What is their record? Stephen Naysmith investigates

Allied Healthcare

One company, Staffordshire based Allied Healthcare, provides care services for at least 12 Scottish councils, including Glasgow, Dumfries and Galloway, Inverclyde, Edinburgh and Renfrewshire.

An inspection of their Perth and Dundee services in October last year found that some previous recommendations and requirements had not been met. Inspectors were concerned about the adequacy of care plans provided for clients by the company and demanded immediate improvements to the administration of medicines. They warned of “one service user’s medication being administered directly from a bottle rather than the required monitored dosage system”.

The most recent report on Allied’s Fraserburgh service notes improvements after a previous inspection had demanded changes to improve support plans and staff training. However, last October inspectors visiting the company’s Dumfries service said it was impossible to know how much time staff were actually spending with clients as travel time was included in the length of visits and there were no gaps between appointments.

Carewatch

Brighton-based Carewatch has offices across Scotland and is paid to deliver services on behalf of more than a dozen councils. It has had numerous complaints upheld against it within the past few years by the Care Commission. In Edinburgh and the Lothians, Carewatch had complaints upheld in 2006 and 2007 about training and administration of medication. Complaints were made about its services in Grampian in March 2008, over poor timekeeping and a failure to follow complaints procedure.

The company’s Fife and Forth service has been the subject of complaints between 2006 and 2008. They covered concerns about personal plans, provision of food, the reliability of the service and medication. All were upheld.

Comments in inspection reports suggest a range of familiar problems. In Edinburgh and Lothians, a service user commented: “Workers didn’t know I was blind,” while another said quality was “very mixed, hit or miss, very temporary, often late, well meaning”.

Inspectors warned that information given to staff about an elderly client’s needs was not specific enough and could be as basic as: “assist personal care”.

The inspection results for Carewatch in West Central Scotland in March this year were worse, with the service condemned as “weak” in four categories, and complaints from elderly clients and their carers about regular missed appointments, poor timekeeping and unfamiliar staff who did not understand their care needs. Inspectors said some “were not happy with the respectfulness shown to them by staff”.

Choices Care

Choices Care took over the business of Domiciliary Care Services, the company whose staff were filmed by a BBC team in secret late last year. The company’s record includes a complaint about the lack of care plans and other issues in its Glasgow and West Lothian/Falkirk service from 2008 last year. However, the Care Commission has lifted an improvement notice imposed on the company earlier this year.

Constance Care

Constance Care, based in Kilmarnock, was inspected in November 2008, when clients told the Care Commission of “nine carers in one week – sometimes no-one turned up” and of “six different staff in a day”. One carer wrote: “The company have not given my mum continuity of care. They send so many different ladies and therefore can’t build up a trust with mum for her to feel safe with them.” Inspectors said: The issues raised were common to significant numbers of people.”

ScotHomeCare

ScotHomeCare, which also trades as Halo (Health and Lifecare Options) has contracts with councils including Glasgow, Edinburgh, Falkirk, East Renfrewshire and Argyll and Bute. Inspection reports record comments from service users about the lack of a personal care plan, frequent changes of carers, a lack of information when staff are going to be late or a visit has to be cancelled. Comments included “strangers turned up and introduced themselves as carers”.

In January, branding the service “weak”, inspectors said staff from ScotHome­Care in Renfrewshire, Glasgow and Inverclyde were missing and turning up lates for visits, and clients would like more consistency in who turned up to care for them. “These are issues which the service is trying to address. However, there is still work to be done,” the report concluded.

HRM Homecare

HRM Homecare is named by several councils as a provider of care at home services. These include East Renfrewshire, Falkirk and North and South Ayrshire.

Quotes in a report from January this year include: “Usual staff (know what they are supposed to do) but they send in new ones that don’t have a clue and my wife has to talk them through it.” Another ­Wservice user said visits took place at any time within three hours of when they were scheduled.

