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Share your dilemmas and get honest opinions from other Mumsnetters.

How do we solve the social care crisis ?

334 replies

Worriedddd · 31/10/2022 13:33

We have complex needs patients being stuck in hospital for up to 2 years. Some even more they are ready to leave just there's no social care placements and they can't get the right staff anyway. For minimum wage carers will have support people with very challenging needs. There is high risk of assault in many care settings employers don't offer the right training like de-escalation and breakway. . You could get more money working for Lidl and aldi. Even with immigration people leave and find another job. What's the solution to this ?

OP posts:
Burgoo · 01/11/2022 17:49

@JockTamsonsBairns "And we are totally devalued by the whole of society.
Why?"

Because you are willing to take all that BS and not complain about it. I worked out years ago that I am not a charity. If you want me to work in this field, you pay me decently. The problem is, as long as people do the job because it makes them "feel good" and because they feel they "need to" then things won't change.

The NHS is a prime example. It runs solely on good will of staff. If staff didn't do extra work out of hours etc the whole thing would crumple. I know people that do 3 hours of admin EVERY NIGHT because they haven't got time to do it in work time. They don't get paid for doing it, it is almost expected if you work in outpatients/community NHS. NHS managers know this. They rely on good will. The problem is, because good, hard-working nurses are willing to forego their own self-respect and personal time to do it, nothing gets solved. Whilst they work extra hours, doing the "right thing" by their patients, the government have absolutely no incentive to pay them more and increase resources. Why would they if they know nurses will do it anyway? They rely on guilt and collective shaming for not "going above and beyond" to get nurses to do things they aren't paid for.

Unfortunately, NHS and social care workers are their own worst enemy and I say this as someone who has been around decades in the area and see exactly why they do what they do. It's about time that they stand up and say "no, if you want this done you pay for it. I am not a charity!"

miceonabranch · 01/11/2022 17:51

I think we also need some grown up and sensible conversations around assisted dying for those of us who don't wish our lives to continue if we're incapacitated and have lost all hope of independence. If you don't want it, don't believe in it, want god to decide for you, just want to continue existing in any state no matter how diminished your life may have become then fine, but some of us want a peaceful way out instead.

Burgoo · 01/11/2022 17:53

@KatieB55 "Care homes shouldn't take huge profits & pay staff minimum wage."

Whilst I agree, I also know that unless they are a large franchise most companies aren't making mega-money. My sister works in a private care home and the guy that owns it barely makes any money after wages, bills, insurance, governance etc. People forget that things like keeping the lights on has just gone up by 3+ times. These aren't additional extras and companies have to find the money.

As for your point... who is going to fund it? Regardless of what "should" be done, someone has to pay for it. Trained professionals? Fine, but that isn't going to be cheap. If you want quality staff who want to stick around, it is EXPENSIVE. Really, bloody, expensive! And the public don't seem to "get" this.

Burgoo · 01/11/2022 17:54

@miceonabranch

YES! We keep people alive in a state of misery. Many with no capacity or ability to lead a meaningful life.

Vanderpump · 01/11/2022 18:12

Burgoo · 01/11/2022 17:42

Throwing money at the problem isn't helpful if you just hire a bunch of people who aren't RIGHT for the job. That said, there is no respect for care staff nowadays. It's seen as a low-paid, "clean up people's shit" type of job and therefore why would anyone want to go into it?

A few things that need changing:

Salaries: If you want to attract people into the job you need to pay decent rates. I can make more working at Tesco than I do dealing with difficult, challenging individuals with complex needs. It must be seen as a profession and be rewarded as such.

A standardised vocational program for all care staff: We should equip carers to be professionalised, and this means a set standard that all social care staff must meet. This means a code of conduct, training and support to progress.

Stronger emphasis on informal carers: Why are we relying on state funded social care (or even privately funded) when we could fund people to look after their own family members? We already rely heavily on care givers of family/friends - support people to care for their family/friends by funding it adequately. If I have a sick relative, I can't work and look after them simultaneously. This needs to change.

Nationalisation: We shouldn't be throwing away billions a year to private providers. They skim off profits and give dividends to shareholders. Social and Health Care should NEVER be for profit because that's when corners are cut. Money spent on publicly owned services eventually get pumped back into the system through taxation of employees etc. It would also be FAR cheaper. Hence why privatised services get given back to the NHS when private companies can't compete (price vs service provided).

On a side note, there needs to be a REALLY heavy focus on the fact if we want a service, we MUST have an adult conversation about how it is paid for. Because this country is full of people who want a service but aren't willing to stump up the funds for it. We haven't got a bottomless pit of money, and it has to be paid for.

