Dr. Matthew Knight

Concern over conditions for Home Care workers

At Penrose Care we have long been concerned that poor conditions for home care support workers are in large part responsible for driving down standards of care for some of the most vulnerable members of our society. It is for this reason that we have actively worked with Citizens UK and the Living Wage Foundation in raising standards and were one of the first care companies in the UK to adopt the London Living Wage.
A recent article on the BBC News website(^1) aptly describes the current crisis. The Equality and Human Rights Commission in its detailed home care report ‘Close to Home’ concludes that the way in which care is commissioned by local authorities may increase the risk of older people suffering human rights abuses(^2).

We believe that the work of home care workers (Support Workers) is complex, requiring patience, compassion and technical skills. At Penrose Care we are committed to creating the best working environment to support our staff in caring for those in need- we constantly strive to deliver home care with a human touch.

The following quote from the Cavendish review describes the challenges faced by care workers in the community:

“The phrase “basic care” dramatically understates the work of this group. Helping an elderly person to eat and swallow, bathing someone with dignity and without hurting them, communicating with someone with early onset dementia; doing these things with intelligent kindness, dignity, care and respect requires skill. Doing so alone in the home of a stranger, when the district nurse has left no notes, and you are only being paid to be there for 30 minutes, requires considerable maturity and resilience.”(^3)

The Commissions report in particular criticises the practices of short visits and not paying staff for commuting time between client homes (which reduces the actual hourly rate of pay by some 19%(^4), and often takes it below the National Minimum Wage).

Penrose Care provides Home Care in London and surrounding areas, and is based in Hampstead, North London. We have what we believe is a simple strategy for delivering high quality care- a strategy we have been successfully executing since our foundation in 2012:

Select staff both on their technical abilities and their human qualities. At Penrose Care we only take on staff that we are truly happy with, which means we are willing to temporarily fore-go growth for the sake of maintaining the excellence of our staff and services. We only take on clients when we have appropriate staffing levels
We pay staff a fair wage- we set our minimum pay as the London Living Wage. At Penrose Care we believe that our staff deserve to be paid a living wage to help them feel more secure and confident so they in turn are better able to help our client feel secure
We pay staff for things a decent company would pay but which is not common in the social care sector such as travel time between client homes, training time, and staff meetings. The majority of home care workers in the independent sector are only paid for direct care time(^5), as in not paid for their travel time. This unjust practice has come under heavy criticism from the Equality and Human Rights Commission, the UK Home Care Association and Citizens UK. We pay our staff from the beginning of the working day until the end of their shifts.
We invest in training staff properly and maintaing their levels of knowledge. Penrose Care has one of the longest induction training programs in the sector – 12 days. We have regular educational updates for our staff and aim that all staff will fulfill sufficient continuing professional development education per year.
At Penrose Care we do not do ‘short’ visits for purposes of personal care (washing, bathing, feeding). Our minimum visit length is 1 hour for visits involving personal care (we will do shorter drop in visits for security purposes during the day as part of a care package). We believe that both those we care for and our Support Workers (Home Care Workers) benefit from having a longer minimum visit time. Human interaction is a vital, yet unmeasurable, part of care. We structure our care plans to ensure that care does not need to be rushed or hurried through.

The results of our ethical practices speak for themselves: we have had only excellent client feedback, we’ve had no voluntary staff leavers since our inception, the Care Quality Commission found us to be compliant with all care standards, and our staff is made up of substantially high calibre personnel than is typical in England’s social care sector.


(1) “Concern over home care worker ‘poor’ conditions”: 08 Oct 2013 (BBC News, 2013), available here.

(2) Close to home recommendations review (Equality and Human Rights Commission, 2013), available here.

(3) The Cavendish Review (HM Government, July 2013), pg 7, available here.

(4) An overview of the UK domiciliary care sector (UK Home Care Association, Feb 2013), pg 8, available here.

(5) Time to care (Unison, 2012), pg 21, available here.

Dr. Knight trained as a doctor at the Royal Free Hospital School of Medicine, Hampstead and University College London (UCL). He then undertook his postgraduate training in Internal Medicine, based in north west London, and is currently working full time as a Registrar in Respiratory Medicine, at the Barnet General Hospital. His main interests are Asthma and allergy and he is currently studying part time for a Masters degree in Allergy, at Imperial College London. Dr. Matthew Knight is the co-founder and non-executive director of Hampstead-based Penrose Care, a provider of home care services in London to the elderly – including to persons with dementia – and to non-elderly adults with physical and/or learning disabilities.

Penrose Care is proud to be only one of three Accredited Living Wage Employers in the London home care sector out of c 925 agencies. Penrose Care provides short care at home visits, day sitting, night services including sleepovers, and live-in care services.

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