“Home care with a human touch.”

28 February 2018

Ethical labour standards in home care

Robert Stephenson-Padron, Penrose CareKing’s College London

Home Care Policy

Part I. Who am I and what am I here to talk about?

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Who am I? Robert “Bob” Stephenson-Padron

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Co-founder and Managing Director of Penrose CareMr. Padron is a healthcare industry expert and former public servant. Prior to starting Penrose Care in 2012, he was a healthcare research analyst at Merrill Lynch (2010-12), which he joined from Barclays Capital/Barclays PLC (2007-10). From 2003-2006, he served as a commissioner of the City of Berkeley, USA. Mr. Padron also worked for a number of years as a research assistant to eminent epidemiologist Prof. Alison Galvani of Yale University. In 2014, Mr. Padron was named the UK’s Most Outstanding Leader in the Care Sector [acceptance speech] for his pioneering work on establishing Penrose Care, the UK’s pioneer in ethical home care. Mr. Padron received the honour again with respect to the year 2016.

Mr. Padron has appeared on various radio and TV news outlets including Sky News, BBC Radio 4 World Tonight, BBC Radio 4 Today, BBC Radio London Breakfast, the BBC Two’s Victoria Derbyshire, and BBC Radio 4 You and Yours.

Mr. Padron has participated in numerous efforts to help improve and reform the UK’s health and social care sector, exemplifying the wise words of Robert Phillips of Jericho Chambers: “The more trusted organisation of the future looks more like a social movement than a traditional hierarchy. Leaders – business and civic – need to think and behave like social activists. “

Mr. Padron holds a BA in Economics from UC Berkeley and a Master in Economics & Finance from the Universidad de Navarra. Mr. Padron also holds a QCF Level 5 Diploma in Leadership for Health and Social Care and Children and Young People’s Services (Adults’ Management) (England) From Edexcel and a Higher Level Apprenticeship in General Adult Social Care from the Federation for Industry Sector Skills & Standards.

And I’m here to talk about social care: a turbulent sector• Demand is rising: In the UK, the elderly population (65+) is expected to rise from 11.8 million to 18.8 million or

60% from 2016 to 2046 and account for 24.7% of the population, up from 18.0% in 2016. The elderly population rose 22.3% from 2006 to 2016 to 11.8 million.1

• Public funding has been declining in real terms: Despite a rising elderly population, in England, real public expenditure on older people’s social care (roughly 80% of the English social care market) declined to £8.34 million in 2015/16 from £8.45 in 2005/06 (using 2015/16 prices). This has meant:

– 850,000 persons receiving publicly-funded social care in 2013/14, down from 1.2 million in 2005/06

– Age UK estimates there are 1.2 million people in 2017 who do not receive help with essential activities, a 17.9% increase since 2016, and a 48% increase since 2010.

• But providers meant to meet this demand are in disarray: “UK home care industry ‘on the brink of collapse’, says report” – FT (20 March 2017) 3

1Office of National Statistics, Overview of the UK population: July 2017 (July 2017), available online: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/july20172 Age UK, Health and Care of Older

People in England 2017: July 2017 (February 2017), available online: https://www.ageuk.org.uk/documents/EN-GB/For-professionals/Research/The_Health_and_Care_of_Older_People_in_England_2016.pdf?dtrk=true3 Gill Plimmer, “UK home care industry ‘on the brink of collapse’, says report”, Financial Times (20 March 2017), available online: https://www.ft.com/content/e6c08ebe-0d47-11e7-a88c-50ba212dce4d

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Snapshot from the biggest providers• “Three of Britain’s biggest providers of council-paid social care – Saga, Care UK, and Mitie Group –

have quit the sector” since 2015. 1,2

• In the 6 months to 30 June 2017, Mears, one of the largest providers of home care in the UK, saw its hours per week drop to 156,600 from 204,200 a year ago (-23.3% year-on-year), and swung to a loss in the period from profitability in 1H 2016. 2

1 Gill Plimmer, “Sodexo plans to expand UK elderly home care business”, Financial Times (10 April 2017), available online: https://www.ft.com/content/b88fe966-1d16-11e7-b7d3-163f5a7f229c2 Interim results for the period ended 30 June 2017, Mears Group PLC (15 Aug 2017), available online: https://www.mearsgroup.co.uk/wp-content/uploads/2014/01/Results-for-the-period-ended-30-June-2017-020.pdf

2 Half-yearly financial report for the six months ended 30 September 2017, Mitie Group plc (20 November 2017), pg 4, available online: https://www.mitie.com/Mitie/media/downloads/Investor%20relations/FINAL-Mitie-FY18-Interim-Results-Announcement-Final.pdf?ext=.pdf

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Major labour issues in home care• Non-compliance with the national minimum wage.

