Nick Kempe – 30th June 2022
Yesterday the STUC published what we hope will become a ground-breaking report, “Profiting from care: Why Scotland can’t afford privatised social care”, which should be of interest to anyone concerned about the future of social care provision in Scotland. For anyone who lacks time, there is an excellent executive summary at the start.
Despite the UK-wide research showing the private care sector is not working which Common Weal used in The Predictable Crisis and Caring for All, no-one up till now has tried to pull together all the evidence for Scotland. Neither the Independent Review into Adult Social Care nor the Scottish Government showed any interest in doing so before signing up to continued private sector care provision. The STUC report is intended to address that gap and consider the policy consequences. As the authors observe, “while energy and attention is focussed on restructuring the procurement machinery, almost no attention is being given to the structure of the marketplace of care providers which it is procuring from – or, indeed, whether such a marketplace is the most efficient way to provide care in the first place”.
The main body of the report clearly describes the difficulties involved in researching the private sector and almost all its findings are qualified but the main message is clear. The private sector extracts significantly more money in profits, rents, loan interest and directors’ fees than its equivalents in the voluntary not for profit sector and the difference amounts to somewhere between £70-100m a year. That provides detailed evidence to support the much cruder estimate we made in Caring for All, that c£80m is being extracted from care provision each year, much of it out of Scotland. This is clearly wrong and the report also provides new evidence to show how this affects staff, not just their pay but also the support they get to do their jobs (for example, the report shows there are far fewer senior care workers employed in the private sector).
In looking at what happened to profits during the Covid crisis, the authors have not just ensured the analysis they provide is up to date (data extends to March 2022), they have opened up questions about the ways that the state supports the private sector apart from care fees: “At least five of the ten largest for-profit care home operators received £57 million of extra Covid funds in 2020 and 2021. One of these companies made a loss, but the other four made over three times as much profit as the Covid grants they received (over £108 million in profits in 2020 and 2021)” [authors emphasis]. The full extent of public subsidy for the private sector would merit further research.
In considering the alternatives to a privatised care service, the authors have provided an explicit endorsement [page 36] for the proposals we set out in Caring for All on how to transform care provision. While I had provided some advice to the authors before they started their research, help which is acknowledged in the report, neither I nor anyone in the Care Reform Group were asked to comment on any of the drafts or its recommendations. To say we are delighted is an understatement. There is now huge potential to create an alliance of organisations committed to developing a very different type of care service than that which the Scottish Government is proposing.
But again, the authors go further and develop the arguments we made. For example, while they state that they agree with the Scottish Government “that market competition is not the best way to organise care services, shifting towards “collaborative procurement” without altering the sector’s ownership structure amounts to giving extractive private providers a ‘seat at the table’ and insulating them from the pressures of competition”. Absolutely!
In developing a more detailed critique of the possibility of ethical commissioning and recommending how this could be addressed by the private sector being brought into not-for-profit ownership over time – the authors strongly advocate more co-operative and community control of care services – the report does open itself up to some criticisms. For example, the report recommends that the Care Inspectorate should be given new powers to oversee the private market. In my view, in the time it would take to set that up, large-scale private care provision could and should have been phased out and the idea that regulation can be improved will be seized on by many as justifying the continued existence of the profit-making private sector.
Another example is where the report states “commissioners should seek to identify public and non-profit entities that can be trusted to treat workers and care users well, and support them with stable long-term funding”. ‘Trust’ unfortunately is a nebulous concept and this appears very similar to the vague policy aspirations that are so often promulgated by the Scottish Government. What this illustrates, however, is that we need more debate. The authors and the STUC are to be highly commended for producing this report but we will need more research and more policy development if we are to develop a National Care Service that is worthy of the name.