Covid-19 patients discharged from hospital to care homes will be tested as a matter of routine after all. Health Secretary Jeanne Freeman made the announcement yesterday, just 24 hours after First Minister Nicola Sturgeon had said that testing everyone discharged from hospital could create a “false positive” if the person is asymptomatic. Why it took until 21 April for the government to decide on something as important and basic as this is anyone’s guess, but it adds to concerns that the spread of the virus into care homes across Scotland was an at least partly preventable disaster.
237 people have died so far in Scottish care homes, and that number will jump today when the weekly figures from care homes are announced. This a scandal, but we also need to look deeper than mistakes made in recent weeks and months to get to the bottom of the problems in Scottish care. There is a longer history here that must be understood, one where privatisation plays a key role. The story of Four Seasons Care – which owns Burlington Court care home in Cranhill, Glasgow where 13 residents died in one week, the first care home to see a spate of deaths in a short period of time, and also Guthrie House Care in Liberton, Edinburgh, where 13 deaths from suspected Covid-19 have also just been announced – is as good a case-study as any.
Four Seasons started out in 1989 as one care home in Kirkcaldy, Fife, and grew to be at one point the largest private care provider in the UK. It went from seven care homes in 1997 to 101 by early 2000, as the firm seized on care home privatisation to expand rapidly. The 1996 privatisation of care homes was described by Allyson Pollock and Colin Leys in NHS PLC as “one of the most under-reported sell-offs of the Thatcher and Major years”.
“Hundreds of care homes and the land attached to them were transferred to for-profit companies or voluntary associations at rock-bottom prices,” they wrote. “In Scotland, for example, Dumfries & Galloway Council obtained consent from the government to sell five residential care homes with a total market value of £2.03 million to a private company for £1 each.”
Four Seasons continued to grow, and underwent not one but two buyouts by private equity firms, first by Three Delta in 2006 and then by TerraFirma in 2012, leveraged by enormous amounts of debt. In 2011 Four Seasons bought out a major competitor, Southern Cross, which went into administration, drowning in debt. And last year, Four Seasons succumbed to the same fate, entering administration with £500 million in debt with £50 million service costs per year.
Four Seasons had 16,000 people under its care when it entered administration. It handed over 44 care homes to its rivals in December, but is still running many, including Burlington Court and Guthrie House Care. The GMB, which represents Four Seasons workers, said they had been kept in the dark about the future of its members, the social carers employed by Four Seasons.
“Going from one private equity owned care firm to another is like shuffling deckchairs on the Titanic and will do nothing to address the growing crisis across the Scottish social care sector,” GMB Scotland organiser Kirsty Nimmo said at the time of the administration. “These companies are juggling the debt, while the business is either sold or sliced.”
Suffice to say, this sort of chaotic management of care homes is not good for service provision. In a paper last year on social care, the IPPR found that the private markets provides less training, has lower pay and higher staff turnover, and highlighted the case of Four Seasons as an example of how “under these models the cost of servicing this debt is usually passed onto consumers in higher fees.”
Since care homes privatisation, the number of residential homes has fallen and the size of homes has grown dramatically, despite widespread evidence that smaller homes provide better care. Since the SNP came to power at Holyrood in 2007, the number of adult care homes in Scotland dropped by 21 per cent in a decade, while the number of people in care homes was down just 5 per cent. Undoubtedly, smaller homes would have been a major advantage in terms of suppressing Covid-19.
And while the 2002 introduction of free personal care was an early success of the Scottish Parliament, it did nothing to slow the march of privatisation. The number of local authority care homes decreased by 31 per cent from 2007-2017, while private care homes fell by just 5 per cent. Local Authorities are largely funding privately-run care: 69 per cent of those in care homes are mainly or wholly local authority funded, while 59 per cent are in private care homes, with 27 per cent in not-for-profit care and just 14 per cent in council-run homes. The Royal College of Physicians Edinburgh found in a report last year that Scottish care was “in-keeping with wider UK trends in predominant privatisation”.
Demographic changes mean many more of us will be in care homes in a decade, with a 14-34 per cent increase in demand predicted. Care homes is big business, with a 2017 Competitions & Market Authority study finding the big providers (like Four Seasons) can expect to generate profit margins of 21 per cent. Labour costs (mainly workers’ wages) take up 50-60 per cent of revenue, and funnily enough global private equity giants don’t like to pay social carers much: “Providers have told us that they have been particularly affected by the recent increases in the National Minimum and National Living Wages,” the report found.
Is this how we want ‘key workers’ to be treated from now on? Do we really want care homes to be run by private equity firms that buy them up on debt, run them as cheaply as possible and then dump them just as quickly? Would you want your mother or father or grandmother or grandfather in a Four Seasons care home right now? If not, then why do we accept this for other Scots, and what are we going to do to change it?
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