David Oliver: Taking carers for granted
BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1523 (Published 04 April 2017) Cite this as: BMJ 2017;357:j1523
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Taking carers for granted
Many thanks to David Oliver for his timely article. This problem is going to get worse, with the ageing of the population. He is right that spouses are often carers, but they too grow old and increasingly less able (as in my case: I am 85, my husband, seriously disabled after a stroke, is 88). In Scotland we are fortunate that personal care in the home is not means-tested, but even so there are challenges.
One problem that particularly concerns me is the introduction four years ago in Edinburgh of a new shift-work pattern, designed to cover every day of the week. Staff work four days on, four days off, which means that their duties move on one day each week. This is confusing particularly for patients, who somehow have to keep track of the workers who need to perform weekly routines such as changing clothes, catheters, etc. When these move on one day each week, and workers inevitably change, go on holiday, and so on, jobs can be forgotten if the informal carer is not on the mark. For those with dementia, or those who have no informal carer, life must be even more difficult: and for such people the care worker may be the only human being they see during the whole day.
But worse than this, our local shift-work pattern requires full-time workers to work from 8 a.m. to 1.00 p.m., then break until 4.45 p.m., work till 10.00 p.m., and then start again at 8 a.m. the next morning. This split shift only gives them 10 hours between shifts instead of the mandatory 11 hours required according to the European Working Time Directive. This working pattern is particularly difficult for workers with children, or who live far out of town: there isn't enough time to get home, have a meal, get 7 hours' sleep, get up, have breakfast, and be back at work by 8.00 a.m. The time off in the afternoon isn't very useful: there's rarely time to go home. We have already lost many workers, particularly those with children.
In other parts of Scotland the night shift starts at 8.00 p.m., so this kind of split shift is not inevitable. I know it must be difficult to arrange appropriate shift-work patterns, but it is surely not impossible. However, Council workers do relatively well compared with those in the private sector, where conditions appear to be worse. Also, with the integration of Health and Social Care, there should be similar terms and conditions for healthcare assistants in hospitals and those working in people's homes.
The additional issue at this crisis in our history is the fact that so many of these healthcare workers come from Europe, at a time when their future is uncertain. (Others come from Commonwealth countries.) We owe it to them and to our old and frail citizens to overhaul the system and make sure it is fit for purpose before it's too late and we lose even those workers who at the moment want to stay.
Heather Goodare
Competing interests: No competing interests
Re: David Oliver: Taking carers for granted
I found this article very insightful and bang on the mark. I am 50 and look after my 72 year old spouse. I had to give up a high 5 figure salary because of the lack of suitable care in the community. Even though my Husband qualifies for NHS Continuing Health Care, we have found it impossible to get the right fit in quality and reliability of care-workers. We also live in such inaccessible accommodation that many care agencies have refused to work in our home. I have worked out I save the NHS over £100k a year, for which the state compensates me with £62 per week, loss of career, loss of control over our own destiny, treats me like an idiot. Caring of all kinds in the UK is not valued, it has no status. While this is the case no one stands any chance whatsoever of getting decent consistent care for their loved ones and many of us unpaid carers will continue to be viewed as collateral nil value damage .
Competing interests: No competing interests