Healthcare assistants do the care, nurses do the paperwork

Healthcare assistants, not nurses, often do most of the front-line work

Healthcare assistants, not nurses, often do most of the actual care in the UK

In nearly twenty years of part-time and full-time work as an agency healthcare assistant (HCA), I have worked with many qualified nurses in care homes and hospitals who do an excellent job caring for residents and patients. In many situations however, it is the regular staff HCAs who are doing the hard work.

Due to increasing awareness of an ageing population, it is only now being acknowledged that much of the nitty-gritty hands-on caring for the elderly (be it in their own homes, nursing homes or hospitals), is actually done by “unskilled” HCAs and carers on little more than the minimum wage. Drastic cuts in social care budgets and other political problems are not helping the system as a whole. The Tory government have made a belated but predictably inadequate attempt to improve the general low pay situation in the last budget but there is still a long way to go. £9.00 per hour by 2020, excluding those under 25? Not good enough, not nearly good enough. In the meantime, most carers struggle on with around £7.00 per hour. Due to existing financial pressures, many local trusts, councils and care providers are not happy about having to give carers any kind of pay rise at all. However, as they are such caring folk, the many Chief Executives of organizations profiting from care will of course be taking cuts in their six figure salaries. Of course!

What does a healthcare assistant actually do? The underpaid, undervalued and “unskilled” work of caring for your parents, your grandparents and possibly YOU one day

The infamous Bristol Stool Chart

The infamous Bristol Stool Chart

As anyone who has worked in care and nursing knows, the supposedly unskilled work of an HCA can be physically, mentally, emotionally and even spiritually demanding in the extreme. During a 12 hour care home or hospital shift, particularly early shifts, there can be a massive amount of practical multitasking. Waking the patient or resident gently (“We have to get this lady up because her family insists on it, even though she hates getting up at this time.”), moving of heavy hoists in restricted spaces (“Why can’t they do something about these flipping leads in the way under the bed?”), toileting (“Here we go… nice and tall… ouch there goes my back again!”), wiping bottoms (“Excellent bowel action, 3 on the Bristol Stool Chart!”), washing (“There’s no soap again…”), shaving (“Gunged up blunt razor blade, I’ll have a hunt round for a new one…”), dressing (“Mind she doesn’t get another skin tear. Why hasn’t this lady got any clean knickers?”), helping with eating and drinking (“Thickened fluids… Thick and Easy? That’s just the staff!”) and so on. All the time you try to remain friendly and supportive to everyone around you, in an often extremely stressful environment.

In the meantime, the qualified nurses on a much better wage are usually getting on with dispensing medication, paperwork and attending meetings

NursesPaperworkWhich is sometimes important work in itself but this reality completely put me off the idea of qualifying as a nurse, a long time ago. (I’m not a big fan of western medicine and the very dodgy pharmaceutical industry anyway – but that’s another story!) From a 2013 Royal College of Nursing study:- “More than three quarters of nurses said the time spent completing paperwork prevented them from attending to patients.” Financially of course, qualified nurses get a relatively good deal compared to carers, starting at over £20,000 in the NHS. But it might be wise to remember who is often doing most of the hard physical and emotional work – and who is often being diabolically paid for it and sometimes being taken advantage of by their employers. Finally, a carer has recently taken a company to court for failure to pay the minimum wage.

Over the last few years, at last, there has rightly been plenty of mainstream media coverage about the problems with abuse and poor standards of care. More relatives are complaining to the Care Quality Commission. But beyond the moral outrage, isn’t it time we all started digging a bit deeper into some of the causes of these problems – the cultural attitudes and political decisions behind them – and did something about it? Why, for example, aren’t the still increasing numbers of foreign care assistants required to take a basic English test? Filipinos and Polish workers in particular can be more committed and better at the job but I have lost count of the number of times I’ve heard “It’s so nice to have a conversation with someone who speaks proper English”, from a resident or patient.

Be it in home care, nursing homes or hospitals, many of the (mainly female) staff are exhausted, demoralized and broke. Profits are still being made by many private companies who often pay their staff less than can be earned in supermarkets or factories. The situation is not anything like as extreme in many other countries and the whole culture needs to change here.

Carers, our parents, and our grandparents deserve better.

Why are care workers on the minimum wage?

Wayne Rooney, £1,785 per hour

Wayne Rooney, £1,785 per hour

With the announcement last week that Manchester United striker Wayne Rooney is about to earn £300,000 per week – that’s £1,785 per hour – my mind turned yet again to the low pay of care workers in the UK. Most of the ones I work with earn the minimum wage of £6.31 per hour or slightly more.

Professional footballer = £1,785 per hour.

Care worker = £6.31 per hour.

Am I missing something or is this complete, total and utter madness? Would care workers be so badly paid if most of them were men? Who cares for the carers, where is the public outrage? What kind of society are we living in that apparently accepts this situation?

I have worked with more than one Healthcare Assistant who has loved the job but has had to move on because of the bad pay – in one case to go and earn more on the checkouts in Tesco. By contrast, a small percentage of places pay their staff around £8 or more, as do care agencies who provide temporary staff such as myself. £8 per hour is closer to the so-called “living wage”, a strange concept, the obvious implication being that those on the lower “minimum wage” are not actually living! As you would expect, the staff are usually happier and far more settled when paid more, and the residents/patients receive a better standard of care.

Care worker, £6.31 per hour

Care worker, £6.31 per hour

Care work is considered unskilled, the implication being that anyone could do it. Is this actually the case? In my experience, work in nursing homes, NHS hospitals and the community can be physically, mentally, emotionally and spiritually demanding in the extreme. There is often poo, vomit and blood to wipe up. At the risk of stating the obvious, sick and dying grandmothers and grandfathers are not always easy people. Almost superhuman patience is sometimes required.

The chances are that, one day, you will be one of the vulnerable and elderly being cared for by exhausted and underpaid carers.

I have heard that the situation is nothing like as bad in Scandinavia and many other countries. No remotely civilized and decent society would quietly allow such a situation to continue. Gavin Kelly, (chief executive of Resolution Foundation, an independent thinktank aiming to improve living standards for low to middle income families in the United Kingdom) has drawn attention to the fact that, due to not being paid for the time spent travelling between home visits, many carers are being paid even less than the minimum wage.

Professional footballer = £1,785 per hour.

Care worker = £6.31 per hour.