Home Care in crisis? The evidence is lacking

The headlines that greeted the Equality and Human Rights Commission report on home care, published this Wednesday, made gloomy reading.

“Cruelty of the Carers” said the Daily Mail. “Abuse of the elderly by carers ‘leaves many wanting to die’” said The Times. “Scandal of elderly facing abuse and neglect in own homes” was The Independent’s headline, while the Daily Express went with “Patients robbed and abused by their carers”.

But was this a comprehensive survey, based on proper principles, which proved beyond doubt that the home care business was rotten? That’s the impression the media gave, and few people will have taken the trouble to read the report, or even the measured press release the EHRC issued.

In fact, the results are qualitative and anecdotal, and provide no clear evidence of how common are the abuses that were identified. Nobody doubts they happen: carers have human failings like the rest of us. But is poor care 1 per cent of the total? 10 per cent? 75 per cent? The EHRC report and the research it is based on don’t provide a clue.

The EHRC is straightforward about its methods. It consulted, it says, a total of 1,254 individuals and organisations across England, in a variety of ways. There is nothing wrong with any of the methods it used, but all were qualitative: no effort appears to have been made to establish actual numbers.

Take, first, the response to the EHRC’s call for evidence. A total of 560 people and organisations responded, including 361 older people in receipt of care, 148 care workers and 61 organisations. (I make that 570, actually.)  This is neither a random sample, nor a representative one; it is self-selected and will tend, among those in receipt of care, to contain more people with grievances than those who are content.

Despite this, half of those receiving care at home said they were happy with the standard of care. The Times reported this as “only half of the 1,254 people questioned by the commission said they were satisfied with their care”. But 1,254 people weren’t questioned. The number was 361, who selected themselves for questioning.

Who were the rest? They consisted of 13 focus groups, attended by 178 people, 150 interviews with local authority staff and councillors, 40 face-to-face interviews with older people using home care services, an online survey of local authorities with 83 responses (a response rate of 54 per cent), 12 targeted requests for evidence from government departments, plus 250 telephone interviews with providers of home care. Add all these together and you get 1,274, not 1,254, but I assume that’s another mathematical error. It’s curious, anyway, to total up such diverse ways of gathering evidence.

None of these, with the exception of the 40 interviews with older people, set out to be a random selection. The report of these 40 interviews admits (page 9) “One of the most difficult parts of talking to respondents about their experience was eliciting information about their home care that they found unsatisfactory. (The italics are theirs). In other words, extracting the critical comments wasn’t easy. The authors of this part of the research, Wendy Sykes and Carola Groom, attribute this to the need to build rapport.

Possibly, but journalists experienced at interviewing people may come to a different conclusion. It’s often hard to get people to say what you want them to say but with patience and persistence it can usually be done, especially with interviewees unfamiliar with the process. Many of the criticisms amount to little except an understandable dissatisfaction with a life that has become limited and isolated; some are more substantial. There is no reason to suppose the criticisms made are fictitious. But there is no numerator, and no denominator.

Some may wonder why the commission is venturing into this field at all. It argues that people in receipt of care at home lack protection under the Human Rights Act and calls for this to be changed, but it did not need a year’s research to reach that conclusion.  

So it’s not really clear why the media took such an extreme view. The Daily Mail is running a campaign for dignity for the elderly, so its stance was coloured by that. But nobody seems to have read the report in a critical way. Maybe the only way to get stories in newspapers about social care is to exaggerate.

The Care Quality Commssion, whose job this really is, plans a programme of inspection of home care services, to begin next April. It’s to be hoped they can provide some real numbers without which it is impossible to draw any proper conclusions.