Britain's Home-Care Crisis Panorama


Britain's Home-Care Crisis

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Tonight, home-care companies in crisis because they can't

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recruit enough staff.

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I have sleepless nights because I worry.

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We are physically not being able to fit them

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in on the carers rotas.

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Good morning.

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We meet hard-pressed carers on zero-hours contracts.

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It is hard.

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Because I didn't have a contract, they wouldn't

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allow me to buy a house, or anything like that.

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We discover nearly 100 councils have had home-care contracts

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handed back to them.

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That was a terrible thing to do, both for service

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users and for care staff.

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Frankly, what choice did we have?

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The nationwide shortage of carers means people are stuck in hospital,

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blocking precious beds.

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It won't be long now, so I am doing everything to get you home.

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The Government's just promised more money for social care,

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but is it too little, too late?

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I struggle to find a word that's one higher than crisis ? I think

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in a sense we're probably at the point of near failure.

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The Llyn peninsula in north Wales.

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It's eight o'clock in the morning, and home-carer Amanda

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is beginning her working day.

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Her first call is in Pwllheli.

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Good morning!

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Have you got your bleeper on?

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My bleeper, why?

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What bleeping time do you call this?

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Amanda's one of the UK's 800,000 home-care

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workers, helping the elderly and disabled live

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independent lives at home.

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Today, she's with former teacher William Williams,

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who has multiple sclerosis.

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It's just nice knowing that I could go out there

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and help other people and make sure that they're safe

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in their own home, and that they can actually stay home, and live

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at home in their own house, and don't have to go into care

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or anything like that.

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I'm 72, remember.

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I haven't got much time left!

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We have!

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Many years to go again!

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The girls, I have to admit, are terrific.

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Absolutely terrific.

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They're caring, they're understanding

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and they're full of fun.

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Like many carers, Amanda struggles to make ends meet.

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She's paid ?7.55 an hour, just above the national living wage,

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but she's on a zero hours contract, which means the hours

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she works are not guaranteed.

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I did look into buying a house four years ago,

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but because I didn't have a contract they wouldn't allow me to buy

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a house, or anything like that.

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It's hard, it is hard.

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You see your friends out every weekend, going

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for supper with each other.

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It's just like "No, I can't come."

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Try and be a little earlier than this morning, will you?

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I'll be sat in the car, waiting!

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Ta-ra, Will!

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It's really a hard day's work really.

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With working out in the community.

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You could work from 7.30am straight through to 10pm but you do get

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breaks in that time.

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But I could see up to about 10, 11 people a day.

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Amanda is one of 200 staff at a family-run care company

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near Bangor in Gwynedd.

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Hello.

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Cymorth Llaw.

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Cymorth llaw, which means Helping Hand,

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is paid by local councils to provide home care.

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I'm just concerned about her safety and welfare, really.

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Menna is one of the managers at the company, and has

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worked here for 14 years.

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The change in that time, the sense of recruiting ?

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for the last two years recruitment has been phenomenally

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hard out there.

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Have you got blank rotas I can have, please?

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Menna's trying to juggle the staff rota.

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There are gaps that need covering.

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She's also trying to find carers for new clients.

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Due to staffing availability, and the hours of care

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that they require, we physically cannot fit them in on the carers'

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rotas, unfortunately.

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And that's part of the job I do not like to do,

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And how does it make you feel in those situations?

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I have sleepless nights because I worry.

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Across the water in Liverpool, and the pressures are the same.

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A shortage of care workers means it's difficult

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to get people who've been in hospital back home.

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This way?

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Yes.

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Bad leg up?

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Yes.

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Bad leg up.

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86-year-old Anastasia O'Leary was transferred to the Granby

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Rehabilitation Unit from the city's Royal Liverpool University

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Hospital last November.

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I was very sorry to hear about your fall,

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and you were on the floor for five days?

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Five days I was on the floor, love, for five days, and it was a really

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dark night.

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All me nose was bleeding and me mouth was bleeding.

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I had terrible scars on me hands trying

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to grab hold of the cabinet to get

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meself up off the floor, but I couldn't.

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I just had to lie there ? I was only banging on the walls for five days

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but nobody heard me, but, on the fifth day,

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somebody must have just heard me, and the next thing I knew the fire

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brigade had to smash all me door down and get me out.

