The summer of 2018 represented one of the rare occasions during my adulthood when my mother would once again be a presence in my life. Yet, being the damaged person who consistently sabotaged anything positive which came her way that she was, she would soon be gone again from my life as suddenly as she re-entered it. For now, however, a fall during which she broke her femur coupled with her irascible husband's inability to provide any practical care saw me step in. My doing so provided some protection from his impatience and lack of understanding of her immediate needs.
Having moved from Maidstone the year before, my mother and step-father now resided in the rather obscure Norfolk village of North Walsham. Primarily a matter of geography, the task of caring for my mother during her convalescence fell to me rather than my siblings, with my elder sister Dee living in Lincolnshire while my younger sister, Saskia, remained in Maidstone. Furthermore, having worked in care consistently for the past year and being the child most likely to enforce boundaries with her, I seemed the obvious choice in the short-term.
The brief stint during which I provided care for my temporarily infirm mother coincided with my role in live-in domiciliary care. With my current placement situated on the Wirral, I found myself taking the train every three weeks between Norwich and Liverpool to care for an elderly bed-bound gentleman with severe vascular dementia. Despite the additional support of local domiciliary carers, I could expect to work up to twenty-four hours should the need arise and with a two hour break each day. While care work is inherently challenging and among the most rewarding work I've ever done, my wages in no way reflected the demands and responsibilities of the role. While I've never chosen a job based on pay, of all the roles I've undertaken, this is the one with the greatest disparity between the responsibilities and risks involved and the amount of money I earned.
To some, care work may sound pretty straight forward and not overly taxing. However, in reality, care work involves supporting a client to maintain their personal hygiene, prompt or actually give them their medication, prepare and, where necessary, feed them their meals, provide them with companionship, take them to appointments and advocate on their behalf. In certain cases it can also involve staying up with them all night in addition to managing the day to day running of their home. Furthermore, working with a dementia client can present far more difficult challenges. Nevertheless, care work left me in no doubt that clients would die far sooner without care than they would otherwise. Left to their own devices, many clients, especially those living with a dementia, would neglect to wash and eat thinking they had already done so when in fact they'd done neither. Similarly, they often forget to take their medication or, worse still, forget that they had taken their medication already and end up double-dosing.
While I feel sure that few carers enter care work expecting to make their fortune, there is, for owners of care homes and care companies, money to be made in care. Indeed, my time working in children's homes gave me a glimpse of the cost implications for already cash-strapped local authorities of outsourcing care to the private sector. This matter would have relevance in my next role and, as such, is a concern I shall revisit later on in this chapter.
Meanwhile, being unaware as I was at that time of any alternatives by which to provide my services, I continued working for a care company based in Central London. Curiously, this particular organisation had decided to set up operations across the entire floor of an office block above one of the busiest train stations in the city. While I considered the company both professional and their training delivered to a high standard, I found myself questioning their motivation in operating from such an obviously expensive location considering how much they were paying their carers. Indeed, I'd learn subsequently how my client and his family were being charged in excess of £6,000 per month for twenty-four hour live-in care while I had been earning little more than minimum wage.
Desirous of a piece of the pie commensurate with the life-preserving responsibilities of the role, I progressed from live-in care to become a personal assistant (PA). Despite having to manage my own taxes, being a PA enabled me to keep more of my earnings which otherwise would likely end up in the pockets of company shareholders. Incidentally, my time working in live-in care enabled me to work in places around the country to which I'd never been. One such place, considered home to the English Riviera and the birthplace of Agatha Christie, has, since the beginning of 2019, become the place I too regard as my home.
It's true to say that I came to Torquay quite by accident, literally. However, this accident happened not to me but to the client for whom I'd come to the south-west to provide crisis care. On account of his unsettled night-time presentation, my client, a spindly ninety-seven year-old gentleman, required waking night support. Having arrived back in Norfolk from Bude the day before, I had not expected to be travelling back down to the south-west again so soon. Yet, to the south Devon town of Totnes I headed by train the following day in anticipation of being met at the station by my client and the day carer. From Totnes, we were then to make the short trip by car to my client's home situated on a cliff edge in the coastal Devon village of Hope Cove.
