In 2010 when my sister and I agreed that our 89-year-old father needed help in order to live “independently” at home, the domiciliary care provider we chose, Bluebird Care, was among the largest providers of homecare in the UK. Its charges were £15 an hour on weekdays, £18.30 at weekends, double for bank holidays. My father was cared for by its Bluebird Care Barnet franchise.
I assumed – naively – that the care workers themselves were paid around £10 an hour. A couple of years later, the shocking reality was conveyed to me by one of my father’s favourite workers. I was horrified when he told me he was actually paid £6.39 [in fact workers were paid £7 an hour, see footnote] .This was before zero-hours contracts had hit the headlines.
My father – who died this year, nine days short of his 94th birthday – had managed on his own for a decade after my mother died. But weakened by strokes and low in mood, he stopped eating properly. We soldiered on for a while, with the kindness of neighbours and Margaret, our lovely Irish factotum, helping to keep him on top of things. But the situation was exacerbated by her sudden death and, concerned about his day-to-day welfare, I rang Bluebird Care, whose brochure then carried the Boots logo.
My father was resistant at first, but gradually got to know the group of young men and women who came for a couple of hours to do the housework and cook dinner. It wasn’t all smooth-running, and when it didn’t work I’d call Maria, who ran the local franchise in Barnet, north London, and we’d talk it through. She was receptive and attentive – to my father and to me – and would drop in for a chat, cheering him up with her easy charm.
When the local Bluebird franchise changed hands, the new owner was rarely available on the phone or via email. And by this time my father was more frail, his stroke-impaired speech increasingly difficult for strangers to understand. So there was always a good deal to sort out – doctors’ appointments, the endlessly tricky management of his warfarin medication.
By last summer, I could no longer cope and my father agreed, reluctantly but graciously, to move into a home. His last care visit was on 30 July 2014. Despite several reminders, I’m still awaiting a final accounting from Bluebird Care Barnet and a refund of several hundred pounds for visits cancelled in good time. “I will look into this and come back to you in due course,” was the last word on the subject, in an email dated 10 September last year.
Care at home is a booming business, and it is easy to understand why. Who among us really wants to move in to a residential home? Founded in 2004, Bluebird Care was bought in September 2013 by Florida-based Interim Healthcare, which has operations in 530 locations across seven countries and “combined network sales of $850m”. The UK homecare market is estimated by Bluebird Care to be worth £20bn and includes not only older people but those of any age with physical or learning disabilities. More than 800,000 people in the UK receive homecare. Bluebird itself delivers “in excess of £115m of care at home per year across the UK” where it has 180 franchise businesses delivering 7.5m visits a year to 10,000 people.
Its new chief operating officer, Duncan Berry, has 12 years’ experience in franchising. Its website offers “Six good reasons why you should become a Bluebird Care franchise owner”, saying it is an “unrivalled” franchise opportunity, and a business with “an exceptional average annual growth increase of 112%”. Around a third of franchise owners trading for over two years are achieving a turnover of between £1m and £2m annually, with two star turns doing between £2m and £3m. Some 30 owners operate more than one franchise. It is “almost impossible to saturate the local market” the website advises, so “a Bluebird Care business can be built to be as big as you want it to be!”
The stated aim is to recruit “the very best people to uphold our business ethos and to shoulder the responsibility of the safeguarding and promotion of our brand”. It’s easy to see that a market-driven model of care-giving is not necessarily going to attract the right people. Moreover, how closely are franchise owners monitored once they are in business? My own experience suggests not very closely. One of the small group of care workers employed by the Barnet franchise, who I insisted be the ones to look after my father, said that induction courses were usually no more than one day. There was no requirement to study for an NVQ, and anyone wishing to do so must fund themselves.
“With Maria, there was a four-day induction using a proper training company. There was a lot of information – about how to handle people, about medication, about cooking,” recalls Rafik, one of my father’s preferred care workers who has since moved jobs. I gave him a reference for Nazareth House, where my father spent the last five months of his life . “Quite a few failed. These days the training is done in-house by ‘a supervisor’ who may have very little hands-on care experience.” Rafik says the new owner of Bluebird Care Barnet was so desperate for staff he would take anyone. Some people came from the local jobcentre and clearly had neither the desire nor the aptitude to be care workers, he tells me.
In my experience, no-hopers would sometimes be visited upon my father. Some were nice enough, but had no clue as to what they were doing. One was quite keen on a little light dusting but notably less interested in cleaning the bathroom and kitchen. Another thought wet wipes sufficient for washing the floor. Others had not the faintest idea how to cook everyday dishes. To one I had to “explain” a fried egg. Custard, even in an Ambrosia pot, was an alien concept. Porridge? All foods that older people like, none of them complicated.
