The fight-back has started. David Bell, Professor of Economics at the University of Stirling, has said the idea of a National Care Service is a “distraction”. He said we should instead be focusing on how to increase funding to the sector, and what a fair funding mechanism would look like.
Donald MacAskill, CEO of Scottish Care, a member organisation for private sector care providers, agrees, saying it’s time for a “grown-up discussion” about funding, and that instead of “hindsight” about what has gone wrong in social care during the pandemic there needs to be “political foresight” about what’s needed in the future.
MacAskill added: “My personal view is that all the focus on a national care service is a soundbite from politicians which makes people feel like they are doing something – it makes people feel that this sounds like the National Health Service.
“A one size fits all national model does not offer that local choice and diversity people want in social care.
“One of the risks of using the phrase national care service, we paint a picture of one national unit, which cannot work – we cannot have that for social care.”
Let’s unpack this a little. First, the argument that how to fund social care and the ownership structure of the sector are separate issues doesn’t hold up under scrutiny. A 2017 Competition & Market Authority study found the large care providers can expect profit margins of 21 per cent. That’s billions in profits which leaves UK social care every year to go to investors and shareholders, which could have been spent on improving services. Add to that the costs to the public purse of having to clean up after financially unstable entities owned by private equity firms collapse under the weight of their debt, as has been the case with Southern Cross in 2011 and Four Seasons last year. Finally, the cost in executive pay among private providers is something that a National Care Service would not be burdened with: the CEO of UK’s biggest care provider, HC-One, earns £800,000 a year.
Second, the idea that the debate about the future of social care can be divorced from what has happened during the pandemic is perverse. Are we really supposed to turn a blind eye to the fact that there has been significantly more outbreaks among private providers than local authority run care homes during this crisis? That NHS Highland had to buy-out Home Farm care home from HC-One at significant cost to the public purse, due to repeated failure by management to ensure basic standards on care and infection control were being met? And what about the stories of the impact of low-pay on high staff turnover, staff shortages, and on workers feeling like they must continue to work while infected in fear of not being able to put food on the table for their families? How a sector responds in the most difficult times is the best indicator of whether it is a good model for the future. The pandemic care homes scandal has to be at the front and centre of the debate about the future of social care.
Third, when MacAskill talks of “local choice” and “diversity”, what exactly does he mean? Is he saying that the quality of social care provision on offer should be based on how much you can pay, or that there is some special value for residents in staying in giant care homes with low staff-to-resident ratios, which is what the big private providers tend to provide? And of course as the big private equity firms have merged together and gobbled up smaller competitors, the sector has become more concentrated over time – ten big providers make-up a quarter of all care home places in the UK. The present financialised care model is reducing genuine choice, which should in any case be about ensuring maximum independence for the person being card for, not the ownership structure of the sector.
Finally, MacAskill says a National Health Service type structure wouldn’t work in social care, but he doesn’t explain why. Many people said the NHS wouldn’t work before it was created.
As news that another outbreak of 50 staff and residents at a HC-One care home in West Lothian has claimed the lives of seven residents, we should not take our eyes off the debate about the future of social care in Scotland. There are many vested interests in keeping the private providers in charge, and they won’t give up easily.
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