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I was in a pretty bad way, wasn't I, love?

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You was, and look at you now.

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I was, love, in a bad way.

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Anastasia's been well enough to go home since January.

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She'll need four visits a day from carers.

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But finding that care package is proving difficult.

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There's currently about five people.

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Anastasia is one, that are still with us now.

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They've been here more than the 28 days,

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is on average the amount of time people spend with us.

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Some patients have been with us 12 and 14 weeks because all the therapy

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is complete but unfortunately there's no care package available

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at the end of it.

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Back at the home-care company in North Wales,

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there's a crisis looming.

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Is there a possibility please that you could help us out

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this evening at all?

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You can't?

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Right.

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OK.

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Thank you.

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A member of staff is sick and there's no-one to visit

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an elderly client this evening.

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We've been trying to cover this shift since Monday morning and we're

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having great difficulty due to lack of staff in area.

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Could you please get back to me once you've had this message?

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Time's running out to fill the shift

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but, after some frantic phone calls, they eventually find a member

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of staff to step in.

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We are caring for people's lives here.

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It's not just...

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you know, anybody.

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It's important that we do provide that professional care for them

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out in the community.

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Home-care companies across the UK say one of the biggest

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problems they face is recruiting and keeping carers.

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Staff at Cymordd Llaw are receiving training.

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The company says it's an important area to invest in,

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but sometimes that can back-fire.

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When they've attained such qualifications,

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they can quite easily walk into the local hospital

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as health care assistants.

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Yes, they are staying in care and, yes, they are doing a valuable

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job in the local hospitals but, of course, that leaves us

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short in the community.

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And the pay and conditions working for the health board are far,

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far better than what we can offer.

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Carers at the company ? where there are around

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30 staff vacancies - aren't just leaving

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to work in hospitals.

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We know the local supermarkets are paying considerably more

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in wages than what we can pay and of course when you work

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in a supermarket you're not putting 50, or 100 miles

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a week on your car travelling from village to village to see clients.

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You just go to the one venue, do your shift, and go home.

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Single mum Kirstie Jones worked as a carer for five years

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in the Prestatyn area of North Wales.

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Sometimes we were the only people they actually saw in day to talk to.

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You do become close to them ? I don't think you're

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human if you don't.

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It was hard work, but it was fulfilling.

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After gaining qualifications while working as a home carer,

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she got a job as a healthcare assistant at her local hospital.

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The pay was better, the hours were better.

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No wear and tear on my car.

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Don't get me wrong, I do miss the clients,

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but I definitely don't miss the hours.

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For carers still in the job, like Anne-Marie, they continue

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to do their best despite the many demands they face.

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It's eight o'clock starting and got four calls this morning.

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After three visits in Gwynedd, Anne-Marie

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is already behind schedule and calls the office.

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Hi, Teresa.

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It's Anne-Marie.

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All right?

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Can you give my 10am client a ring and let them know I'm running late

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for about 20 minutes?

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You got to do the personal care, got to do the breakfast,

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prepare lunch, sometimes just need to talk to you ? five

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minutes of your time ? but you've got to rush,

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in and out, in and out with them.

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So you feel a bit rude.

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Like her colleagues, Anne-Marie is on a zero hours' contract.

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Have you seen this, Ken?

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The company's been in business since 2000 but it's

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seen its profits fall over the last few years.

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What they do make, they plough back into the family business but say

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it's still not enough to increase wages.

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We pay as much as we possibly can and we've always paid

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above what was the national minimum wage and the national living wage.

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They get a mileage allowance, they get paid travelling time

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between their clients.

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As a company we are legally obliged to pay, you know, 1% pension,

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13.8% National Insurance and of course training

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and all the other things that go to employing a person.

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It doesn't leave a great deal.

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The company used to provide care for three

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councils in North Wales.

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But last year it stopped working with one ? Conwy ? which initially

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paid ?14.20 an hour for care.

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They then offered to raise that to ?15.00 but the company decided

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that still wasn't enough, so they handed back the contract.

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We didn't think we could provide this level of service for that

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amount of money that Conwy were offreing.

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We were very reluctant to leave, but we had to leave.

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It was as simple as that.

