Common Weal today publishes a very important report on the Care Homes crisis written by Nick Kempe, former Head of Service for Older People in Glasgow. The report can be read here, and is worth taking the time to go through carefully. A full analysis will appear on Source later.
Here, I will only focus on one aspect of Kempe’s analysis. That until 17 May, the Scottish Government had, other than in the provision of PPE, left the responsibility for what happened in care homes up to private providers. On that day, two days after new and much more comprehensive guidance for care homes had been issued by the Scottish Government, Health Secretary Jeane Freeman wrote to Health Boards to make it clear they now had responsibility to provide clinical oversight at all care homes, private or public sector. Kempe explains that had the 2016 Cygnus Report into pandemic preparation been acted on, the 15 May comprehensive guidance would have “been available from the start”. In other words, the private providers should never have been in control during a pandemic.
This raises a bigger question about outsourcing and public services – when the provision of elderly care is a statutory responsibility of government but the service is delivered out-with government, who is ultimately responsible? Freeman has claimed that because 70 per cent of care homes are “delivered by private business” her power to “direct and instruct is limited”.
She added: “Whether or not that is the right place for us to be, whether or not in the longer to medium-term we want to be in a different place, is an important debate for a different day.
“I have to deal with the reality of the sector that I currently have.”
This is in effect an admission that the privatisation of care homes, which has advanced under the SNP’s watch (the number of local authority care homes decreased by 31 per cent from 2007-2017), was a mistake. But it’s also clearly not correct that her power was limited to intervene, since its the Scottish Government’s own updated guidance which has prompted this change. Kempe finds that the decision not to do so until 17 May was “the privatisation of the responsibility for Older People in Care during the crisis” and “had the later U-turn been made at the beginning many lives would have been saved”. Ultimately, the buck stops with government in a pandemic – that privatisation leaves them in a weaker position to act is one thing, but to claim that they did not have the power to act is quite another.
There is an important lesson here that stretches beyond care homes to all areas of public service delivery – democratic accountability is paramount. Outsourcing obscures the lines of democratic accountability, and creates distance between those carrying out service delivery and those ultimately accountable. It is not only that we should keep the private sector out of public services to avoid extractive practices driven by the profit-motive, it’s also that those who deliver our public services should be fully accountable to the public.
This problem of public service accountability was also raised in another issue yesterday, when the SNP and Tories voted against Andy Wightman’s amendments to support tenants. In justifying his opposition, Housing Minister Kevin Stewart mobilised the opinions of the Glasgow West of Scotland Forum of Housing Associations, which said the proposals would be “catastrophic” for HA’s. Before council housing stock transfer, which Nicola Sturgeon opposed in Glasgow in 2002, Stewart would have had to take sole responsibility for his lack of support for tenants. Many of those who argued against stock transfer at the time did so for that very reason – that where does the buck stop when it comes to the right to decent, affordable housing? Source Directreported two weeks ago that Living Rent had written to Stewart about reports from members across the country of HA’s removing cleaning services, leaving lifts and hallways filthy. They’ve not even received a response. Presumably the Housing Minister thinks the condition of social housing in a pandemic is nothing to do with him.
We need to have a conversation in Scotland about public services and accountability in wake of Covid-19. Pass-the-buck government is not good enough. Public services need to be public; that means no profit-move, and that those we elect have ultimate responsibility.
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