– If we use the last known travel in-work time average of 19% from Laing & Buisson1 and the average frontline wage of a care worker of £7.762, implies that the effective average hourly rate of an English home care worker is £6.29 per hour, below the National Living Wage of £7.50 per hour. [OUTSIDE OBSERVERS SHOULD BE SUSPICIOUS OF ANY HOME CARE COMPANY WHERE THE HEADLINE WAGE IS LOWER THAN £9.26 per hour)

– The deep scandal following the EAT’s April 2017’s Royal Mencap Society v Mrs C Tomlinson-Blake (following the initial ruling of August 2016) revealed widespread non-compliance of the NMW for sleep-ins.3

– Training time often goes unpaid.4

• Misclassification of employees as self-employed to avoid Employer’s national insurance, holiday pay and labour rights.

• Widespread use of “zero hours” contracts. 50-70% of frontline home care workers are on zero-hour contracts according to estimates by the UK Home Care Association.5

• Insufficient safeguards for sicknesses and public health. A 2013 survey by Unison found that 59.5% of care workers in the private or voluntary sector were not paid for sicknesses.6

1 Domiciliary Care UK Market Report 2011 (2011). P.35. Laing & Buisson Publications. Not on web.

2 The state of the adult social care sector and workforce in England, Skills for Care (September 2017), pg 7, available online: http://www.skillsforcare.org.uk/Documents/NMDS-SC-and-intelligence/NMDS-SC/Analysis-pages/State-of-17/State-of-the-adult-social-care-sector-and-workforce-2017.pdf

3 Rob Preston, “How sleep-in shifts became a crisis for charities” Civil Society Voices (December 8, 2017), available online: https://www.civilsociety.co.uk/voices/an-avoidable-crisis-learning-disability-charities-facing-sleep-in-stalemate.html

4 Ensuring employers comply with the national minimum wage regulations 2016, National Audit Office (May 2016), pg 21, available online: https://www.nao.org.uk/wp-content/uploads/2016/05/Ensuring-employers-comply-National-Minimum-Wage-regulations.pdf

5 Colin Angel, “Use of zero hours contracts in the homecare sector,” ACAS (2017), available online: http://m.acas.org.uk/index.aspx?articleid=4901

6. Time to care, Unison (2013), pg 23, available online: https://www.unison.org.uk/content/uploads/2013/11/On-line-Catalogue220152.pdf

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Results•High staff turnover. 27.8% in 2016/17 according to Skills for Care data, nearly

twice the UK average.1, 2, 3

• Labour shortages. In 2016/17, England’s social care sector was short of an estimated 90,000 care workers. 1, 2, 3

•Questionable quality of care.

1 Nicola Slawson, “UK social care sector in crisis due to staff shortages,” The Guardian (8 March 2017), available online: https://www.theguardian.com/society/2017/mar/08/uk-social-care-crisis-staff-shortages

2 David Rhodes, “Social care system 'beginning to collapse' as 900 carers quit every day,” BBC (11 April 2017), available online: http://www.bbc.co.uk/news/uk-england-39507859

3 The state of the adult social care sector and workforce in England, Skills for Care (September 2017), available online: http://www.skillsforcare.org.uk/Documents/NMDS-SC-and-intelligence/NMDS-SC/Analysis-pages/State-of-17/State-of-the-adult-social-care-sector-and-workforce-2017.pdf

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Part II. In a turbulent sector, you have an organisationcommitted to doing good: Penrose Care

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“The path out of darkness begins with those exasperatingly persistent individuals whoare constitutionally incapable of capitulation.” - Jim Collins (2009)

A video introduction of Penrose Care from the Living Wage Foundation

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Introduction from the Living Wage Foundation

https://vimeo.com/248127054/b73847fe30

At Penrose Care, the “Theory of Ethical Care” is a Reality

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• Penrose Care (founded in 2012, started trading in 2013) is a private regulated home care provider in London, UK, primarily for the elderly and disabled, with a unique commitment to ethical practices in social care which foster excellence in care in a sector reputed for mediocrity at best.

• Penrose Care’s co-founder and managing director was named the Most Outstanding Leader in the UK Care Sector in 2014 & 2016 at the UK Housing Over 50s Awards due to Penrose Care’s pioneering work in Ethical Care.

• London Living Wage Champion 2016

• Most Outstanding Homecare Provider in the World 2017

• Clients of Penrose Care consistently rate the quality of Penrose Care’s services as Outstanding.

