Goodbye Southern Cross, Hello Open Public Services

So Southern Cross – the largest private care home provider in the UK will be closed.

What of the 31,000 residents who live in their properties? Well, the government has given us its assurance that they will be ok so that’s alright then.

Or not.

Goodbye, Hello

m kasahara @ flickr

On the day that the Open Public Services White Paper was published  (which can be found here – pdf) – which couched in the comfort of positive words like ‘choice’ , we would do well to heed the warnings of the way in which social care was sold off in chunks, from public to private and reflect on whether it is better to allow care homes to ‘fail’ in order to prove that the strongest will rise to the ‘top’.

The problem is that Southern Cross WAS the strongest. It did rise. It also speculated on property and ownership transferred away from the core business base of providing care and homes for those who needed both.

But on a more pressing issue, what will happen to those who live in Southern Cross homes and work for Southern Cross homes.

As the Independent says

Analysis by the GMB union revealed the names of 80 landlords who own 615 of the homes, many of which are subsidiaries of larger companies registered overseas. This makes it much harder to obtain financial information about the companies as rules governing accountability and transparency, especially in “tax havens” such as Jersey, Cayman Islands and British Virgin Islands are significantly more lax.

In addition, the GMB was unable to trace more than 120 landlords, which mean thousands of people are living in care homes where the identities of the owners and directors are unknown.

In the absence of full company accounts and other relevant information, such as the names of directors, it is “nigh on impossible” to assess whether they are suitable to run care homes funded in large part by public money, according to Andrew Craven, GMB statistician and researcher

At least the ‘Department of Health’ spokesman says

“Whatever the outcome, no one will find themselves homeless or without care. We will not let that happen. Today’s announcement does not change the position of residents. The Care Quality Commission will continue to monitor the services provided… We have been in constant contact over the course of discussions and remain ready to talk to all parties.”

That’s reassuring. Or not. Would that spokesman or anyone in the Department of Health want that level of uncertainty lying over their head or the heads of one of their parents? The residents of the homes will not know who their landlords are or whether they are fit to run care homes at all. Of course no-one will find themselves homeless – it will be the local authorities, the elected local authorities who will have to spend and fret themselves out of this one – nothing to do with the Department of Health’s reassurances – unless the Department of Health is going to compensate those local authorities for the time and cost they spend to ensure the welfare of residents of Southern Cross homes that may close.

As for the CQC, I think we have established that it is unfit for purpose and unable to regulate a care industry that has grown too large and too costly to be regulated efficiently. How about an idea? The Department of Health invests very heavily directly in the CQC so that they can provide at least twice-yearly, unannounced inspections together with a host of lay visitors attached to every single residential and nursing home?

No, the Department of Health is weedling out of this crisis as it will weedle out of the cost of ensuring that the residents of Southern Cross Care Homes are not made homeless.

Now, I want to link some of these issues to the Public Service White Paper that was published yesterday and particularly one or two sentences I picked out.

Firstly

In the context of rolling out more extensive ‘choice’ in other areas of government, the paper says

‘We will ensure that individual service providers are licensed or registered by the relevant regulator for each sector (e.g. the Care Quality Commission) so that those choosing services can known that providers are reliable, without stifling cost”

Does that not lead to a tiny little shiver down ones spine? The CQC is being held up as a reason to trust in this extension of ‘choice’.  Has noone mentioned the cost of good quality regulation, either.  It’s worth reading this post at The Small Places for more consideration of the way the CQC regulates social care services. The CQC has failed to regulate and the care sector is failing to deliver on personalisation so far. The care sector has had time to learn as well. We had direct payments for many years and before that the ILF (Independent Living Fund) which allowed payments to be made directly to adults with disabilities to choose care. The system should be sophisticated enough by now to deliver good quality, equitable services but it has taken many years even to reach this point. There’s a long long way to go.

Secondly

“The wider public sector has much to learn from local authority successes in commissioning, for example, in adult social care”.

See, look at us, government, we’re a success! Success. This is the end-result of success. Adult care commissioning is not a success. It has not extended choice unless of course (and I think I’ve found the key) success is based on the principle of privatisation and provision of contracts to the those who deliver at the lowest cost regardless of quality. That is the adult social care ‘success’ that the government is lauding in the Open Public Services White Paper.

We are dazzled by words such as ‘choice’ and ‘open government’  but they have no meaning outside ‘lowest cost’ and ‘discharge of responsibility’.

Think of Southern Cross. Think of Adult Social Care. It’s coming to our homes, our hospitals, our high schools and our highways.

So much for my week of positivity!

Men Needed

Perhaps it is unsurprising to learn that the majority of people who work in ‘social care’ are women. The Joseph Rowntree Foundation published a report last week explaining why it was necessary for the sector to reach out and attract more men to the workforce.

stepheye Stepheye at Flickr

Some of the points made will come as no surprise. Care is traditionally  the province of women. For as much as we shout about inequalities and assumptions it cannot be disputed that while there are more male electronic engineers, there are more female home carers.

The report stated how informal care has been provided by women in society over a long period of time. An increase in women moving into the workforce from the latter part of the 20th century has created jobs and a sector in a way that might not have existed previously.

Basic sociological history so far.

One of the reasons given for the massive bias in the gender balance in the care sector is the low pay in the sector. It is less likely to attract men to the sector if the pay rates veer around the minimum wage level. While I think this is a factor, perhaps it isn’t a factor that affects only men and low pay rates probably deter a significant amount of quality applicants and potential carers.

Another reason given was that

Privatisation of residential and domiciliary care has produced a labour market with insufficient opportunities for training and career development. This is unlikely to attract men, and women will increasingly leave as their employment opportunities improve.

This isn’t a point that I see as particularly gender specific but it does raise a lot of questions about the way that social care is delivered and more importantly by whom. I work in a profession that values development and training and willingness to see work on a continuum with learning.

So why should the social care sector, meaning those that deliver hands-on care, should have the training dead end and the lack of opportunities? Why do wages at the residential homes where I place people hover around the minimum wage? (A pay cut was enforced following the privatisation of those homes).

It is seen as a ‘throwaway’ or stop-gap job – something you do when you are looking for a more permanent job. It shouldn’t be.

I always maintain that if a good training programme is in place with ways to advance and develop as well as a sturdy pension plan then the wages can be lower. People will look to benefits if necessary but when there is no added value on top of base salary and organisations rely on the ‘feel good’ factor in members of staff to take lower paying jobs, they are creating a false economy by paying poor wages.

I have to mention that there are many good private companies out there. The ones I, personally, have come across tend to be smaller but there’s no reason a large company cannot be an excellent employer. I am just slightly more sceptical.

Coming back to the Joseph Rowntree Report, they suggest a few ways of moving forward

  • This situation will be unsustainable for meeting society’s care needs unless:
    – pay and conditions improve to retain more women and encourage men to enter the care sector;
    – unpaid carers receive financial and other support, and working hours are reduced for all, so that more people can combine family care with employment;
    – cash payments to individuals are not allowed to drive out funding for vital community services; and
    – policies are judged by the quality of care they support and how much they encourage a stable, less gender-divided workforce, as well as value for money
  • Any other solution would be unworkable, unfair and inconsistent with government commitments to reduce gender inequalities.
  • Sounds fair enough to me!

    Now, just to find some more men..