The more one finds out about Home Farm care home in Portree, Skye, the more clear it is that something fundamental is wrong, not just here, but in the way care homes are run in this country generally.
The Care Inspectorate have now submitted an application to cancel the care home’s registration, run by private provider HC-One, which operates 56 care homes in Scotland and is the single largest provider UK-wide. NHS Highland has in effect taken over operations at the care home. The West Highland Free Press, which has submitted ten questions to the company about Home Farm all of which have not been answered despite repeated requests, say that their local sources insist the staff on-the-ground have done their best, but have been let down by company executives. There is lots of evidence mounting up which suggest failures run deep.
In December 2018 an Inspection Report found that care at Home Farm had dropped from Very Good to Good to Adequate. The Care Inspectorate (CI) issued two legal orders to HC-One to improve the care it provided at Home Farm. In April 2019, a follow-up inspection found none of those requirements had been met. CI then investigated two serious complaints near the end of the year which led to them pressing HC-One over the two outstanding legal orders and a new one relating to infection control, set a new deadline of 31 December and assessed staffing in Home Farm to be “weak”. A further unannounced inspection was then held on 21-24 January which found none of the requirements had been fulfilled, and extended the legal requirement to 30 March. Before Covid-19, an observable pattern of repeated failure by HC-One at Home Farm can be identified.
The January Inspection Report found that staffing was so “inconsistent” that there should not be new admissions to the care home until it was fixed. It stated that there were infection control risks, and raised questions about the management of wound care plans for residents at the home, saying they “had not been fully implemented, were not always followed and had not become established enough to be effective at the time of this inspection.”
The chairman, Sir David Behan, has refused to directly answer questions about whether the requirements placed on HC-One on staffing and infection control in January were fulfilled by 30 March. The decision of the CI to seek to revoke their registration following the latest round of inspections and NHS Highland taking over operations and beefing up the number of experienced staff speaks for itself. Clearly, the extent of the spread of Covid-19 in Home Farm, where almost all residents have now been infected, is out of the ordinary even a country where care homes have been so badly hit as Scotland. CI will have to answer questions as to whether they acted too late, but clearly it raises concerns about HC-One’s management of care homes not just at Home Farm but in general.
It is still not known how Covid-19 got into Home Farm, but the most likely explanation is via staff drafted in from outside of Skye. A member of staff was brought in from Kent, in south England, in March, and an area manager and four staff arrived at the home without being tested. This is where the Scottish Government comes into the picture. The lack of systematic testing of social care staff and the fact there is no hard rules preventing agency staff from moving around the country to work in different care homes means HC-One can legitimately say they have broken no regulations on the drafting in of untested agency staff, however unwise that may be. Health Secretary Jeanne Freeman has said there should be “no transfer of staff from one care home to another”, but the updated guidance last Friday, which has now been removed from the Scottish Government website and not replaced, was more ambiguous, stating: “Where temporary staff need to be used, steps should be taken to restrict the movement of staff between care homes”.
Clearly, neither HC-One nor government (and possibly not the Care Inspectorate, either) are going to come out of this episode blameless. Attempts to say “it’s government” or “it’s the private providers” seek to deny the obvious reality that they are two sides of the same system that has clearly failed to protect the most vulnerable people to Covid-19. But there is some things about HC-One which really need to be registered, as they should have alarm bells ringing about what exactly has happened to social care in this country:
- HC-One is owned by Libra Intermediate, based in the tax haven of Jersey, and which in turn is owned by FC Skyfall LP, based in the tax haven of the Cayman Islands.
- HC-One’s highest paid director earns £808,000 per year.
- It has managed to rack up £265 million in debt in its nine year existence, after being created out of the debt-fuelled collapse of Southern Cross in 2011.
- Its chairman, Sir David Behan, was formerly chief executive of the Care Quality Commission until 2018.
Tax havens, debt-fuelled entities, ludicrous salaries for top executives, revolving doors between regulators and private providers – none of this is what the provision of care for elderly people should be about. Behan has sought to argue that this virus “has exposed…the underfunding of adult social care throughout the UK”. Nice try, Sir David. Just as the problem of the banks was not and could not be resolved by bailouts, the problem of care homes cannot and will not be resolved by throwing more good money after bad. More public funding almost certainly is needed, but not to the line the pockets of HC-One.
Wholesale change will be needed in the care home sector after this. Common Weal will be publishing a report on this soon. A key principle of the future of care homes must be: get the financial exploiters out of the sector.
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