Janet Finn with son David who found she hadn't been visited for 24 hours
Care of the elderly is a professional job. Assisting medication, feeding, changing, bathing, even using hoists demands a level of expertise we expect in the care of some of our most vulnerable people. But when Panorama went undercover in some of Britain's biggest homecare suppliers we found carers with little more training than they needed for a job in a burger bar.
Our undercover carers were sent into companies where during months of research, we had heard first hand accounts of serious systemic failings. They completed four days of training with Age Concern Training, exceeding the government's national minimum standards. Emergency medical cover was on standby throughout the time they were working.
When applying for jobs, both Hayley Cutts and Arifa Farooq said they had some caring experience but no formal training. It wasn't long before they got work. Hayley's first job was with a company claiming to be Britain's fastest growing care provider with around 15,000 elderly clients.
Hayley's training at Carewatch consisted of four 20-minute DVDs and a tutorial lasting 90 minutes. A check with the Criminal Records Bureau is a legal requirement but Hayley was allowed to work 14 shifts before she was cleared. The company apologised for what they said was an administrative error.
On shift, Hayley finds tight schedules causing havoc for staff. While visiting a 77-year-old terminally ill man, her colleague's phone rings. As the elderly client asks for oxygen, his carer is talking on the phone about work throughout.
Panorama used secret filming to unveil problems in some homecare providers
Carewatch says company policy states that phone conversations should not interfere with work. But the piling on of visits is not unusual during Hayley's time with the company. This makes visits rushed and those towards the end of the day can even be missed. It also said it was "determined to ensure that any lessons to be learnt from this covert investigation are learnt".
"You had back to back appointments and you weren't factored in travel time. So it meant that if I had to drive 20 minutes outside of York, I would be late before I even started. And on top of that, if any service user needed a little extra bit of care, no matter how small like just extra time to get to bed or they needed a little longer on the toilet that day, that time wasn't factored in," says Hayley.
The company denies that travel time is not factored into schedules.
But the pressure on carers' time is not isolated to this one company. Missed appointments can be a matter of life and death for some, but when Hayley moves to work for Care UK she finds the same story. The company has 48 care contracts around the country, mostly in England, looking after 15,000 clients. Last year it was awarded a £2.4 million annual contract by Hertfordshire county council.
Janet Finn is 89. Suffering from dementia and doubly incontinent. She depends on carers to visit her three times a day for half an hour. In June 2008, Janet's visits were skipped for an entire day. Her son David found her. "She'd had 24 hours with no food, no water, no medication and she was sitting in her own faeces and urine," he told Panorama.
Care UK admitted she had dropped off their computer system and apologised to the family. Janet has since moved to a different care provider and now gets four visits a day.
Andy Wilson depends on carers but his visits were often cut short
After thousands of complaints and over 900 missed calls Hertfordshire Council got rid of Care UK, just 10 months after they had been awarded the contract. But the company still has a contract in neighbouring Harrow where a care inspector's report found Care UK "is run more in the interests of the staff than the people they are supposed to be caring for." The inspectorate gave Care UK Harrow a zero star rating and assessed its standard of care provision as "poor."
By the time Hayley went undercover in Harrow, Care UK should have put right 20 of the 22 failings indentified by the inspectorate in October 2008. However she found some of those failings were ongoing, including a lack of care plans in clients' homes, care plans that were up to two years out of date, problems with the provision of medication and erratic timings of visits to clients.
Care UK told Panorama that where they had not met the high standards they set themselves, they apologised wholeheartedly and had acted to ensure performance improves. They said within a week of Hayley's departure all care plans had been fully updated and that the incidents referred to in the programme, while distressing to the individuals and families involved, are extremely rare.
Care of the elderly is a lucrative industry after the doors were opened to private companies in the 1990s. Research from the London School of Economics, commissioned by Panorama, found that 70% of home care is provided by the independent sector today and is worth £1.5 billion. The figure was just 2% in 1992. English local authorities spend around £22 an hour providing elderly care, but the independent sector provides it for around half that.
One company assigned carers their jobs in a car park every morning
Panorama went to South Lanarkshire in Scotland where an online auction decided the council's new care provider. Domiciliary Care won the auction which saw bidders bidding down, not up. It's one of Scotland's largest care providers looking after more than 1,500 people. While it won with a bid to provide care for £9.95 an hour, South Lanarkshire says the decision to award the contract was based only 40% on price with 60% based on quality of care.
Andrew Wilson, 78, was one of the clients whose care went to Domiciliary Care (Scotland). Mr Wilson is hard of hearing, blind in one eye and unable to walk more than a few steps. With no close family he lives alone and depends on carers. He allowed Panorama to fit secret cameras in his home for 19 days.
The cameras showed him receiving a bed bath with his carer constantly on the phone and revealed that of his four half-hour visits a day, the lunch and teatime visits were often curtailed. While his care assessment says his lunchtime carer should prepare and cook a meal, he was routinely fed on sandwiches, packets of quavers and toast.
Domiciliary Care denied neglect, saying their carers were under no obligation to go shopping for Mr Wilson but routinely did so as there was often no food in the house.
'Tragic and scandalous'
After four days of training, which exceeded national minimum standards, Arifa Farooq found a chaotic system with carers relying on clients to tell them what they needed. Care plans should be provided for every client detailing what the carer should do on every visit including any medicinal requirements. A copy should be kept at headquarters and one at the client's home. Arifa found that frequently there was no plan. She saw confidential care plans stacked in the boot of a company car and strewn across back seats.
Joan Bakewell said the bidding practice translates into less care
During her time with the company, Arifa found she often had little time to spend on a visit, with one call lasting just three minutes. South Lanarkshire council, who awarded Domiciliary Care the contract, declined to be interviewed but watched the covert footage and said they found Panorama's allegations deeply concerning and have launched a full investigation.
Six months ago, Domiciliary Care was taken over by Choices Care Group which says it is appalled by our findings. It says some of the problems are inherited and that an internal investigation found some of the programme's allegations to be proven, including curtailed visits. It went on to say that changes are now being implemented.
As a result of our programme South Lanarkshire council have removed three clients from Domiciliary Care including Andrew Wilson. He is now with a different care provider and tells reporter Paul Kenyon his life has changed entirely.
A Department of Health spokesman said: "Every older person is entitled to high quality, safe and dignified care, whether it is provided in their own home or anywhere else. Anything less is unacceptable.
"The new Care Quality Commission has tough powers to penalise or close down providers who offer substandard care. We expect CQC to use these powers to crack down on cases such as those highlighted by Panorama."
Joan Bakewell, broadcaster, author and now a government advisor on ageing is horrified by Panorama's findings. "There are places where achieving old age is something to celebrate," she said.
"As things stand the UK is not one of them. Selling elderly care to the lowest bidder can do nothing to improve that. Neither can the pitifully low wages offered to carers.
"I'm not altogether surprised," Bakewell told the programme, "but the proof is really tragic and scandalous. It's easy to say but something has to be done. Somebody must take responsibility for these lapses in standards and must ensure that standards are kept in the future."
What the elderly should expect in terms of their care
Britain's Homecare Scandal: A Panorama Special is on BBC One, Thursday 9 April at 2100
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