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The scandal of a 15-minute care slot

11 October 2013

A cowardly strategy has been exposed, says Paul Vallely

THERE was an extraordinary dignity about Sally Lubanov, the 83-year-old house-bound woman who told several million radio listeners this week that she had not been able to take a bath for three years, and whose carers are not allowed to cut her toenails. "I'd like to make it clear I'm in no way complaining about my own circumstances," she said firmly.

What she was complaining about was a system that means that carers spend the first ten minutes of a half-hour visit booking in, checking what the previous carer has done, and kitting themselves out. This leaves only ten minutes to do the actual job, before embarking on ten minutes of exit duties.

Mrs Lubanov is one of the lucky ones. She has switched from short daily appointments to fewer longer appointments to ensure that things get done. But those who are more infirm, and who need help with washing, dressing, or going to the lavatory, do not have such flexibility.

The Leonard Cheshire charity reports that 15-minute care slots are now routine in two-thirds of local authorities. In some councils, more than 75 per cent of care visits are carried out in less than 15 minutes. "What I'd like most", Mrs Lubanov told Today on Radio 4, "would be for someone to have time to have a chat, to cook a hot meal, and sit down and have it with [me], for someone to take me shopping."

Her interviewer, John Humphrys, was suitably outraged by the shortcomings of the system. But he failed to understand that what the 83-year-old wanted most was not practical care, but human interaction. "I'd like to talk to you for hours, but . . ." he said to her, unwittingly exemplifying the problem.

His next interviewee, the Care Minister, Norman Lamb, understood. The key thing the old lady had craved, he noted, was "companionship, contact with other human beings. . . There is nothing worse than loneliness and isolation." But Mr Humphrys interrupted with a litany of practical tasks - having a bath, getting the bed-sheets changed, having her toenails cut - which the state had the obligation to provide.

Neither man offered the solution. The interviewer's calculus was purely utilitarian. But practical tasks are more than the fulfilment of need. They are a manifestation that someone cares. The minister acknowledged this, and said that the answer lay in a richer collaboration between local volunteers and statutory authorities. But he failed to accept that even this will cost more than he is prepared to allocate.

A former care-worker laid bare the truth the next day, explaining why she had quit the job. Her problem was that she cared too much. She was constantly in trouble from her employers for spending too long with her elderly clients. "What is a carer to do on arriving for a 15-minute call to find the client soiled, confused, and extremely distraught?" she asked. "Administer the medication as instructed, or to clean and change the client, or to make a hot drink, and try to calm and reassure the client? All three in my book, but the present times do not allow for this."

The fact is that the contractors employed by many councils give their staff unrealistic schedules. They do this because the Government allocates unrealistic budgets to the job. Everyone colludes in this cowardly strategy because it enables them to shift the blame to someone else. The harsh reality is that the authorities have to drop some individuals from the care list, which would cause them political problems - or to allocate more money, which would cause financial ones. With an increasingly ageing population, our politicians cannot continue this dissembling.

Paul Vallely is Visiting Professor in Public Ethics at the University of Chester.

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