Imagine you are elderly, and you and your family are discussing whether to move into a care home. Maybe a Source Direct subscriber out there is in this situation. Naturally, you would be worried about covid-19. One of the questions you may have about a possible care home is: ‘How has it done so far in protecting residents from the pandemic?’ According to the Care Inspectorate, the Scottish regulator for the care sector, and the Care Quality Commission (England’s equivalent regulator), this is not something you should know.
Both regulators have responded to FoI requests from The Guardian for home-by-home data by coming up with a myriad of reasons for why transparency wouldn’t be helpful, including that it would “substantially prejudice services commercially”, according to the Care Inspectorate. They added that without the public knowing other information, like underlying health conditions, this data could create a false impression about the safety of homes, potentially leading to competition for homes deemed safer.
But wait a minute: if you bring the private-sector into care homes it automatically creates a market for care. What we’re being told here is that only works on the basis of information that commercial providers want out into the open, otherwise – god forbid – they could be judged on their actual performance in looking after people, rather than their PR.
It’s not as if the Care Inspectorate don’t already produce data which the public can access on specific care homes. As care expert Nick Kempe has shown, the limited number of inspections that CI have under-taken – rating care homes either ‘Very Good’, ‘Good’, ‘Adequate’ or ‘Weak’ – can be compared with their pre-Coronavirus ratings. And then there’s plenty of media reports doing the rounds. The regulators have got this back to front: the choice isn’t between partial information or no information for the public on specific care homes, it’s between partial information or full disclosure, giving people as rounded and complete a picture as possible of the situation. The fact that such full disclosure could intensify market competition is only proof that there shouldn’t be a market in social care.
And of course the prevalence of Coronavirus is not random; it’s related to structural factors about the sector. It is more prevalent in private care homes than local authority and voluntary sector ones, in bigger care homes than smaller ones, and in care homes with higher resident-to-staff rations. NHS Lothian and the University of Edinburgh found last month that the likelihood of a covid-19 outbreak tripled with every 20 additional beds. The ten largest corporate providers in the UK make up a quarter of care home places, and are significantly more likely to have large care homes. Indeed, since 2007 the number of care homes has fallen significantly in Scotland (down 21 per cent), while the care home resident population has fallen just 5 per cent, showing how the size of each care home is expanding as privatisation has intensified.
On Source Direct we looked at the specific case of Four Seasons, which began as one Fife care home in 1989 and grew to at one point to be the largest private provider in the UK, before entering administration after successive debt-fuelled take-overs by private equity giants. Now, a University College London study has looked at the company’s Covid-19 performance, and found a clear link between the firm’s higher resident-to-staff ratios and more infections. Two-thirds of Four Seasons care homes have had outbreaks, much higher than the average.
“When staff care for fewer residents they also have reduced likelihood of spreading infection between residents,” the study finds. “Higher staff-to-resident ratios may also decrease reliance on agency staff who may spread infection between long-term care facilities, and indicate better-resourced [homes].”
So let’s have all the information readily available and accessible to the public. Not just covid-19 death rates, but staff-to-resident ratios, occupancy rates, Care Inspectorate ratings, and so forth. And then let’s get rid of the market, so that the government is accountable to improve standards across the board, and the quality of care you receive is not based on what you can afford to pay.
“I would be terrified of any relative going into a care home without that information, because it does speak volumes,” June Findlater, whose 98-year-old father died from coronavirus at a care home near Glasgow, told The Guardian.
Who can blame her?
Source Direct is a free morning newsletter providing you with all the latest Scottish news in your inbox each morning, including:
- Analysis of the key stories
- A summary of what’s in the Scottish papers
- The latest on Source
- Interesting opinion pieces from around Scottish media
To sign-up for Source Direct, click here.