With an arrival time of approximately 9pm that early February night and with half an hour still to go, I gazed out of the window past my own reflection and into the darkness beyond. Travel weary, my head began to dip and my eyelids lower when the sudden ringing of my phone brought me back to full consciousness. Having answered, I listened intently while an unknown caller explained how there'd be nobody to meet me at Totnes station and to wait on the platform until someone arrived. The caller went on to reveal how my client was at that very moment being conveyed to Torbay Hospital having fallen while getting out of the car at Totnes station and hitting his head on the kerb. Consequently, while my client would spend the night unexpectedly laid up in Torbay Hospital nursing a head injury, I unexpectedly found myself tucked up in hotel bed a stone's throw away from Torquay seafront, intrigued as to what the coastline looked like in daylight.
Come the morning, I would not to be disappointed after peering out of a hotel window to be greeted by the sight of winter sun, palm trees and Torquay's cheerful looking promenade stretching far away into the distance. The presence of palm trees were particularly intriguing as I had never seen them anywhere else in the UK. While my client convalesced in hospital, the day carer and I made regular visits to him to provide company and complete his personal care. In addition, a little off-time during the few days that followed allowed for further exploration of Torquay's seemingly endless promenade and its vibrant harbour. Consequently, I found myself sufficiently charmed by the little I'd seen of Torquay to feel somewhat disappointed upon the news that my client had been assessed as medically fit for discharge.
Despite the blow to his head, the advancement of my client's dementia had led him to become so torturously unsettled at night that his sudden death from a suspected stroke the following month provided welcome relief of his suffering. Yet, his death meant temporary unemployment with the end of my current assignment and the need to secure another. However, with no other assignments on the horizon with my current employer and nowhere else I needed to be, a voice in my head told me to head back to Torquay, and that's exactly what I did.
Considering how much I've moved and been moved around in my life, it's little wonder that starting over has never really bothered me. Indeed, I feel no apprehension to 'up sticks' and head somewhere where I don't know anyone. Wherever I go, I make friends, and enemies, with relative ease. Furthermore, travelling lightly through life and accumulating little more than I've needed to live has been conducive to my freedom of movement. That said, having eventually reached the point in life of wanting somewhere to settle long-term, I'm glad to call Torbay my home.
Having lived in Hove fourteen years before, I'd come to appreciate the nostalgic and faded charm of British seaside towns. Therefore, prior to my move to Torbay, I took the opportunity while in Norfolk of hopping on a bus and heading down to somewhere else I'd never been before, Great Yarmouth. With Yarmouth still very much in mind as I ventured away from Torquay seafront, I couldn't help but notice Torquay's comparatively quieter high street a feeling of gloom in the air relative to Yarmouth. Indeed, there appeared to be little around me as I wandered through the town to attract people and keep them there. While Yarmouth retained many of the big name stores, Torquay hadn't, with many of them relocating to retail parks north of the town. Unfortunately, the sight of the numerous empty shops peppering the town centre and a lack of variation in the stores which remained, painted a rather dismal picture altogether.
Lamentably, the most noticeable sight common to both Great Yarmouth and Torquay was the prevalence of street homelessness. Soon after moving to Torquay, I took the opportunity of enjoying hour long morning walks which took me through the town and along the seafront. In contrast to the physical exertions of the town's street cleaners were the slumbers of those who had taken up temporary digs in the empty shop doorways across town. Indeed, my walks through town invariably consisted of dodging cleaners, either on foot or in cleaning vehicles, window cleaners, delivery men and those feet poking out from under a soiled old duvet or shabby sleeping bag into the street.
Similarly pitiable was the sight I'd often witness when taking the stairs of the multi-storey car park at the top end of town. Situated in an area named 'Castle Circus', also the location of Torquay's homeless shelter, I'd often find myself having to step over a small gathering of the town's homeless folk smoking heroin. As shocking a sight as this must be for innocent bystanders, what else is to be expected when the housing needs of vulnerable people are in the hands of uncaring and under-resourced councils while control of their addiction lies firmly in the hands of their dealer? Therefore, in lieu of any long-term solution to address the problem, vulnerable people will continue to cause disruption on the streets where many among the town's residents declare themselves too fearful to go.
