Town Hall hears concerns on domiciliary care, and plans to resolve them

A Town Hall meeting on the local domiciliary care service provision laid bare public frustrations, highlighted key issues, and signalled plans for improvements during a three hour-long lively session at Ince’s Hall on Tuesday afternoon.

The meeting centred around the snap transition to Community Care Domiciliary Services Limited [CCDSL] to provide for Gibraltar’s care needs.

Just a week and a half into the new service, CCDSL and the Care Agency provided in-depth explanations and fielded questions from the public.

Questions centred around continuity of care, the level of service and general queries on how the new service operates.

At times, public questions led to heated exchanges as frustrations boiled over from some of those present in the theatre, who expressed often very personal experiences to underline their points.

The underlying thread from the session is that issues are being detected, assessed, and CCDSL and the Care Agency are actively working to provide an improved service for all.

The panel consisted of CCDSL supervisor Susan Edwards, CCDSL Managing Director Gerry Lane, the Minister for Health and Care, Gemma Arias Vasquez, Head of Disability Services Jennifer Poole, Head of Finance Andrea McGee, and Care Agency CEO Carlos Banderas.

Mrs Arias Vasquez recognised that the transition has been a “very painful process”, adding that the team have “tried their damnedest” after a previous provider, Lifecome Care, had “mismanaged” the service.

“CCDSL have had to take over a service which in many instances was not working,” Mrs Arias Vasquez said.

“They have had to take over from a provider who was not up to standard and was not meeting its contractual obligations.”

“They have had to take over from a provider who, to put it lightly, has not been as forthcoming as we would have liked in the transition process.”

She added that rotas, contract details, bank details, time sheets and annual leave information was not provided by the previous company during this transition.

But she said that despite this, employees were paid on time and carers’ contracts will be changed from zero-hour contracts to fixed 15-hour contracts.

She said carers have shown resilience, having worked under real strain amid confusion over rotas, issues of pay and uncertainty about their contracts.

“We will not allow that to happen again,” she said.

The budget for care this financial year is £4.2m, and Mrs Arias Vasquez said as CCDSL is a non-profit service, this means any funds are reinvested into the service.

It is hoped that trust can be rebuilt, the service will raise its standards, and there will be oversight of how public money is spent, she said.

Ms Lane said she would have never imagined the service was in such a state before CCDSL took over and asked for service users to bear with them while they settle in.

CCDSL has committed to holding regular public engagement sessions.

The local need has grown over the past 20 years, from 90 service users to 512 and 28 people waiting in St Bernard’s hospital for service.

“The service keeps growing, the demands keep growing, and there is a finite team that are working behind the scenes to make sure that this happens,” Ms Poole said.

She added that none of the service providers in Gibraltar could provide a full service, which meant the Government was relying on multiple companies, each with their different salaries, employee contracts and terms.

“We were eventually using all companies, with different rates of pay, with different terms and conditions, with different ways of working and training, and we had many, many concerns and complaints from service users that things weren't working as they should,” she said.

The CCDSL has taken the global service in Gibraltar with around 20 days’ notice.

Ms Poole said it was expected that 230 carers would transfer over to CCDSL, but they found that several were on maternity leave, long-term sick, had resigned or did not want to transfer over to the new company.

This meant CCDSL ended up with far less staff.

During this transition those in hospital in need of domiciliary care were not discharged, which she said created a “bed blockage”.

“That, for the whole of the community, is a huge catastrophe,” Ms Poole said, adding that those service users were prioritised.

ISSUES

Ms Poole underscored that most carers are exceptional at their jobs, but there had been issues with the quality of the care provided.

She said there was evidence that some carers had limited travel time between appointments on their time sheet, meaning that they were not providing a full service to users.

This meant some carers were essentially eliminating travel time to bill more hours, Ms Poole said.

She added that some carers had also been carrying out tasks out of their remit, for example, washing windows and walking dogs.

Ms Poole said these carers had “broken all professional boundaries” and given services which are not needed, which in turn meant service users had become accustomed to this level of care.

“We have had the hard task of having to reassess, relook at why people are getting care and see which ones are the genuine cases and which ones aren't,” she said.

The pressure on the service, she said, has been compounded by some service users incessantly calling.

She recognised that most callers have genuine concerns, but there are some that have demanded specific time slots.

“We heard that we were heartless, that we weren't taking into consideration anything from the service users, that basically we were just in it for the money,” Ms Poole told attendees.

“I can tell you clearly on behalf of myself and all my colleagues at the Care Agency, we could have all had a lovely Easter and gone home. We didn't want to be there working, but we had to.”

“Why? Because we wanted to make sure that you all had the care that you needed. We didn't have to.”

“But we understand the nature of this service and the importance of it. You are dependent on this service. Otherwise, we wouldn't be here now asking for certain things to change, and that is what we're committed to doing.”

“But we need time to make those changes happen. Things don't happen overnight.”

Ms Poole said she was not trying to justify mistakes, but that if service users’ time slots or carers have changed, this has been due to assessments.

This issue, she said, has also been compounded by a minority of carers coaching service users to call up and request them.

Ms Poole said there had been “sabotage” from some carers, which has left the service very worried.

She said friendships have been enabled with vulnerable people which has created a sense of co-dependency that a service user cannot be cared for by anyone else bar a particular carer.

Ms Poole said elderly users have been “guilt tripped” by some carers which has meant that “service users are advocating for carers that at the end of the day are abusing their position of trust”.

Ms Edwards added that some carers have “taken advantage of the vulnerability of service users” who were being “manipulated”.

She said the CCDSL team has banned gifts from being exchanged and found that some carers have asked service users for money.

CHECKS

The CCDSL has zoned Gibraltar into four areas to reduce travel time for carers and four supervisors will be doing home checks to ensure carers are attending their appointments.

Ms Edwards said that carers should not be administering medication, taking blood pressure or testing blood sugars.

She underscored that carers are not trained nurses and asked attendees to notify them if this occurs.

“This is gross misconduct,” Ms Edwards said.

She added the CCDSL will have a phone line to report any issues to supervisors and reiterated that carers should not leave before their allocated time.

RECRUITMENT

Over the years the Care Agency has found it has been a struggle recruiting carers due to Brexit.

Ms Poole said UK carers are unwilling to work in Gibraltar due to the uncertainty, despite an active recruitment campaign for the last six months.

This has meant there are not enough carers working in Gibraltar.

Ms Edwards said the culture locally needs to change as Gibraltarians are not applying for these vacancies.

There are 100 people on the waiting list to be assessed and there is a need to recruit to enhance the service.