A loose grab rail, a missed lunch club, a change in medication: care workers often see the connections others miss. Karolina Gerlich, Chief Executive of The Care Workers’ Charity, asks why the knowledge holding services together is still too often left out of decisions
At half past seven, a care worker starts their shift. There is a note on the table from the district nurse about a dressing. The grab rail by the front step is still loose, although the housing association said someone would be round last week. The client’s tablets have changed again, so the blister pack no longer matches what is on the MAR chart. Propped against the kettle is a card from the neighbour who runs the church lunch club, asking whether they still want their Thursday place.
Four other organisations have been in that kitchen and, in many cases, none of them have spoken to one another. The care worker is the person who joins those fragments together, usually with a phone call from the car. They can do it because of the relationship they have built. They are there every morning: the one constant in the week, the person trusted with the small details while the tea brews, and often the only professional who can see how each part of the system affects the rest. That is what a care ecosystem looks like from the inside. It already exists, but too often it is coordinated almost entirely through the person who is with someone most often.
The point is not that care workers should carry more responsibility. It is that they are already carrying a large part of the care ecosystem, often invisibly, and the system works better when that knowledge is recognised, paid for and included in decisions.
Take the lunch club as an example. To the neighbour, the person has missed three Thursdays and may have lost interest. To the housing association, the loose rail is one repair in a queue. To the district nurse, who comes once a week, this is someone who is not getting out much. The care worker knows these are all the same story. The person has not gone off the lunch club at all. They still love it. They are frightened of the front step. Each organisation is reading its own part correctly and still getting the whole picture wrong, and the only person holding that whole picture is the care worker.
That knowledge travels in very ordinary ways. It might be a word with the district nurse on the doorstep as one arrives and the other leaves, or five minutes over the fence with the neighbour from the lunch club. We tend to treat those chats as a bit of luck, but I think they are where the real joining up happens. They carry what the care worker knows to where it is needed, and they teach the care worker how the other organisations work: who can agree to what, which number actually gets answered and how to get something moving. That is how a rail gets fixed this week instead of next month, and how someone gets their Thursdays back, which is the only outcome they really want.
That matters when the professionals around someone sit down to talk about their care. Reviews and multidisciplinary team meetings often go ahead without the care worker, so what they know arrives second hand, if it arrives at all. I do not think anyone means to leave it out deliberately. We just have not got used to treating it as professional knowledge: something built through skill, consistency and relationship.
Recognising this does not need a new structure. It needs the district nurse, the housing officer, the pharmacist and the lunch club to see the care worker as the colleague who holds things together. It also needs the rest of us to make sure care workers have the paid time and training to do that work well. Charities like The Care Workers’ Charity work day in and day out to make sure care worker voices are at the table.
As a former care worker, I know how often you are the one making those calls from the car. I also know how good it feels when they work: when the rail is fixed, the fear of the front step eases, and you are waving someone off to the church hall on a Thursday. That is one ecosystem doing what it should. It is already there in kitchens all over the country. With proper recognition for the person at the centre of it, we can stop treating that coordination as luck and start using it to make the care system stronger for everyone.