International Recognition

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April 26, 2016: Third Japanese research delegation visit to Penrose Care.

March 14, 2016: Penrose Care's managing director, Robert Stephenson-Padron (left), Dr Mayumi Hayashi (middle) of the Institute of Gerontology at King's College London

and Professor Manami Hori (right) of Tokai University.

June 3, 2015: Visit from Deborah Simon, CEO of Ontario Community Support Association (Canada).

August 13, 2015: Large research delegation led by the Japanese Government visits Penrose Care.

Some feedback from foreign researchers

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“We were privileged to observe excellence in action. Clearly a person-centred, quality driven model of care provision. The quality of the care staff is

guaranteed by the quality of their terms and conditions: and this quality becomes the benchmark of the excellent care experienced by the clients.”Dr. Mayumi Hayashi, Research Fellow, Institute of Gerontology of King’s

College London

“We found that [Penrose Care’s] vision is very clear and innovative. In Japan, home care is also very important and we also have a lot to do to improve our system. Today’s meeting is very productive and I would like to thank [Penrose

Care] again.”

Mr. Kosuke Wada, First Secretary (Health, Labour and Welfare), Embassy of Japan in the UK

Part III. Philosophy behind being an ethical organisation

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“The time is always right to do the right thing.” Martin Luther King, Jr.

What is ethical care?

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1 Marina Barnes and Tula Brannely. Achieving Care and Social Justice for People With Dementia. Nursing Ethics 2008; 15(3): 384-395.2 Commission for Social Justice. Social justice. Strategies for national renewal. London: Vintage, 1994.* Definitions from www.merriam-webster.com

• Barnes and Brannely (2008)1 define ethical care as consisting of:– Attentiveness: Showing care for the needs or desires of others; caring or

courteous.– Responsibility: Able to be trusted to do what is right or to do the things that

are expected or required.– Competence: Having the necessary ability or skills.– Responsiveness: Quick to react or respond.– Trust: Belief that someone or something is reliable, good, honest, effective,

etc.• Ethical care is intended to contribute to social justice: “A belief that all individuals

are of equal worth and are thus entitled to be able to meet their basic human needs, experience equality of opportunity and be protected from unjustifiable inequalities.”2

What are signs ethics is an issue in UK home care?

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1 Close to home: An inquiry into older people and human rights in home care: Nov 2011 (Equality & Human Rights Commission), pgl 27, available here: http://www.equalityhumanrights.com/sites/default/files/publication_pdf/Close%20to%20home.pdf 2 Not just a number: February 2013 (Care Quality Commission), pg 6, available online: http://www.cqc.org.uk/sites/default/files/documents/9331-cqc-home_care_report-web_0.pdf3 "Time, pay and lack of training are main challenges for homecare staff": 30 Oct 2013 (Guardian, 2013), available: http://www.theguardian.com/social-care-network/2013/oct/30/main-challenges-homecare-survey-findings4 Ramesh, Randeep, “Social care providers flouting minimum wage rules, tax inspectors find”: 25 Nov 2013 (The Guardian, 2013), available online: http://www.theguardian.com/society/2013/nov/25/hmrc-finds-care-firms-breaching-minimum-wage-laws

Ethical Feature Indications of Underlying Issues

Attentiveness • A 2011 inquiry into homecare by the Equality & Humans Rights Commission found that “it became clear to us that some older people were likely to have been victims of breaches of their rights under the European Convention for Human Rights” against inhuman or degrading treatment. 1

Responsibility • The Care Quality Commission, England’s regulator of health and social care, in its 2013 report “Not just a number” found systemic issues in the UK home care sector: 1) Late and missed visits, 2) lack of consistency of workers, 3) Lack of support for staff to carry out their work, and failure to address the ongoing issues around travel time, 4) poor care planning and a lack of regular review, and 5) staff understanding of their safeguarding and whistleblowing responsibilities. 2

Competence • A joint Guardian Social Care Network and Department of Health survey into home care held in 2013 found that 56% of respondents cited insufficient training as a major challenge for home care workers. 3

Responsiveness • Issue 4 of the the Care Quality Commission’s 2013 report “Not just a number”: “poor care planning and a lack of regular review”2

Trust • In 2013, the HMRC which enforces the national minimum wage found 48% of social care providers investigated were not paying the minimum wage. 5

Trust: Penrose Care’s concrete ethical measures

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• In November 2012, Penrose Care become the first of four home care providers in the UK (out of nearly 6,000 providers in England) to become an Accredited Living Wage Employer

– The London Living Wage is currently £10.20/hour vs the National Minimum Wage for persons 25 and above of £7.50/hour.– The London Living Wage is meant to be the lowest wage to a person residing in London that supports a decent standard of living.– Minimum wage violations are prevalent in the home care sector (1)

• In October 2013, Penrose Care became the first and is currently the only independent sector home care provider to comply with the Social Care Charter which entails

– Paying workers the Living Wage– Paying for travel time between visits– Providing a sick pay scheme– Providing training– In October 2013, Penrose Care became the first and is currently the only independent sector home care provider to comply with the

Social Care Charter which entail

• Taxi rides home if working after 9pm.