Despite those unfortunate elements which blight Torquay and serve to detract from the allure of the 'English Riviera', Torbay's mild climate, attractive seafront and coastal beauty charmed me sufficiently to want to stay and seek work locally. This I did initially working as a personal assistant. Desirous of seeing more of my hourly wage in my own pocket than that of care company owners, I joined an introductory agency as a PA to provide domiciliary care. Among the services provided, including personal care, meal preparation, medication prompting, light housework and taking clients to appointments, were akin to those I provided for live-in care. Interestingly, the individual circumstances of clients and families for whom I provided support would inform my understanding of the complexities of the role I'd undertake next.
At this point, it is worth describing in very general terms the circumstances of every day clients and their families. Indeed, most of my clients lived alone and while some did have family and friends locally, some did not while other had none at all anywhere. Curiously, despite the crude categorisations, I found myself during my time as a PA dividing my clients and their families into one of three categories. The first category consisted of families who were both caring and supportive of their loved one and their carer and were always available when needed. The second category consisted of those family members who, for various reasons, were content to abdicate all responsibility for the care of their family member to carers.
Arguably the most fractious situation was the third, in which territorial and controlling family members, friends, or, quite often, a disgruntled housekeeper, would officiously attempt to micro-manage and undermine everything the carer attempted to do, The difference in their respective approaches lay in intent, with carers acting in the best interests of their client, whereas family members or friends tended to act in either what they considered to be the cared for person's best interests or, in certain situations, their own. Regardless of the category into which the client fell, the critical point about care lay in the individual needs of the client and whether domiciliary care provided the most appropriate means by which to meet those needs. This principle would be central to the role I'd undertake following my departure from PA work. Little did I know beforehand that while lacking the disciplined culture of the police, the structure and related inefficiencies of the organisation I was about to join would resemble my former employment in every other respect.
Despite the disruption caused by the Covid-19 pandemic of March, 2020, which occurred the month after I joined the NHS, for all 'front end' workers it was business as usual. Generally speaking, my role in social care consisted of processing referrals for such community based services as physiotherapy and occupational therapy in addition to conducting assessments of need for domiciliary care. Depending on the outcome of these assessments, a number of measures were put in place to meet those needs, from a piece of tech equipment such, as a pill dispensing machine, to a walking aid, such as a frame in addition to a package of care involving the kind of services I provided as a PA. Predictably, Torbay's local demographic, consisting of a significant retirement population, presents particular challenges in order for the supply of services to keep pace with an ever increasing demand.
For a 'front end' worker, managing that demand effectively depends from within on critical elements such as supportive and competent management, streamlined processes and fit for purpose IT systems. From without depends upon realistic public expectations as to what the service can provide in addition to its appropriate use. Furthermore, it goes without saying that what underpins all of this is sufficient funding. That said, sufficient funding is directly related to efficient and appropriate use of funding and I've come to realise how wasteful it is to continue to throw ever greater sums of money at public services which are no longer efficient for either those who work in them or those using them.
While I've no doubt that inefficiencies exist at all levels within public sector organisations, as a 'front line' worker, I can only speak from my experiences in public facing roles. Specifically, my experiences in the police and the NHS have led me to recognise the negative impact on both services of the 'top down' structure of management both currently operate. Moreover, I've come to recognise how a lack of protection and clear understanding of the nature of front line roles has led to inevitable chaos resulting in inefficient and highly unsafe ways of working.
It seems self-evident that organisations are structured in the way they are so as to maintain order and maximise both productivity and efficiency. Effective leadership of these organisations and their efficient running depends upon crucial elements such as good communication, a strong understanding of how individual departments relate and how decisions intended to solve a problem for one department may spell potential catastrophe for another. The lack of awareness by every organisation's leader and manager below them of these crucial considerations can, and does, quickly lead to inefficiency and chaos, particularly for the front line worker.
Indeed, contributing to the mounting inefficiency and chaotic ways of working are those individuals placed in managerial positions created unnecessarily. Likewise those promoted to positions of responsibility who without question pass down potentially erroneous decisions which can, and do, cause mayhem where the buck stops, with the front line worker. The conclusion of numerous workplace studies that the most stressed among a work force tend to be those who have the least amount of control over their work must come as a surprise to no-one.