The other thing is we need to be MUCH more radical re: the culture in the UK of not taking care of ourselves. Much of the issues facing social care are at least in part related directly to people not taking good decisions re: their health. For example, obesity is a HUGE crisis, leading to diabetes, heart conditions etc. the fact is we have to take much more responsibility over our bodies and health if we are to stem this problem. Just throwing money at it isn't enough. We need to value the services we have, and that means not needlessly causing ourselves more physical ailments that will cost the system billions a year.

I am NOT talking about neurological conditions/disabilities or other problems that are beyond our control. I am talking about the fact we spend hundreds of billions on preventable conditions that need social care support. Diabetes, hypertension, alcohol or drug related conditions etc are all HUGE drains on the system. Have a stroke, you may need 24-hour care. We need to drive the message that a stroke is something which is at least in part preventable and that it is a responsibility of each one of us to avoid these things happening. That isn't to blame those who have strokes, though if you smoke 40 a day, have a few take aways a week, barely move from your sofa etc it is hardly surprising you have one.

I've worked in the sector for decades. NOBODY seems to want to face up to their own responsibility to society re: doing everything they can to avoid needing extra care and support services. If you want the righ to "free" health and social care, then you must also have a responsibility to avoid needing it unless necessary. This shouldn't be controversial, but people will scream about it.

I couldn't agree more, I have worked for years as a Snr Manager within a local author Health and social care provider and relate you everything you have said

Free personal care Isn't working, unrealistic expectations , poor recruitment, inexperienced managers , poor working conditions and all of this within budget restrictions

Dinoteeth · 01/11/2022 18:57

@tomissmymum that's horrendous to hear that about your poor mum. Dementia in your 50s is horrific. There is definitely a point where people cannot cope at home.

I know two people who ended up in homes after Dementia related accidents. Basically it took the accident and hospitalisation the authorities to accept they needed 24hr care.

tomissmymum · 01/11/2022 19:06

Dinoteeth · 01/11/2022 18:57

@tomissmymum that's horrendous to hear that about your poor mum. Dementia in your 50s is horrific. There is definitely a point where people cannot cope at home.

I know two people who ended up in homes after Dementia related accidents. Basically it took the accident and hospitalisation the authorities to accept they needed 24hr care.

She went into hospital on a Saturday - Monday GP rang at 8am and said, don't take her home . Hardest thing I've ever done in my life, its taken me several months to come to any sort of peace with it and even then I've still got days where I think, what the hell have I done . The only way I can sit with it is remembering GP saying I'm the one that's got to go on living, said I had to make a break while there was still enough of me left that I could recover . There just isn't the support for people to continue caring alone at home - you need a whole team of people .

Maverickess · 01/11/2022 19:11

Burgoo · 01/11/2022 17:49

@JockTamsonsBairns "And we are totally devalued by the whole of society.
Why?"

Because you are willing to take all that BS and not complain about it. I worked out years ago that I am not a charity. If you want me to work in this field, you pay me decently. The problem is, as long as people do the job because it makes them "feel good" and because they feel they "need to" then things won't change.

The NHS is a prime example. It runs solely on good will of staff. If staff didn't do extra work out of hours etc the whole thing would crumple. I know people that do 3 hours of admin EVERY NIGHT because they haven't got time to do it in work time. They don't get paid for doing it, it is almost expected if you work in outpatients/community NHS. NHS managers know this. They rely on good will. The problem is, because good, hard-working nurses are willing to forego their own self-respect and personal time to do it, nothing gets solved. Whilst they work extra hours, doing the "right thing" by their patients, the government have absolutely no incentive to pay them more and increase resources. Why would they if they know nurses will do it anyway? They rely on guilt and collective shaming for not "going above and beyond" to get nurses to do things they aren't paid for.

Unfortunately, NHS and social care workers are their own worst enemy and I say this as someone who has been around decades in the area and see exactly why they do what they do. It's about time that they stand up and say "no, if you want this done you pay for it. I am not a charity!"

I sort of agree with this, but, I think you're missing a big factor here in that society demands that nurses/carers be in it because it's their vocation and not for the money - "Well we don't want people doing it for the money do we? We want people who actually care" which in essence is true I think, except when we've reached the point where these jobs aren't just putting up with a wage that's low or conditions that aren't ideal, there's an attitude that you should be grateful for the privilege of not being paid enough to live on, told you're not working hard enough to do any better for yourself, not have enough resources or support to do the job well and then get blamed for it and take the fall for it too.

Owners, management, share holders, budget managers in social services need to be held more to account rather than throwing their staff under the bus when something goes wrong - it's one of the reasons that I left social care, because I saw it too many times, people left in an unsuitable environment because no one wanted to spend more money on more suitable care, then when something happens it's blamed on incompetent staff, shifts short staffed day after day and then when something goes wrong the finger is pointed at the staff on shift - there needs to be an overhaul of standards for those at the top - proper staff/residents ratio devised and not just left up to the care provider to decide - because their interest is going to be saving on wages every time, especially when they have a convenient Scape goat to blame, while they wring their hands and whine that they don't know why they can't get and keep staff - yet do nothing about it.

