There is a permanent contradiction in the sphere of health and social care in that one person’s home is another person’s workplace, such that people’s private lives are intertwined with public responses to those lives (i.e. the state provision of care and support offered to someone living with an illness or disability). This is the intersection of the public and the private. The private lives of disabled people and elderly people are situated within the public care sector, which is itself part of a care industry, (and the wider labour relations this entails). The value of service users, both as individuals and collectively, is intertwined with the value of the people paid to support them.
This interplay between public troubles and private lives would not necessarily be problematic in a society where disabled people are esteemed, and elderly people respected. However, currently in the UK, the low pay and poor working conditions of the staff that come into people’s homes to provide support is a compounded social insult against all of the groups involved. It has clear symbolic meaning in terms of how society perceives the contributions of disabled people and elderly people, as well as the women and non-UK nationals who are disproportionately employed in the support work and homecare sectors. It also has serious material implications for all parties included.
Currently there is a national dispute between care providing organisations such as Mencap and the UK government about rates of sleep-in pay for support workers who stay overnight in service users’ homes. Following a number of tribunals brought by care staff against care providers, the government has confirmed that workers who are required to be on site at night (in case they are called upon to deal with any incidents) should be paid at least the national minimum wage for their time. Failure to do so could result in severe penalties for the employing organisation, including HMRC enforcement action and might include awards of up to six years’ back pay. Care providers argue that the quality and availability of support will be diminished if they are required to pay what has been estimated to be £400 million. In this instance the safety of service users is compromised as care providers and the UK state essentially tussle over who is accountable for the chronic undervaluing of support staff.
In terms of homecare, where staff make visits to service users’ houses, issues relating to pay are equally dire. In September this year, Unison released a damning report -‘Homecare: making visits matter’, which lays bare the context of homecare in the UK. Using data from a sample of over 1000 homecare workers, the report concludes that there is endemic underpayment of care staff, with many working for less than national minimum wage, and/or on zero hour contracts. Care provision has long been sustained by ‘bank’ staffing, before ‘gig economy’ and ‘zero hour contracts’ even entered the common vernacular.
This, in combination with inadequate allocation of staff and the overloading of rotas generates high employee turnover. Care providers cannot ensure consistent staffing, and individual employees are so time-poor they are frequently unable to provide adequate support. In terms of the people receiving care, the end result is often that the most personal of needs end up being met by strangers, if they are met at all.
This disheartening view of the UK care sector seems to be a world away from technological advancements in artificial intelligence (AI), a research area which commands billions of pounds of investment. However, according to Nigel Gittins, the managing director of Webroster, it is in AI that the answer to the needs of the care sector lie. He argues that AI represents a ‘hugely accessible and feasible solution’ to the issues raised in the Unison report. For example, he discusses the advancement of the ‘Optimiser Engine’, developed as part of a four year partnership with the University of Nottingham. The engine has been designed to mimic the decisions of a care coordinator. It requires that the priorities and values of the user business are inputted, which it then uses to create a roster that optimises those values. Gittins stresses that AI will not make care coordinators redundant, but will instead offer consistency, and ensure ‘your business values’ are being reflected in each rota’ – one value he lists as a suggestion is ‘cost-efficiency’. He advises that care providers will be able to forward forecast more effectively with regard to finances, staffing numbers and the care requirements of service users, going so far as to suggest that homecare workers will gain more time with the individuals they support.
Despite the optimistic tone of Mr Gittins’ press release, it is not immediately apparent how the use of AI will materially improve the service offered to disabled and elderly people in the UK. It is not clear how AI will help those support workers due back pay for sleep-in time, or move workers to less precarious employment contracts. In terms of value it seems farfetched to speculate that the financial investment in AI will somehow transform how we view the recipients of care, or the people who care for them. Similarly, the time it takes to travel from one home to another, to adequately support someone with feeding or toileting remains fairly static. I do not doubt that AI can be a useful resource in terms generating rotas. However, what its proponents do not acknowledge, is that it represents the application of an expensive (and rather inadequate) plaster, over what is a gaping wound. It does not address the systemic failures within the system, nor does it challenge the how and why of social care being under so much pressure. Nor does it require a fundamental shift in social perception, from one that sees care and caring in terms of economic value, towards a model of caring which sees it in terms of social values.
It is true that social care needs an investment, an investment of time and money – though last week’s budget implies this might not be forthcoming – to recognise the value of those receiving and those providing care. Perhaps, once we have this, and as part of a wider, more equitable technological revolution, we can begin to discuss the role of ‘iHomecare’. Perhaps…