Predictably, a system of poor leadership, incompetent management and a lack of communication can, and does, have dire consequences for front line workers trapped within an inefficient structure while attempting to provide a high quality of service to the public. To do so relies ever more on their good graces in going the extra mile and, in many cases, doing the job of two or more people. While previously as a police officer and currently as a front line NHS worker, I've lost count of the number of times my colleagues and I would be pulled into a meeting to be informed of a change in process which would adversely affect the quality of service delivery and further weaken our efficiency. Quantity often comes at the expense of quality.
Regrettably, it is so often the case in the public sector that what is not broken is readily fixed while what is truly broken remains that way indefinitely. For a police officer such sudden changes often meant yet another form to fill out which further reduced the time I spent on the street. As an NHS worker, yet another detrimental change often leads to corner cutting elsewhere in order to manage the administrative burden.
The material point is that we as front line workers can spot a mile off the potential flaws to any and every change imposed upon us yet are consistently only ever consulted immediately before implementation of any change. It is lamentable that those with the most comprehensive knowledge of their job and what they need in order to do their job effectively rarely find themselves part of the decision making process, yet, have to manage the potential fallout of decisions they had no hand in making. Two prime examples of incompetence and a short-sighted approach to problem solving I myself experienced in the form of Operation Ganymede, Thames Valley Police's quick-fix attempt to purge our ever growing in-trays and Lambeth Council's flawed End2End drug treatment pilot scheme.
The consequences for front line workers of incompetent management aside, much of my work in social care involves managing public expectations and meeting the needs of the individual in the most cost effective way. Yet, in the manner of those families for which I provided care as a PA, generally speaking, I can divide the majority of callers into social care into two crude categories. These categories consist of those who contact the service with particular regularity and those who should have made contact with us long before they actually did.
It is worth pointing out that the function of social care is to keep people out of hospital and adopting a person-centred approach to assessing and meeting a client's needs while promoting their independence. Nonetheless, there remain those among the general public who unnecessarily over-burden the service although who tend to be offset to some degree by those who either don't call at all or call only call reluctantly once they find themselves in crisis. Among the things I learned during the Covid pandemic was how, in the vast majority of cases, where people have no other option but to meet their own needs, they can be very resourceful. Similarly, to a certain type of individual, as long as services remain easily accessible and, most importantly, free, they will continue to overburden them.
Some take the view that in order to fix healthcare you must first fix social care. Yet, meeting the domiciliary and residential care needs of an ageing population comes at a considerable and ever increasing financial cost. Since working in children's homes and learning of the considerable sums of money my former employer had been charging local authorities for residential care services, I've become more aware of the financial burden placed on local authorities. The Covid pandemic effectively demonstrated, in the absence of any in-house care, just how much local authorities are dependent on profit driven private sector providers. With care costs increasing year on year and demand set to do likewise, something will eventually give. Adding to the grim forecast, a declining birthrate tends to suggest how in the future there will be fewer people among the work force to pay the valuable national insurance contributions which fund both health and social care. Personally, I remain sceptical of the view that outsourcing care to the private sector is more cost effective than the provision of in-house care and local government run care homes. However, I have learned to base my views on fact, not ideology, and will go wherever the evidence takes me.
As the Covid pandemic laid bare, the true test of an organisation's efficiency is how it well it performs in times of pressure and high demand. While I remain incredibly proud to have worked within the public sector, I don't consider any organisation in which I've had experience currently fit for purpose. Considering its public facing aspect, the front line should be sacrosanct and its roles among the most sought after in any organisation. Instead of which, for many if not most, the front line represents relentless stress, pressure and chaos compounded by mismanagement, onerous processes and outdated IT systems, all of which serves to frustrate any attempt to deliver a quality service to the public. For the overworked, overburdened and under-resourced front line worker, many of whom following their working day must go home and be parents, once sufficiently used up and worn out, they resort to self-protection mode, seeking less stressful positions away from the front line and taking their valuable experience with them.
While I cannot claim to have all the answers, part of the motivation in finding them comes with the realisation that our needs can only be comprehensively met by services fit for the 21st century. However, this will not come about as a result of short-term solutions and quick fixes. Instead this is perfectly achievable with the kind of reform that deals once and for all with wastage, poor management, inefficiency and self-interest. No longer can our public services and those protecting no other interest except their own, remain resistant to fundamental change. The greater interest of those who fund and use those services and those who work in the interests of their organisation's continued success demand it. To those who have no interest in becoming part of the solution, I say get the fuck out of the way and clear a path for those who do.