• RESULTS! Penrose Care attributes its ethical framework to its high level of client satisfaction. We monitor our services by a 1 (worst) to 5 (best) rating system. Our average ratings are consistently between 4-5.0

• The best way to promote a caring workforce is for the organisation itself to be caring1 Ramesh, Randeep, “Social care providers flouting minimum wage rules, tax inspectors find”: 25 Nov 2013 (The Guardian, 2013), available online: http://www.theguardian.com/society/2013/nov/25/hmrc-finds-care-firms-

breaching-minimum-wage-laws

Results: High Levels of Client Satisfaction

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Average Annual Satisfaction Ratings (1 worst, 5 best)

Year Client Family Professionals

2013 4.8 5.0 5.0

2014 4.7 4.5 4.0

2015 4.4 4.5 5.0

2016 4.6 5.0 5.0

2017 Staff Turnover Rate: 5.6% vs 27.8% for the industry.

Some other notable information

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•Due to our comprehensive ethical approach, our Occupational Sickpay Scheme has been affordable. In 2017, our OSPS only amounted to 0.3% of our wage bill.

•38% of our staff (eight people) earn more than £2,076.25 gross per month, or more than the median salary of a registered nurse.

•19% of our staff (four people) earn at least £3,000 gross per month, or as much as a junior investment banker.

•In February 2018, sleep-in allowances in compliance of the minimum wage laws accounted for 21.5% of our gross wage bill

Some feedback

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“At Penrose Care, I can happily say that it is the only job I’ve ever had where I am happy to wake up and get ready to go. My manager is always contactable 24/7 - it’s

very pleasant to feel that we are never alone. The company has a variety of very good working conditions, such as the London Living Wage, and it has a culture which is more like a family. I myself used to be a retail manager and never had the privilege to treat

employee in the ways in which Penrose Care treats us.” Carina Bessa, home care worker, Penrose Care (20 February 2018)

“I am genuinely impressed by how careful and comprehensive [Penrose Care] is, dealing with her medications, and in trying to care for her and love her (yes,

that’s the word).”

Psychiatrist and family member of an elderly care client of Penrose Care

(12 November 2017)

Some feedback on our generous taxi policy

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"After a long shift taking care somebody, being passionate and giving100% of your energy during the day, it is pleasure to go home by taxi after a long shift.

A policy that shows how much the company cares about its staff.”

Nikoletta Makouli, senior care worker, Penrose Care (28 February 2018)

“The taxi is an excellent benefit after a long and sometimes difficult shift and when iIhave to carry my overnight bag or suitcase. When I sit in the taxi, t's my

first relaxed breath before I get home.”

Teresa Silva

(28 February 2018)

Part IV. How did we pull it off?

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“The Right ethics. Right morals. And you need a brand. And look after your customers... And a customer complaint doesn’t have to be bad. If handled correctly, it can turn a customer into a lifelong customer.”– Lee Phillips, Managing Director, Roger Skinner’s Pet Foods explaining how to be a successful manufacturer in an OECD country(December 14, 2017)

The Penrose Care model is unique and sustainable as the role of publicly-funded care continues to reduce

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The Penrose Care Model: A virtuous cycle supporting sustainability

Typical Home Care Model: A vicious cycle on the path to obsolescence

Staff

* Vocation to care

* Excellent training

* Top-end infrastructure

* Good working conditions

Clients

* Attracted through traditional and advanced marketing

* Receive excellent care

Success

* Strong reputation needed to attract

private clients

* Low staff turnover

Staff

* Occupational last resort

* Little training

* Public sector-like infrastructure

* Poor working conditions

Clients

* Referred by the public sector (marketing infrastructure not

needed)

* Receive mediocre to poor care

Obsolescence

* Little to no reputation (cannot cope with reduced public provision of

care)

* High staff turnover

Penrose Care

9 McCrone Mews

Belsize Lane

Hampstead

London NW3 5BG

United Kingdom

Tel: 020 7435 2644

Fax: 020 3514 8992

Email: enquiries@penrosecare.co.uk

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