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Conwy Council says it's committed to supporting vulnerable

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people in communities, despite facing financial challenges.

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Conwy's not alone.

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Our research reveals that, across the UK,

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almost 100 councils have had home-care contracts

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handed back to them.

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?12.60 in the North East, ?12.95 in the North West.

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These are the average figures some councils pay companies per hour

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to provide home-care, according to the

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industry's trade body.

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It says many companies are really struggling.

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We have some really desperate providers, who really do not know

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whether they're going to be able to continue in business, um,

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beyond the next year.

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That means they're really having to make some hard,

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commercial decisions, whether they might need to cease

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trading or indeed just hand back work to local councils.

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Home-care company Mears is the second

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biggest in the industry.

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It used to have a contract with Liverpool City Council but

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handed it back last July, saying the ?13.10 an hour paid

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simply wasn't enough to cover their costs.

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That was a terrible thing to do both for service

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users and for care staff.

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We absolutely did not take that lightly but frankly

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what choice did we have?

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Mears says it needed at least ?15 an hour to provide

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the care expected of them, and like home-care companies

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across the UK, claims its costs are often greater than the amount

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councils are prepared to pay.

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We just cannot do the two most basic things

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that you need to do in homecare ? one, pay staff the absolute

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minimum of living wage and, two, be able to recruit people,

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enough people to deliver the service that Liverpool Council

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actually expected from us.

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Mears has also handed back contracts to two

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other English councils, with more in the pipeline.

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Over the last seven years, Liverpool City Council's budget

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has been cut by ?330 million.

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Now it has to find a further ?90 million over

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the next three years.

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Samih Kalekache is the outgoing director of adult social services.

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When Mears pulled out of the city, other providers managed to pick up

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the work but the pressure remains.

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It is concerning when the care provider is saying, "We can't

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maintain this level of care."

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Absolutely we could see that, and that's why ourselves,

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and all the directors nationally, are looking to address it.

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But, frankly, how could you address it when there are no resources

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coming from elsewhere?

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Most home care across the UK is provided by the private sector.

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Panorama has commissioned analysis of the financial state

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of Britain's 2,500 home-care companies.

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The research suggests that more than one in four of them

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are at risk of insolvency.

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The analysis also reveals growing numbers of home-care companies

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simply shutting up shop and walking away ? 69

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in the last three months alone.

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We've had 25 years of the market economy

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and I think everybody recognises the word often used

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is, 'we're in crisis'.

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I struggle to find a word that's one higher than crisis,

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I think, in a sense, we're probably at the point of near

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failure in the market.

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Oh, hi.

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It's Jo from Care Brokerage here.

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I was just wondering if you could let me know if you've

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got any capacity today, and if so in which postcode areas?

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If you could have a little look at it for me?

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Like many councils, Liverpool has a busy team constantly

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searching for carers.

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Nothing at all?

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All right then.

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Thank you.

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Bye.

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They're trying to find care packages for people at home and those

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in hospital waiting to leave.

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We're really desperate to get him out of hospital.

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But it's not easy.

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It's the staffing isn't it, basically.

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There's quick turnaround with that job, I think people do it and then

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they leave and then they're stuck.

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Yeah, like yesterday where a care provider had

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picked up a hospital case.

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It all been agreed.

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The gentleman was discharged from hospital at 9.30am yesterday,

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and then care provider got in touch called at 11am to say due to two

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staff resigning night before, they weren't able

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to provide the care.

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So it's a bit of a crisis situation.

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This gentleman was now at home.

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Family were there for now, weren't they?

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Yeah.

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They were going to try and organise a home visit.

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We've got a provisional offer from one provider,

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who's going to get back to us later today.

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So, fingers crossed.

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That provisional offer fell through.

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It took another two days to find a company able to take the case on.

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If they've got capacity, then obviously they want the work.

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There's too many people need care and not enough carers.

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It's the same picture in North Wales.

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Lovely, ta-ra, ta-ra, ta-ra.

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Menna's just got off the phone to Gwynedd Council.

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Its Social Services team is trying to find care packages for people

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waiting to leave hospital.

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There's a client at home here, waiting for care.

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There's another one still in hospital, waiting discharge.

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I requested an updated list of clients that are waiting to come

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out of hospital or are at home already that need care.

