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Ideas on how to fix the care industry (Part 1 of 2)

Updated: Nov 18, 2021

We speak to Andrew Burton, a former care agency owner. He shares his stories of the memorable moments that stood out for him, and the immense challenges he faced in starting a care agency. In our next article, we will discuss his proposals for improving the care sector, and his advice to those interested in starting a care business.

Interview with Andrew Burton, written by Elizabeth Beh

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“I remember driving on the motorway, and hearing a story on the radio - of an elderly woman who had been left on the floor, in her house by her carer. It was only when a neighbour came, that they discovered her. You hear of all these horror stories in homecare, and I thought ‘goodness me, that’s some terrible service going on in that industry’.”

“That was what piqued my initial interest in the homecare sector. I hoped to bring my business skills and compassion, to try and build a five-star quality business, in a sector which seemed to have a lot of challenges.”

Andrew is British-born and bred, went to a grammar school, and started his career in the banking sector with Bank of Scotland in their graduate training scheme. In 1990, Andrew left banking and went into business with his brother. Together, they bought the master franchise for Thrifty Car Rental UK. At its peak, Thrifty had 80 locations, with 60 franchisees, and a fleet of ~10,000 vehicles. After a successful sale of the Thrifty business in 2006, Andrew moved into the vehicle-leasing sector. He also did some commercial and charitable consulting, before starting a homecare agency venture in 2015.

“I was looking for a new venture, and wanted to do something with a social angle to it.”

Andrew started investigating the homecare sector and considered various options. “One was starting from scratch. Second, was buying an independent care business. Third, was going down the franchise route. Eventually, I ended up with option two – buying an existing business.”

Day One – wake up call

“Literally on day one, I received a call saying one of our carers had been involved in an accident while driving our client. And the client was in the hospital with a fractured leg. At that point, all the blood drained from my face. It turned out that a truck had hit the carer’s car from behind. So, the truck driver admitted all liability, and there was no negligence on behalf of our carer. But it was a very, very memorable start to what was a very memorable four-year adventure.”

Andrew Burton

Memorable moments that stood out for Andrew

1. The gratitude of our clients

When our clients are living on their own, and can’t get out of the house, oftentimes, the highlight of their day would be their carer coming. We had many clients telling us how amazing their carers were. It was wonderful and emotionally rewarding, to know how grateful our clients were. The carers weren’t doing anything spectacular, they were just looking after them, washing them, caring for them, but there was a deep sense of appreciation and gratitude for the help given. This would be my overriding memory from the experience, and it is one of the best parts of the business.

2. Total admiration for our carers

Sometimes, our carers would get up at 6am. They would then work a shift from 7am-10am. Have a 2-hour break, then do a lunch shift from 12pm-2.30pm. Followed by an evening shift from 6pm-10pm. It’s a very busy and long day, and to make up their hours, they could sometimes do 3 shifts in a day.

“Their willingness and determination to work hard for relatively low pay is just admirable.”

Most people would not want to do what they were doing – hard work for relatively little money. But the majority of our carers had a tremendous sense of pride in their work, and most carers love the joy they can bring to the client. It never ceases to amaze me when carers join us who have never been in care work previously, and after two weeks, they’d say, “I absolutely love this job!” Doing care work feels meaningful, and they are having a huge positive impact on people’s lives. The clients benefit from receiving good care. The carers are adding value through their job, and providing a real social benefit to society.

3. Difficulty identifying & managing poor carers

Unfortunately, as in any business, you always had a percentage of employees who are not performing, and it was no different in care. However, unlike other sectors, the consequences of not doing a good job are critical. And when you combine that with lone working, where you can’t see their performance, it is challenging. Of course, everyone can put on a smiling and efficient face when their superior is auditing them on a dual visit. However, when they’re doing client calls on their own, it is difficult to monitor. Sadly, occasionally we found carers who had falsified their visit reports to cover issues up. It was only when the client provided negative feedback, we discovered what’s going on. Too often though, clients were frightened of providing negative feedback because they were afraid of the carer ‘taking it out on them’ later.

Identifying and managing poor-performing carers is a complicated dynamic of the care sector and a constant underlying challenge of the business.

High-risk business – dealing with life and death

Andrew shares some early incidents, which made him realise, “we are in an extremely high-risk business, dealing with life and death.”

One incident is a story of Sarah* who was manager of a garden centre who joined as a carer, as she wanted to get into more meaningful employment. After completing the first few weeks of training, in the very first week of her handling appointments on her own, she had a client visit with an elderly couple. Over breakfast, the wife choked and died while she was there. Sarah did the right thing. She phoned 999 and followed their instructions for 20 minutes until the ambulance arrived. “Imagine, 3 weeks before this incident, Sarah was working in a garden centre, and 3 weeks later she was providing emergency medical care to a dying person. This is the care world in a nutshell. It is sometimes, a life and death business, as you’re dealing often with, towards end-of-life care,” Andrew tells us.

“You're serving toast and marmalade on a normal morning, and your elderly client chokes and dies in front of you and her husband.”

Andrew shares his admiration for how Sarah handled the situation and says this incident did not faze her, and she remains in care work.

Challenges facing the care industry

Andrew shares with us, what he considers to be the biggest challenges he faced:

1. Lack of good quality carers

“It is a well-known fact in the industry, that there is a lack of good quality carers. Often, but not always, it tends to be the poorer performing carers who are on the market searching for new work. So, we found it was great when we hired people who were new to care, and we could train them on our best practices. But there simply aren’t enough good carers in the industry. Thus, it’s a constant challenge to meet the rotas and get them filled.”

2. Managing poor-performing carers

“For me, the most stressful part of the job is managing poor-performing carers, and worrying they are underperforming dangerously in a way you cannot monitor. In most other sectors, you’ve got supervisors, colleagues, and a lot of interaction where you can monitor employees on the job. However, it is not easy to monitor a single remote worker. Having suspicions they are not doing a good enough job, and then proving it and putting them through the disciplinary process is exceptionally hard.”

“How do you prove a remote carer working on their own is not doing a good enough job?”

Andrew shares a story: “We had a lovely carer, everyone loved her, the clients, her colleagues. She got along well with everyone. Every time we did a monitoring visit, she would tick all the CQC boxes. On paper, she was a 10 out of 10 carer.” Sadly, one day, Andrew discovered she was stealing money from clients. What seemed well on paper was different from reality.

3. The bureaucracy required by CQC and local councils

There is an extremely heavy workload of bureaucracy and regulatory reporting required by the CQC and local councils. Often, causing duplication in paperwork and is made worse by inconsistent standards between the CQC and local councils, as Andrew illustrates with an example.

“Our medication policy listed 16 medication errors. Our particular local council required us to report every single error. The CQC only wanted a medication error reported when there was a serious incident resulting in illness of the client as a result, or physical harm to the client. In the 4 years, we never had any such incident. The medication error form used by our business was better than the local council’s form, thus we couldn’t do away with our form. However, the local council would not accept our form, which had all the information needed. So, whenever there was a medication error, we needed to complete our business’s form, and then replicate all the information on the local council’s form.” Understandably, this and other areas of bureaucracy caused a lot of frustration and additional cost.

Stay tuned for part 2 where we discuss the solutions Andrew would propose if he had a magic wand, and his advice for those looking to start their own care business.

If you would like to learn more about carers and their unique stories, please subscribe. And if you are a carer, whether paid or unpaid, please do join our forum.

* Name of carer has been changed

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