Home Care Services
Ecas believes that elderly and disabled people in Edinburgh are having to put up with inadequate levels of home care services.

We commissioned research from the Strathclyde Centre for Disability Research, at the University of Glasgow, into the provision of home care services for disabled people in Edinburgh. The research report 'Domiciliary Care in Edinburgh' was finalised in September 2008. It made a number of conclusions which criticise current home care service provision. These included concerns about the toileting services being provided; the quality of food being prepared; and the reduction in the duration of home visits.

These criticisms have proved controversial, with City of Edinburgh Council refusing to accept the validity of the report. However, we believe we have uncovered further evidence to back up the report's conclusions, through the Ecas Befriending Project - with at least one client suffering inadequate and degrading toileting services.

This story has been reported in the Evening News. The research report is available to download from the publications section of this website. The main findings of the research are:

The introduction of external tendering for new care at home packages has resulted in the City of Edinburgh Council exerting a significant influence in the mixed domiciliary care marketplace, particularly in relation to the purchase price of such services.
• There is a clear feeling among care providers that the main criteria adopted by the local authority in the tendering process is cost and that the whole exercise is seen as a cost cutting measure. This belief exists despite the local authority’s emphasis on both quality and cost of services in the tendering process. The Local Authorty claims that 70% of the contract was based on what it termed a ‘quality analysis’.
• Care providers had to substantially reduce their costs in order to gain the work, in some instances reducing their hourly rate by £2 to £3. As a result many organisations were involved in exploring methods of income generation to offset these reductions, leading to an ‘air of entrepreneurship’ amongst care providers.
• This study revealed tensions between some voluntary sector organisations and large private care companies. Not-for-profit voluntary sector organisations expressed concern in relation to the presence of profit making organisations in the marketplace. Furthermore, disparity in infrastructure and resources to participate effectively in tendering processes fuelled these underlying tensions
• Some voluntary sector organisations expressed concerns that the tendering process has no mechanism for user involvement or consultation, thereby cutting across some organisations ethos and key principles informing their working practices.
• There have been significant changes in entitlement to shopping support, which in the past has been a key element of care at home for many and less people now are qualifying for such help than in the past.. The suggestion that individuals use online shopping services to
purchase groceries rather than relying on help from the Local Authority reflects a lack of awareness of service user profiles and life circumstances. In some instances family members have taken on a shopping role for relatives, others have financed a private shopping service. None of the service providers could confirm how people with no extended family or finances to pay for such a service purchase basic food supplies.
• All care providers noted that the nature of care at home is becoming more complex, while the time allocated to provide care is reducing. The reduction of one hour visits to 30 minutes and the introduction of 15 minute ‘pop ins’ and the potential for these to become routine is of great concern as short duration visits do not enable the delivery of meaningful care. Furthermore, reduced frequency and duration of visits may lead to social isolation of an already marginalised group of people.
• There is an increasing focus on tasks associated with the provision of support and care at home rather than on the processes associated with that care. As a result of this shift the importance of, for example, social interaction is lost.
• The reduction of time allocated to meal preparation from one hour to 30 minutes does not accommodate the preparation of a meal from fresh ingredients. As a result, the majority of people in receipt of care at home live on microwaveable ready meals. Care providers expressed grave concerns for the nutritional status of individuals consuming convenience foods and ready meals on a long term basis.
• The provision of toileting assistance outside of scheduled visits is another area of concern. Such a request currently involves care providers seeking authorisation to provide the support and identification of available staff in the vicinity. Authorisation is often declined if an individual is due a scheduled visit within an hour. This situation is distressing, degrading and humiliating for service-users, as presumably a request for assistance to use the toilet, responded to an hour later would be a mute point. Care providers individually or collectively need to develop a rapid response capacity to such requests.
• The current budget for care at home services in Edinburgh is stretched and further reductions in the duration and frequency of visits constituted the two main areas of concern for providers. Some were of the opinion that any further reductions in duration of visits would compromise the safety of users and care staff. Edinburgh City Council is ranked 22nd out of 32 in terms of budget for care and ECC is spending less per capita than most other cities in Scotland.
• Most providers noted difficulties recruiting care staff citing low unemployment rates in Edinburgh and low status and low pay in the care sector. Reductions in the duration of visits, where staff are paid for visit times and not travel time, will further exacerbate these difficulties.