Worriedddd · 01/11/2022 20:03

Another thing preventing people staying at home is the closure of NHS respite centres. Respite closes and families don't get a break so they ask social care to step in and provide permanent care costing more money for the state !!!

OP posts:
JockTamsonsBairns · 01/11/2022 20:21

@reigatecastle

And given we have thousands of illegal immigrants, maybe some of them can work in our care sector (on a paid basis, I don't mean for free, I mean on the same (improved) wage that anyone would get), even if it's only on a temporary basis until they are qualified to do something else

I rest my case. This is my point entirely. Society thinks that "illegal immigrants", supposedly young Albanian men with little grasp of the language, and zero experience in care, can step up to the job and be good enough.

What an utterly ridiculous suggestion. What gives you the right to devalue my job like this? I've worked hard to build up my skills, and I've gained 26 years' worth of experience in being able to deliver the quality of care that vulnerable people deserve.
Absolutely disgusted by your post.

Worriedddd · 01/11/2022 20:40

JockTamsonsBairns · 01/11/2022 20:21

@reigatecastle

And given we have thousands of illegal immigrants, maybe some of them can work in our care sector (on a paid basis, I don't mean for free, I mean on the same (improved) wage that anyone would get), even if it's only on a temporary basis until they are qualified to do something else

I rest my case. This is my point entirely. Society thinks that "illegal immigrants", supposedly young Albanian men with little grasp of the language, and zero experience in care, can step up to the job and be good enough.

What an utterly ridiculous suggestion. What gives you the right to devalue my job like this? I've worked hard to build up my skills, and I've gained 26 years' worth of experience in being able to deliver the quality of care that vulnerable people deserve.
Absolutely disgusted by your post.

This also the ratios in care homes tends to be much more female than male. We don't young men with no employment history being forced to care for our most vulnerable. It's disgusting and abuse waiting to happen.

OP posts:
JubileeTrifle · 01/11/2022 20:48

We had a family member who fought for 18 months to keep her unwell elderly father alive. He bounced in and out of hospital every few weeks.
He was awake for only a few hours a day. Person would shout at doctors and nurses about his care and what improvements could be made. They would then ring us to complain about how no one was helping him get better.
He was then sent to a different hospital and
one doctor sat her down and told her that her dad was dying, he would not improve 1% from where he was at now and in fact would get worse for every day he was alive. That he was basically exhausted and she needed to give up.
She agreed and he actually passed away a few days later. I don’t think anyone had been honest in that 18 months with her. I can’t imagine what it all cost.
There’s too much belief in people getting fixed when really, it shouldn’t happen.

When MIL died in the end it was because she wouldn’t take medication properly. The doctor told DH they shouldn’t do anything to help her as she wasn’t even helping herself. It was the right thing to do. If DH had disagreed then it could have gone on and on though.

We have an elderly neighbour (she’s horrible) who will need help soon. Her son won’t ever help her, he won’t want her in a home as he wants her house money. God knows what will happen when she becomes unwell. i half suspect he’s going to look to me to do it (I won’t).

XingMing · 01/11/2022 21:21

But not everyone who gets old. frail and ill has abused their body. MIL is a trained nurse and knows how sensible eating looks. But at 93, all she can taste is sugar. The other taste bud receptors have failed and bailed.

Askinforabaskin · 01/11/2022 21:26

A doctor friend of mine said that doctors need to be more like vets when it comes to appropriate treatment and the resulting quality of life.

ancientgran · 01/11/2022 21:30

Askinforabaskin · 01/11/2022 21:26

A doctor friend of mine said that doctors need to be more like vets when it comes to appropriate treatment and the resulting quality of life.

A friend was in hospital when covid was rife. In the next bed a retired doctor, in his 80s I think. He was demanding he was moved too ICU, he wanted a ventilator. Friend heard Consultant talking to him, telling him it wasn't appropriate and it was time to speak to family and say his goodbyes, sick doctor not having it. Consultant said it is what you would have advised. Sick doctor agreed but said his feelings had changed now he was the one who was dying.

ancientgran · 01/11/2022 21:33

JubileeTrifle · 01/11/2022 20:48

We had a family member who fought for 18 months to keep her unwell elderly father alive. He bounced in and out of hospital every few weeks.
He was awake for only a few hours a day. Person would shout at doctors and nurses about his care and what improvements could be made. They would then ring us to complain about how no one was helping him get better.
He was then sent to a different hospital and
one doctor sat her down and told her that her dad was dying, he would not improve 1% from where he was at now and in fact would get worse for every day he was alive. That he was basically exhausted and she needed to give up.
She agreed and he actually passed away a few days later. I don’t think anyone had been honest in that 18 months with her. I can’t imagine what it all cost.
There’s too much belief in people getting fixed when really, it shouldn’t happen.

