The growing dichotomy between direct payments and flexibility and fair Ts and Cs for PA/carers

The care sector is a fast growing area of our economy. As longevity becomes the norm, so more of us will succumb to the ravages, infirmities and disabilities associated with old age; and thus have a greater call on care and support in our later stages of life.

As family demographics change, with fewer children per family unit; as offspring are expected to work longer; and as the benefits' system begins to militate against people opting to act as unpaid carers, so we'll begin to experience a radical change in support patterns, for both disabled people and those contracting age related conditions and illnesses.

The other negative factor in this equation is of course the very future of the NHS. Like so many others born at a time when free health care at the point of need was regarded as the norm, I've spent most of my life secure in the knowledge that my health needs will be met, as and when needed, by the NHS.

But today the salami slicing of the NHS presages a gloomy, if not terrifying future for all but the wealthy; especially so if you've knocked at the door of middle age and been admitted...and disabled to boot!

As someone who already receives a local authority care package and who also works within the voluntary sector as a direct payments worker, I'm viewing the current care situation from these two perspectives; and as a disability and trade union activist I can add another couple.

Historically the care industry has relied upon the good will of its labour force as well as the vocational calling associated with the work. Whether employed in a residential care home, or as a traditional home help these days, largely, superseded by workers termed as PAs (personal assistants), the pay is low and the hours long. The rewards, I guess, are reaped from the caring nature of the work.

But, let's take a look at the working patterns of some of these workers. Samantha Nelson gets up at 5.30 am to begin a day's work that can last until 11 pm - 17 hours a day; that's some work shift! If a company CEO worked those hours he'd demand a six figure salary, plus an inflated expenses account, and because 'he's worth it' a stonking shares allocation.

Conversely, because Samantha is not paid for her time driving between clients, over 50 miles a day. Though she will often cover an 18 hour day as she is on a Zero-Hours contract she's not paid for the travelling time between jobs. Consequently, as she is only paid for the 'care hours' she works, this drags her hourly rate to below the statutory minimum wage.

This area of employment is ripe for wider coverage, and I suggest you look at this link: http://www.theguardian.com/society/2013/jun/13/care-firms-law-on-pay

Though PAs employed by direct payment users are not normally subjected to quite the Orwellian style of supervision imposed on their agency-employed counterparts, there are many parallels.

As local authorities pare back care and support packages, sometimes from five or six hours per day to an hour per day, so the PA becomes more stretched. Where once upon a time she or he could get by on one or maybe two clients per week; she's now forced to work at three, four or more jobs.

What then happens is this. The flexibility that directly paid for services was sold to disabled people becomes a thing of the past. Think it through. If a PA has two clients there is usually room for flexibility within the package.

Say she works three hours per day (Mon-Fri) over two shifts for one client, maybe 1.5 hours each am and pm (15 hours); and does five 4.5 hour stints, again Mon-Fri, with another (22.5), totalling 37.5 hours per week - not including the time she spends making 30 trips per week to and from the homes of clients.

Now extend that to four clients, say visiting one two times a day for an 1.5 hours (15); and the other three over the same five days in three 30 minute shifts (22.5), again totalling 37.5 hours per week - again travelling to and from the place of work a staggering 110 trips per week! It's doable if the clients are very close to one and other, say in the same sheltered accommodation complex.

Sadly the choice element of direct payment diminishes with each budget cut

Sounds incredible. But remember Samantha Nelson's 17 hour day for which she was only paid actual time spent with the client.

This leads me to the final point I'll make on this subject for now. Not only does this sector offer poor Ts and Cs to its workers, and sadly we DP users are drawn into this as we're also PA employers, but it makes a mockery of the very idea of the flexibility that underpinned the whole concept of self-directed support for disabled and elderly people.

Until and unless we set up a National Care Service along the original model of the NHS, except offering care and support free at the point of need the problems I have outlined will persist and worsen as time passes.

It is my intention to gather more information on this sector, particularly around direct payments (DPs), PAs, and organising both agency and DPs PAs.