker employed by Safe Harbour Homecare, Hampshire, winner of the home care worker award in the national Great British Care Home awards 2014:

I have been a care worker for 28 years. It started from personal experience when I looked after my uncle who had cancer and one of the nurses said I’d make a good nurse. I have worked in homes and now work in the community. Before I’d been a consultant for Estée Lauder and an assistant manager in Dorothy Perkins. I enjoy working in the community because elderly people want to be in their own home and the service I provide enables them to do that. I do palliative care too which is very rewarding – it’s a privilege to be with people at that particular time of their life. It’s a joy to get up in the morning because you get so much back from the people you meet, knowing that everything you do makes their life a bit better. I don’t think care workers get the recognition they deserve, they often put a lot more into it than they have to and they work a lot of hours. For me being a care worker just felt right; it’s been to the detriment of friends, family and social life and everything – my job comes first. I just can’t help it.”

Andy Burnham, Labour MP and shadow health secretary

“Today, England has a fragmented health and care system. It makes no sense to cut simple support in people’s homes only to spend thousands keeping them in hospital. But that is what we’re currently doing. We can’t afford it and it’s not right – the ever-increasing hospitalisation of older people is no answer to the ageing society. But at home, people’s common experience is of a series of disconnected encounters with professionals and the frustration of telling the same story to every person who comes through the door.

Labour’s answer is to fully integrate health and social care to build a single service able to see the whole person. It means you can start with the person in the place they want to be, at home, and build from there. It allows us to rebuild our NHS around you and your family. No longer needing to ring the council for this, the NHS for that, but having one service, one team, one person to call. We will recruit new teams of home care workers, physios, occupational therapists, nurses, midwives with GPs at the centre. We will build a culture of respect for all people who care and end the indignity of flying 15-minute visits – an end, once and for all, to the scandal that is care of older and vulnerable people in England in 2014. We will change the way the NHS supports family carers too, with paid breaks, help with hospital car parking charges and the right to ask for an annual health check. Labour’s plans are based on the simple notion that, if we give people the support they are asking for – when and where they need it – the more likely it is to work and provide better value for money.”

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Writers: David Brindle and Debbie Andalo
Main Images: Dylan Thomas
Twelve Voices: Graham Turner, Andrew Hasson, Fabio de Paola, Mark Pinder, Linda Nylind, Anna Gordon, Henry Browne
Archive Pictures: Getty Images, Rex Features

For more information please contact:
Stacey-Rebekka Karlsson - 0203 3532165
Chris Birch - 0203 3532159