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I've given them availability of the hours that we can give them.

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Unfortunately, we cannot offer them the times that they request,

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as there's just no capacity at that time slot for any more clients.

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Menna recognises one of the patients, the same person

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was also on the waiting list for care last week.

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So what's happened to that person now, where is he or she?

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Still in hospital.

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That client will remain in hospital until a suitable

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time comes available.

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Bed-blocking.

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Bed-blocking.

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There are more than 6,500 people across Britain stuck

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in an acute hospital bed, despite being well enough to leave.

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In England, a third of these are waiting for a home care package.

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Hello.

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I'm back again.

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82-year-old Shirley Haughie has dementia.

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Her daughter Yvonne has come to visit.

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You don't think so?

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That's OK then, isn't it?

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Shirley was taken to Liverpool's Royal University

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hospital suffering from dehydration in early January, then transferred

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here to Broadgreen Hospital shortly afterwards.

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I am doing everything to get you home.

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She doesn't know where she is.

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It's a strange place.

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The confusion is just devastating.

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It's hard to sleep when you're in hospital, isn't it.

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Yeah, yeah.

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Yvonne's getting her mum's house ready for her return.

0:18:470:18:51

Shirley's been well enough to leave hospital for nearly nine weeks.

0:18:510:18:54

But difficulties finding her a care package are delaying the process.

0:18:540:19:00

Hi, it's Yvonne here.

0:19:000:19:01

You rang me earlier about the care package we're hoping to get

0:19:010:19:04

in place for my mum.

0:19:040:19:08

She's medically fit to come home and they want her to go home.

0:19:080:19:11

She has been assessed by a social worker.

0:19:110:19:13

Everything has been approved, the care she needs,

0:19:130:19:17

what she requires.

0:19:170:19:19

That's all been approved.

0:19:190:19:21

Direct payments have been approved, now it's basically finding somebody

0:19:210:19:25

who can provide that care, which is not as easy as it sounds.

0:19:250:19:31

We're finding it really, really hard.

0:19:310:19:33

You know, you think there's loads out there.

0:19:330:19:35

It should be dead easy, but it isn't.

0:19:350:19:38

It won't be long now.

0:19:380:19:40

Yeah.

0:19:400:19:42

OK?

0:19:420:19:46

Pressure on council's social services departments across the UK

0:19:460:19:50

is growing each year, as life expectancy increases.

0:19:500:19:54

There are more than five million people over the age

0:19:540:19:57

of 75 at the moment.

0:19:570:19:59

There'll be two million more in ten years' time.

0:19:590:20:03

The Granby Rehabilitation Centre in Liverpool is run

0:20:030:20:05

by the City Council, to relieve pressure on the area's

0:20:050:20:09

larger acute hospitals, but it too is full.

0:20:090:20:19

We've had four referrals this morning

0:20:200:20:28

There's only two beds.

0:20:280:20:30

We're still under tremendous pressure to get as many patients

0:20:300:20:32

home as possible from the patients at the Royal across to ourselves

0:20:320:20:35

and get them reassessed.

0:20:350:20:36

I think this week, the bed crisis, A was just chock-a-block.

0:20:360:20:38

For Liverpool's director of adult social services,

0:20:380:20:40

it's a familiar story.

0:20:400:20:41

Chris, what's the status today?

0:20:410:20:42

Today we've got 28 people in Aintree hospital,

0:20:420:20:44

who are awaiting care packages or placements in care homes,

0:20:440:20:47

or short-term care.

0:20:470:20:48

We've got 45 people in the Royal hospital.

0:20:480:20:50

Most of it is because there's quite lot of people waiting for care

0:20:500:20:53

packages and beds in intermediate care or care homes.

0:20:530:20:55

It's just a matter of trying to source those packages.

0:20:550:20:59

Is there a crisis in the homecare services?

0:20:590:21:01

I'd say yes, there is.

0:21:010:21:04

And it's not just money.

0:21:040:21:06

It's the sheer volume of demographics.

0:21:060:21:10

We've got an ageing population, which we welcome, but we don't have

0:21:100:21:13

enough people coming into the industry.

0:21:130:21:17

It's estimated we'll need at least two million more

0:21:170:21:20

carers in England alone, in both domiciliary care

0:21:200:21:23

and care homes, to cope with the growing demand by 2025.

