Private Care Puts Profits Over People

Nick Kempe

On Sunday the Ferret published an excellent investigation which showed that private sector homes had triple the rate of complaints per care home compared to the public and voluntary sector and that four of the care home chains with the largest number of complaints are ultimately owned in tax havens. The important context which was not stated in the Ferret Report is that most older people in care homes are either unwilling or unable to complain and the complaints recorded are therefore the tip of an iceberg. The evidence that has been provided by relatives to the Scottish Covid Inquiry about care homes during the pandemic corroborates that.

The type of analysis undertaken by the Ferret was missing from the so-called Independent Review of Inspection, Scrutiny and Regulation published in September. Indeed, the IRISR failed to include any data held by the Care Inspectorate and Scottish Social Services Council, let alone consider what it might tell us about care services which are run for profit. Instead, it repeated the Scottish Government’s mantra that the solutions to non-existent and poor care services lie in a “National Care Service” which promotes “improvement” and “rights-based approaches” but perpetuates the private sector. How anyone in the Scottish Government believes that talk about rights will have any influence let alone impact on the financiers hiding in tax havens is unclear.

The data collected by the Care Inspectorate includes that used for Scotland’s annual Care Home Census. The recent version, published on 21st November, was referred to in the Ferret article. After publication Donald MacAskill, the Chief Executive of Scottish Care which represents private care home providers, leapt on the statistics claiming that the number of care home closures shows that the care home fees being paid by local authorities are not enough to cover the costs of care. He described this as an “abandonment” of older citizens. These claims were given widespread coverage, without any apparent attempt to seek other views, and have apparently been accepted by the Scottish Government.

The truth is that the statistics show a very different story. 14 Care Homes closed last year but while some private sector homes closed those most at risk of closure are run by local authorities and the voluntary sector. Indeed, the number of residents in private sector care homes for older people has increased by 2% (456) in the last decade compared to an estimated 33% decrease (1,073) in the voluntary sector and 20% decrease (812) in the public sector. The result is the private sector now provides 79% of the care home market compared to 74% a decade ago.

As for the private sector being in a dire financial position, as Donald MacAskill repeatedly claims, the care homes census shows how care home fees have increased by more than inflation.

As the census notes, “until around 2014, the average gross weekly charge (with nursing care) was broadly comparable to the expected charge adjusted for inflation, for self-funded and publicly funded long stay residents. Since then, the actual weekly charge has been higher than the expected charge adjusted for inflation, especially for self-funded residents. This has become particularly pronounced since around 2017”.

The census reports the average fee for self-funders is now £1,328 per week for nursing homes care. That average, along with much of the other data, is unlikely to be correct because of the 1,037 care homes for adults open on 31 March 2023, there were only 818 (79%) care homes that submitted data for at least part of the Census and 219 (21%) that did not submit any data. After 20 years of trying to collect data from care homes, it has not improved. While that can be explained in part by information technology that does not join up – another legacy of outsourcing – it also appears to be because many care homes have no interest in co-operating and know there are no real sanctions for failing to do so.

The £1,328 average covers a wide variation in charges, with groups like HC-One targeting the lower end of the “market” with fees of  around £1,000 a week, while care homes like North Care Suites charge £1,800 a week and are prepared to evict vulnerable older people whose families are no longer able to pay these eyewatering sums. There is no evidence that these differences in fee levels make any difference to the quality of care let alone that they are needed to “subsidise” publicly funded care home residents.

Whatever the fees, except for managers who sometimes get bonuses based on how much they can extort from vulnerable people, the pay to staff is almost always at best the living wage, with no entitlement to sick pay etc. Many of those staff are now recruited from abroad and if any sector is ripe for an investigation into modern slavery, it is the care home sector along with those of the 135 private nurse agencies registered with the Care Inspectorate which recruit nurses from abroad.

The real story behind the statistics which people are not being told it that is local authorities that have insufficient funds to employ staff at the rates they deserve and that whatever the private sector is paid will make no difference. The care markets will always pay staff the bare minimum and cream off whatever they can from fees as profit.
The amounts now being charged by private care homes in fees is a public scandal of the first order which should be seen for what it is, systematic financial abuse of vulnerable older people and their families.

The Scottish Government has many powers it could use to stop this abuse and phase out for profit care over time if it had the will. However, as long as it continues to place people like Donald MacAskill on all the main care advisory groups and pay companies like KPMG for advice on care services nothing will change. Scottish Ministers need to look at their own statistics, read some of the excellent reports on how the private sector is extracting money from the system – most recently the report from APSE – and start listening to the Trade Unions, local authorities and those parts of the voluntary sector that are not trying to ape the private sector.

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