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Our care home service is designed for profits not people – and that’s why its failing

An unaccountable system governed by the markets has seen has seen adult care bounce from crisis to crisis over the last decade, writes ANNA ROSE

IN 1988 Yazz & the Plastic Population made number 1 in the UK charts with The Only Way Is Up. 

For many in social care, Sir Roy Griffiths’s 1988 report, on funding and organising community care, signalled that the only way for them was in fact down. 

The report led to the 1990 National Health Service & Community Care Act. 

The Act effectively removed local councils from the direct delivery of care. 

It was the epitome of an enabling model: councils having a duty to ensure provision of care but within a market ideal of the private sector stepping up to deliver better, more efficient services. 

The Act led to the exponential growth of private residential homes, with councils funding places but having very little do with the direct delivery of care. What could possibly go wrong? 

Alongside the de-facto privatisation of residential care homes, domiciliary or “home care” was squeezed, both in terms of funding and other resources. 

Directors of adult care moved swiftly to mimic the markets and treated care hours as “widgets.” In-house homecare staff were, after all, employees, pensions had to be paid and sickness cover provided. Surely it was sensible to compare prices and find that the private care agencies could deliver cheaper hourly care packages? 

So not only were services outsourced to private providers but, in many cases, this happened without Transfer of Undertakings (Protection of Employment) regulations (Tupe) applying to the workers. 

Spot purchasing of care hours from new agencies, and with that the core benefits of the local-authority provider model, were lost. 

The workforce lost pay, access to pensions and, as now, were subject to precarious employment models. 

Moreover, the model has palpably reduced the role that was once the pride of service: the training and development of staff. 

This was easily foreseeable. While local councils want to help people live independently, assisted by well-trained staff with new techniques, technologies and ways of working, to ensure that is the case, the market model grows by creating more dependence by users — because more dependence on the service leads to more income for the private agencies. 

Even before the term “ageing population” became a regular headline reason for service pressures, cracks began to appear in this new system of commodified care. Older residential homes, bought on the cheap, had to comply with new requirements for dignity and disabled access; suddenly the profits had to be diverted from shareholders and money spent instead on upgrading facilities. 

Cue the call for higher funding per resident with local councils making up the shortfalls.

These initial financial calls were in many cases resolved and once again — this time with a recognised ageing population — the residential care sector was an attractive financial proposition, councils often agreeing care packages with agreed inflation rises in advance. 

With low interest rates, and ambitious growth from owners, this turned many care homes into simply a shop front for the real money: the foreign investors. 

The properties themselves were treated as assets and spun out of the business, with sale and leaseback arrangements commonplace — the exact model followed by Southern Cross.   

In 2008 the global downturn hit. Now the perfect storm was to follow. Not only an ageing population but a sicker ageing population, living much longer with complex health needs. More importantly, the next decade was to see local councils lose, according to the National Audit Office, about 49.1 per cent in real terms from 2010-11 to 2017-18, which equates to about a 28.6 per cent real-terms reduction in “spending power.” 

On top of that, the sector, mired by low-paid and poor employment, faces a 90,000 shortfall in the workforce. 

With councils’ budgets already geared to social care as the biggest area of spend, it is little wonder that the last decade has seen adult care bounce from crisis to crisis.

And now in 2020 we are hit with Covid-19. For anyone reading the mainstream media headlines, it must seem a confusing time when the billions promised by government is unable to resolve the crisis in social care. 

Older people and care workers are dying. Workers don’t have access to the most basic PPE. Testing is non-existent. The reason lies in a system governed by markets, that is unaccountable to its council “clients” and is designed to serve profits not people. 

The most fundamental flaw in care homes — and for that matter domiciliary care too — in being unable to respond to Covid-19 is because it is no longer a part of the public-service family. 

Co-ordinating supplies to the thousands of providers, with no real regulatory body capable of interventionist action, is a system design fault. It’s the business equivalent of herding cats. 

And yet it is arguably the one sector above all others, with the exception of the NHS, that should have been part of the emergency pandemic response. 

It is unthinkable that the very people assigned to look after the highest-risk group in a major health pandemic are the poorest paid and the lowest valued. 

In the mean time, the council “commissioners” still face a funding crisis. 

The promised “Covid-19 funds” are, by no means, guaranteed and so far have not provided a penny extra for care. 

Councils are on a precarious “spend now, pay later” journey. But this is not just about money.

It would be easy for apologists to demand more money, to insist that care providers are prioritised for PPE deliveries. 

This will not solve the system crisis. The hollowing-out of councils able to provide care where needed is the root of the issue.  

Last week, Adass, the industry body for adult care, wrote a letter to ministers demanding that more should be done. 

This is a bit like Helen of Troy complaining she was allergic to wooden horses. 

In many ways the directors of adult care have ignored the trajectory elsewhere in local councils to insource services, continuing with a failed model for no apparent good reason. 

And therein lies the answer. Adult care services must be insourced to resolve the crisis not just created by Covid-19 but by decades of market and system failures.

Jeremy Corbyn’s Labour created a community wealth-building unit. Its mission was to ensure that real system change happens — not patching up failed models of delivery but changing the very structures that bring misery to workers, service users and local economies. 

An insourced model of social care, under the principles of community wealth-building, starts with a well-trained, well-paid workforce that is integrated across all council services. 

Adult care should never be a standalone service: it should be part of the family of services that can put an arm round the most vulnerable people at crucial times in their life. 

Public services should never be run on the premise of what is the cheapest option, because in reality these models have simply shunted costs to the public purse, care workers reliant on in-work benefits because they have been denied decent employment and pensions — and now denied the PPE that will keep them and those they care for alive.  

If Keir Starmer is to prove his mettle on one issue post-Covid-19, then this is it. Labour needs to be unequivocal in calling for insourcing of all care services. 

When care is insourced, the only way will be up for the carers, the services users and all of society. 

At least then we can give some modicum of comfort to those families mourning loved ones that this debacle can and will be avoided in future.


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