Staff confirmed the problems – more than half said they had cut visits short, and inspectors found worksheets demonstrated staff were frequently being asked to be in two places at once.

Independent Living Services

Independent Living Services works in Highland, Aberdeenshire, Clackmannanshire and several other council areas. For the most part the com­pany’s services do not appear to attract complaints.

However, some elderly clients have commented on staff being hurried, unable to attend at the allocated time and too many different carers.

Right of reply: responses from the care sector

Jacquie Roberts, chief executive of the Care Commission, told The Herald: “We recognise the challenges of providing care-at-home services to a population which is getting older and more frail. Most people, understandably, want to stay at home and be cared for there. This means that the care-at-home sector is expanding and changing.

“As the regulator, we are focused on working with other agencies and bodies to improve the overall quality of care. Poor practice is never acceptable. Where we have identified that standards are not being met we will work closely with the management to ensure swift action is undertaken to improve the quality of care.”

Cosla’s health and well­being spokesperson, Ronnie McColl, commented: “At a national level, we are working with the Scottish Government to develop best practice guidance in relation to the commissioning of social care – we are confident that this will build upon the strong commissioning practices councils currently have in place.”

He added: “We also have to face up to difficult questions about the way social care is funded [and] reflect on whether the current suite of support options offered to older people are affordable into the future.”

Scottish Care at Home is a membership organisation that represents 60% of independent home care providers in Scotland. A spokesman said: “We have worked tirelessly to raise the issue of resources from central and local government so that providers are better equipped to address issues such as staff retention, training and recruitment as well as terms and conditions.”

Kevin Scullion, managing director of ILS, said his company had invested in rostering software and improved staff contracts, which would help prevent future problems. He said some service failures should be put in the context of thousands of care hours delivered by ILS alone.

Rosalind Corr, executive manager of Constance care, said continuity of care was vital for clients but could be difficult to provide. She added: “There are no excuses. It is not impossible to achieve and we have to be able to cope. But we believe our service is at a higher level than suggested by the most recent Care Commission report.”

Case study: Speaking in tongues takes its toll on the carer

For 92 year-old Pippa Orr, Alzheimer’s has been particularly cruel.

In her home in Uplawmoor, near Glasgow, the books are wedged in her bookcases so tightly they cannot be extracted. She used to devour them, now she destroys them, her restless energy leading her to rip out the pages.

Her particular passion was language. A lifelong scholar of French and German, she had always “hankered after academia”, according to son Graham, and learned Russian in retirement.

Now that passion is undone. The words are all there and she chatters away to any guest, but without making a lot of sense, dropping in phrases from other tongues as she goes.

Physically fit, if frail, and bright as a new fivepence,

she is a delightful and delighted host, but her illness makes her difficult and worrying for carers.

Principally, that means 61-year-old Graham, who spends four nights a week at her home.

They can be maddeningly sleepless nights. The memory loss common with dementia is a problem, but a bigger problem is her inability to settle, especially at night.

Pippa is often most active in the early hours and it is fruitless to try to restrain her or force her to bed.

She needs 24-hour care and Graham receives home care services from a range of sources. However, he is suspicious of private agencies. “Their first loyalty is to their wallet,” he says of staff. “Their next loyalty is to the agency and only their third, unfortunately, to the client.”

The charity Alzheimer’s Scotland provides support every Friday with a two-hour respite visit from support worker Rebecca Maskell, who takes Pippa out for trips to galleries or the park. The visits benefit Graham as much as they do Pippa, he frankly admits, as he wonders how much longer his mother can live in her own home.

For Ms Maskell, who has worked in a number of settings including the NHS and private and residential dementia care for 15 years, working for a charity is a privilege. “The advantage we have is time, and the ability to match carer with client,” she says.

However, while several local councils do pay Alzheimer’s Scotland and other charities to deliver such care, it seems impossible that such a service can be delivered to all those who might want it.