Many didn’t know how to make a bed with sheets and blankets – one young woman persisted in putting double sheets on a single bed so they trailed dangerously. One pleasant but ditzy care worker, whose company my father quite enjoyed, was found by my sister grinding up a calcium tablet – it was, she explained, too big for him to swallow. Maureen pointed out that he was meant to chew it. “What’s ‘chew’?” came the answer. I explained things patiently, left notes and sent emails. Managing the care workers was a time-consuming business, and the message eventually got through that I was always going to be on the case. But what happens to those without family close by to advocate on their behalf?
As with care homes, there are checks by the regulator, the Care Quality Commission, but these are notified 24 to 48 hours in advance to ensure a manager is in the office. As a result, care workers would be warned not to speak out of turn if they valued their jobs. Similarly, the folders of any clients (patients, as we’d once have called them) deemed likely to step out of line were temporarily removed, safe from a inspector’s random picking, according to Rafik.
The CQC aims to rate all adult social care services across England by September 2016 as either outstanding, good, requires improvement or inadequate so that people can be clear about whether the regulator thinks the care they receive deserves that description, it explains. A special-measures regime has also been introduced.
All staff are required to be checked for criminal references, yet many are sent out before the results come through, says Rafik. In any case, since many of the care workers are not UK nationals and may be new to the country, the check is redundant – access to international records is expensive and time-consuming. Rafik recalls a young woman arriving at the Bluebird office direct from the airport – by evening she was installed as a live-in care worker.
As with so much in life, it comes down to money. There’s the potential for franchise-owners to make a stash – but it’s done on the backs of an army of underpaid staff. Some have a sense of vocation and a desire to do the best they can – but it’s demanding work and you’re on the run all day. Pay does not increase with experience – it’s a flat rate.
George Osborne has pledged to introduce the national living wage to workers aged over 25 in the UK from next April. But the UK Homecare Association, which represents major providers in domiciliary care, was quick to warn that their businesses would become unviable.
It’s not good enough. The wish to remain at home is a reasonable one, yet the problems I’ve described at one Bluebird Care business are far from unique. In May, the Local Government Ombudsman upheld a complaint against Bluebird Care in Worthing, east Sussex, for overcharging the client’s family. The ombudsman recommended that the business pay back more than £300 to settle the account, which it did.
Statistics compiled by the LGO show that complaints about homecare (private and council funded) have increased more than sixfold, from 73 in 2010-11 to 451 in 2014-15. For homecare arranged, provided and funded privately, as in our case, the number of complaints rose from five to 70 over the same period. But an LGO spokesman says this is “the tip of the iceberg, since most people don’t know who to complain to”. The LGO says it will investigate all complaints about adult social care – a message it is keen to get across.
The chief inspector of adult social care at the CQC, Andrea Sutcliffe, has admitted that the care system is turning good people into bad care workers following a rise in allegations of abuse made against care workers. Care needs to be better regulated. Care workers need to be properly trained and valued, and paid accordingly. And the cared-for must be more than a line item on a corporate profit-and-loss account.
Bluebird’s chief operating officer, Duncan Berry, said in a written statement: “Bluebird Care is committed to our customers. We treat any allegation that a customer is not getting the high level of service they come to expect from Bluebird Care extremely seriously. However, so far [we have] not received a formal complaint from this customer about the care received at Bluebird Care Barnet.
“We therefore invite her to talk to us about what she believes has happened in order for us to fully investigate these allegations. Bluebird Care is a leader in care, delivering the highest quality of service. Our staff pride themselves on the job that they do. In LaingBuisson’s July 2015 analysis of the UK homecare market, [our] offices in England were more than 94% compliant with CQC standards – above the national average.”
Bluebird Care Barnet was rated good at its latest CQC inspection in May, but the management of the service needed improvement and a recommendation was made regarding the recording and monitoring of concerns and incidents.
- This article was amended on 25 September 2015 to correct Duncan Berry’s title and the year Bluebird Care was bought by Interim Healthcare. It was further amended to make clear that Liz Thomson’s father was treated by the Bluebird Care Barnet franchise and that it was incorrectly stated that “there is no mention of the caring vocation” on the Bluebird Care website. Bluebird Care says that the company does offer “very close support” to its franchise owners. This article was further amended on 27 October 2015. An earlier version said that one of Liz Thomson’s father’s favourite workers told her that “he was actually paid £6.19”. This was an error. She says he told her the figure was £6.39. However Bluebird Care Barnet have provided pay slips to show that their rates of pay at that time were £7 an hour during the week and £8 at weekends.