When MIL died in the end it was because she wouldn’t take medication properly. The doctor told DH they shouldn’t do anything to help her as she wasn’t even helping herself. It was the right thing to do. If DH had disagreed then it could have gone on and on though.

We have an elderly neighbour (she’s horrible) who will need help soon. Her son won’t ever help her, he won’t want her in a home as he wants her house money. God knows what will happen when she becomes unwell. i half suspect he’s going to look to me to do it (I won’t).

Your neighbour's son is one of the main reasons allowing family to end a vulnerable person's life is dangerous.

Dinoteeth · 01/11/2022 22:02

@ancientgran there is a long way between someone like the neighbour living independently and someone bedbound in the later stages of dementia. Where the right point is to end it i dont know but probably bedbound with no clue what, where or who you are is definitely beyond the point of quality life.

JubileeTrifle · 01/11/2022 22:27

I suspect soon she will be in that middle ground of just needing more general help than personal care soon. Which most families would pick up (and we have previously but we won’t now, long story). But one bad illness or injury will change that I’m sure.

Dinoteeth · 01/11/2022 23:05

I know what you mean, all elderly caring seems to start with the occasional small job, like changing a light bulb and some will never need much more than that, others will need everything done for them and loose all dignity in the process.

Q2C4 · 02/11/2022 01:48

Dontsayitsuseless · 01/11/2022 12:31

@Q2C4

"Who would pay for the additional costs though? The patients, then the state when the patients' money ran out. So taxes would go up."

OMG ! Taxes would go up !!!! Oh dear !!!

Bring it on!!! You want a decent public services then you have to pay for it through a fair, redistributive tax system!

You might be happy to pay higher taxes and there is certainly a case for that. However, as Theresa May found to her cost when proposing the "dementia tax", many are not.

Winter2020 · 02/11/2022 22:40

Re care home rotas:
If weekday mornings/days are the popular shifts then of course don't advertise those shifts specifically. Advertise evening jobs and weekend ones if they are generally unpopular - it's not rocket science.

As for who would work nights? I work nights and only nights. Seven years in working nights in short break service for people with learning disabilities. I couldn't do a 24/7 rolling rota due to childcare needs shared with my husband and his work. My husband is home overnight and my shifts largely dovetail with his anyway so he is usually home for the kids when I sleep. In the past I have used breakfast and after school provision when needed to extend my chance to sleep during the school day.

Expecting 24/7 availability isn't working out for the sector so why not try something new? Who would want to be available any day, any time for probably the lowest paid sector of all? If retail can offer a Saturday job so can care.

Re immigrants being pretty much forced to work in care: When most other sectors have staff shortages they increase wages or offer golden hellos/bonuses etc e.g. supermarkets/haulage firms. Staff shortage in care = force someone to do it or ship in people from overseas.

How about offer a decent wage and decent terms and conditions (such as regular hours) that allow someone to have a decent quality of life. Radical idea that.

Dinoteeth · 02/11/2022 23:24

Q2C4 · 02/11/2022 01:48

You might be happy to pay higher taxes and there is certainly a case for that. However, as Theresa May found to her cost when proposing the "dementia tax", many are not.

The argument against the dementia tax was it was slapped on NI rather than on IT, which meant only working age people paid it. Those with hefty pension incomes wouldn't be paying it.

Blossomtoes · 03/11/2022 00:28

Dinoteeth · 02/11/2022 23:24

The argument against the dementia tax was it was slapped on NI rather than on IT, which meant only working age people paid it. Those with hefty pension incomes wouldn't be paying it.

That wasn’t the argument at all. Dementia tax proposed taking into account the value of a house when assessing whether people should pay for their own care at home in the same way as residential care. It would have actually saved taxpayers money but those with valuable houses but little in other assets would have had to pay themselves. It was abandoned because opposition came from traditional Tory voters.

Dinoteeth · 03/11/2022 00:43

Sorry I thought you were talking about the NI increase to pay for care homes.

I don't agree with people's assets being taken into account when if comes to care. People should receive care as necessary.
Some people will blow their cash and enjoy it others scrimp and save to leave their kids something. Why should the savers loose out?

Ramblingnamechanger · 03/11/2022 00:56

Reverse Brexit, recruit workers at an enhanced rate of pay and provide fantastic training and support. Maybe nationalise care / nursing homes , provide convalescence . Value the work more.