0:21:230:21:31

Last October, the regulator in England, the Care Quality

0:21:310:21:34

Commission, warned the home care sector was at a tipping point.

0:21:340:21:38

Six months on, it says nothing has changed.

0:21:380:21:42

The homecare sector continues to be a fragile sector.

0:21:420:21:45

It continues to need to have a long-term,

0:21:450:21:55

sustainable solution to the problems that it's got.

0:21:560:22:02

We've carried out our own research that shows that

0:22:020:22:04

one in four companies are at risk of insolvency.

0:22:040:22:07

In some parts of England, it's as high as one in three.

0:22:070:22:09

Does that surprise you?

0:22:090:22:10

I'm afraid it does not surprise me that there are a number

0:22:100:22:13

of services that are at risk.

0:22:130:22:15

And we need those services to survive.

0:22:150:22:16

We need those services to continue to provide good care.

0:22:160:22:19

It is a real worry that the smaller services that are focusing

0:22:190:22:22

on providing high quality person-centred care

0:22:220:22:23

are finding it difficult.

0:22:230:22:26

As pressure builds on the hospitals in Liverpool, carers employed

0:22:260:22:29

by a council initiative called Homefirst are working flat

0:22:290:22:33

out to free up beds, but even this service

0:22:330:22:36

is under strain.

0:22:360:22:38

Hiya, you alright?

0:22:380:22:40

Yes.

0:22:400:22:42

Homefirst carer Gail Bainbridge is helping 79-year-old

0:22:420:22:44

Violet Hill, who's back home after a stay in hospital.

0:22:440:22:46

Is it cold out?

0:22:460:22:49

Yes, it's going cold now.

0:22:490:22:51

Hospitals can discharge patients like Violet,

0:22:510:22:53

if they know a Homefirst carer is free to help them

0:22:530:22:55

regain their independence at home.

0:22:550:22:58

What do you fancy for tea tonight?

0:22:580:22:59

Chicken casserole.

0:22:590:23:02

You go and do it then!

0:23:020:23:04

Come on.

0:23:040:23:05

Shall we go now then?

0:23:050:23:07

Yes.

0:23:070:23:09

No peace for the wicked, you know.

0:23:090:23:11

Homefirst gives the council a breathing space to find

0:23:110:23:13

a private care package.

0:23:130:23:15

Ad the more independent Violet is, the less help she'll need.

0:23:150:23:17

Sometimes I'm already dressed, sometimes they give me

0:23:170:23:20

a hand at getting dressed or having a shower.

0:23:200:23:22

I've gotta be have someone in the shower room with me,

0:23:220:23:24

because I'm terrified in case I slip.

0:23:240:23:28

Can't grumble with them at all.

0:23:280:23:30

They're lovely girls, honestly.

0:23:300:23:32

We have a laugh, yes.

0:23:320:23:34

I wish they could stay longer.

0:23:340:23:38

Hello Homefirst team, can I help you?

0:23:380:23:41

Demand from the local hospitals is overwhelming.

0:23:410:23:48

Right, we'll be able to take it, but wouldn't be able

0:23:480:23:51

to start till Monday.

0:23:510:23:51

We haven't got that in that area, I'm afraid, Jen, no.

0:23:510:23:54

But Liverpool's latest effort to free up hospital beds is again

0:23:540:23:57

hindered by the shortage of home care workers in the private sector.

0:23:570:24:00

No capacity, sorry.

0:24:000:24:03

The longer it takes to find private home care for people like Violet,

0:24:030:24:09

the less space Homefirst has to take on someone new.

0:24:090:24:13

Violet has been with us since October, and she is

0:24:130:24:16

on our list of long-term people, you know.

0:24:160:24:18

She requires a long-term package of care, and it can't be sourced.

0:24:180:24:22

So we keep them.

0:24:220:24:24

Of course, that blocks us then, because we can't

0:24:240:24:26

take anybody else on.

0:24:260:24:28

No, I didn't like that at all, Gail.

0:24:280:24:30

Do you want anything else instead?

0:24:300:24:32

No, not at the moment, might have something later on.

0:24:320:24:35

Have a bit of toast later on, yeah?

0:24:350:24:37

Yeah, bit of cake or something!

0:24:370:24:42

Hello, Cymorth Llaw.

0:24:420:24:45

Back in North Wales, and with the demands

0:24:450:24:47

on her carers increasing, Menna feels they're not

0:24:470:24:49

always valued by society.

0:24:490:24:53

These carers work long hours, unsociable hours.

0:24:530:24:57

They go out in all weathers, weather it's snow, hurricane wind.

0:24:570:25:02

They're out in it.

0:25:020:25:04

How are you, Maggie?

0:25:040:25:06

I don't think care is a recognised profession.

0:25:060:25:08

I think ? oh, somebody's got to do it.

0:25:080:25:10

That career has got the right to be respected.

0:25:100:25:17

Just like any other job out there.

0:25:170:25:18

We need to make sure that we are valuing and recognising

0:25:180:25:21

that these are difficult jobs, but they are incredibly rewarding

0:25:210:25:23

and fulfilling jobs as well.

0:25:230:25:26

But we can't just rely on people's commitment and dedication.

0:25:260:25:30

We have to make sure that we're supporting them properly and we're

0:25:300:25:33

rewarding them appropriately.

0:25:330:25:39

The UK Government has announced ?2 billion extra for social care

0:25:390:25:44

for English councils over the next three years.

0:25:440:25:48

Scotland, Northern Ireland and Wales will decide themselves how

0:25:480:25:51

they spend their extra funding.

0:25:510:25:55

But the industry says that with an increasingly ageing

0:25:550:25:58

population, it's just not enough to keep pace with demand.

0:25:580:26:04

I don't think that the people who make these decisions

0:26:040:26:07

actually realise what goes on in the community.

0:26:070:26:12

For instance, has the Minister of Health ever been out on a wet,

0:26:120:26:15

windy night in the middle of Anglesey with a home career

0:26:150:26:18

at 9pm knocking on somebody's door to go in to put them to bed?

0:26:180:26:22

I don't think so.

0:26:220:26:25

The UK Government declined an interview, but in a statement,

0:26:250:26:28

said it has given English councils a total of ?9.25 billion

0:26:280:26:33

to fund social care.

0:26:330:26:35

It says it will be bringing forward proposals later this year to ensure

0:26:350:26:39

a more financially sustainable social care system.

0:26:390:26:44

Liverpool City council will receive an extra ?27 million,

0:26:440:26:49

following this month's Budget announcement, but like many

0:26:490:26:52

struggling councils, they say it's too little, too late.

0:26:520:26:57

I've been given a sticking plaster, after two to three years,

0:26:570:27:01

if the system doesn't change, I don't think we'll

0:27:010:27:05

be able to maintain the services the way they are.

0:27:050:27:08

It makes me feel very angry, that we cannot provide the care

0:27:080:27:13

which should be available.

0:27:130:27:16

Instead, wer'e having to prioritise.

0:27:160:27:18

Is that a service which I want?

0:27:180:27:21

Definitely not.

0:27:210:27:22

But what else can I do?

0:27:220:27:27

For Anastasia in Liverpool, the waiting is at an end.

0:27:270:27:32

# We'll meet again some sunny day #.

0:27:320:27:38

After being here since November, carers have finally been found

0:27:380:27:42

to help her at home.

0:27:420:27:45

For Shirley, until a care package can be put in place,

0:27:450:27:48

the wait goes on in hospital.

0:27:480:27:52

And in North Wales, it's the end of the working day for Amanda.

0:27:520:27:57

And she's back at William Williams' house to get him ready for bed.

0:27:570:28:01

Hello.

0:28:010:28:02

How are we?

0:28:020:28:03

Still here.

0:28:030:28:05

Still here, well that's a good.

0:28:050:28:07

Her day began at 8am, over 12 hours ago.

0:28:070:28:13

I like my job and I feel good about myself, when I've given

0:28:130:28:16

them that care as well.

0:28:160:28:18

I know I've done everything right and that they're tucked up in bed

0:28:180:28:22

and the doors locked.

0:28:220:28:24

And there we go until the next morning.

0:28:240:28:30

With more of us living longer and a growing

0:28:300:28:32

shortage of care-workers, is time running out

0:28:320:28:35

to find a solution to Britain's home-care crisis?

0:28:350:28:42

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