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!

Waiting for Dilnot

The Dilnot Commission on Care Funding and Support is due to report back to the government on Monday 4th July.

At Arbitrary Constant there is some useful background reading about the Green and White Papers which were published by the previous government regarding changes to the funding of adult social care.  It will indeed, by interesting to compare and contrast with the proposals set out on Monday.

The scare stories about the Dilnot report  started emerging from the press over the weekend with the Observer reporting on a £35,000 cap on payments towards care while the The Times (£) write about a cap of up to 30% of the value of a property.

The very thought about paying for care at these levels seems to strike fear and anger in the  heart of the property-owning middle classes and perish the thought that they might actually need to pay towards the cost of their care. Although it’s important to remember that social care costs can be potentially incurred at any point in someone’s life. It isn’t necessarily about ‘saving up’ till old age or insurance schemes at the age of 60. What if you need the services at the age of 55 or 25?

The King’s Fund has a post which underlines the major issues and potential obstacles to implementation.

And the Guardian yesterday had a good summary piece which seems to have some of the potential details and difficulties highlighted

Meanwhile Community Care reports that there is expected to be a hostile public reaction to Dilnot. The article says

That was the warning today from housing and care provider Anchor, who found that 44% of Britons believed the state should fund all their care costs in a survey of over 2,000 people.

Which is the crux. No-one wants to pay for what they think they should be getting free. The payments into the ‘system’ and into ‘national insurance’ should cover care costs. The thing is, they don’t and they can’t.

Cost have escalated. It isn’t just about care home fees, home care packages and support plans delivered through personal budgets are increasing as people with higher care needs can remain at home for longer.

The sometimes seemingly arbitrary divide between health care needs (free) and social care needs (means-tested) can generate understandable anger as systems like the continuing healthcare assessments can be incredibly complicated and seemingly counter to common sense understandings of what ‘health’ care actually is.

There seems to be a proposal to separate out ‘hotel costs’ of the care home from ‘social care’ costs which will, I expect, lead to all sorts of interesting accounting mechanisms to ensure that the highest fees can be garnered beyond whatever system is implemented.

But I want to be hopeful.  Dilnot is unlikely to be popular in ‘Daily Mail’ land, there are murmurings in ‘Guardian’ land too. Maybe we just need all parties to actually work together for the good of the whole at this point rather than worry about the cost in votes that any change in a system might incur.

Sinful Wastrels

Unemployed man looking for a job in 1928

Image via Wikipedia

I haven’t had time to read through the White Paper on Welfare Reform called Universal Credit : Welfare that Works yet. I finished work late last night and went to bed almost embarrassingly early. Hopefully, I’ll have a chance to look at the details over the weekend.

In the meantime, just a couple of generalised thoughts. I strongly object to a politician using language like ‘sinful’ in reference to social (or any kind of) policy. We may have an established church but I have no time whatsoever for the drawing on religious language. To say it leaves a bitter taste in the mouth is an understatement.

This government is frighteningly making more and  more moral judgements on people with whom they disagree. Perhaps it is a display of guilt about their overt targeting of those who are jobless.

While I understand the general narrative that there is an ‘underclass of scroungers’ I also challenge it. I turn to my constructionist theories and look at what has actually created this so-called ‘underclass’. It is about the structures and choices that have been left open for people, the lack of a coherent and progressive social policy and the poverty of opportunity rather than pure laziness.

I do not believe the human condition is inherently ‘lazy’. Nor is it a class-based attribute yet we are increasingly seeing these issues tied together. What leads to a lack of desire to work? Perhaps the way that society views certain types of jobs like ‘care work’ which should be the most highly admired  but is relegated to a ‘poor status and poor pay’ profession and the perceptions and opportunities of promotion are poor.

Moving back to social work briefly, I’ve mentioned this many times but my route into social work came initially through voluntary work with adults with disabilities which then turned into (as I used the experience I had gained through CSV) paid work as a care assistant. I think there could be a clearer career path identified for care assistants (those who want to, of course) to grow professionally into social work degrees  but often the people who take these roles are encouraged to have lower aspirations where actually moving sideways into a professional role would create a more secure base to work from in the future.

By humiliating and castigating people for whom there are no jobs, we are potentially creating a greater problem for future generations and a perpetual underclass.

Like a lot of these ‘cuts’ on the agenda, there seems to be little long term planning behind them.

A reform in the benefits system needs to come, of course it does,  but it should not be seen as a cost-saving exercise. It should be accompanied, perhaps on a cost-neutral basis on a systemic restructuring of the way the society operates and puts much more of the focus on improving access to equal educational opportunities. The changes in the university tuition fees could be tied into this.

The nefarious political and moral drive behind the welfare reforms have been seen for what they are. They are a bunch of over-privileged millionaires dictating morality to people who survive on the scraps that the state throws them. When they deign to be more selective in their search for employment, they are penalised heavily or forced into ‘community work’ as ‘volunteers’ where the large companies will, no doubt, benefit.

Four weeks of unpaid forced ‘work’ is not enough to create a ‘work ethos’.  It is more of a ‘workhouse ethos’. Nothing wrong with voluntary work – for me it was the route into work and into a profession that I love but that was because I wanted to do it and I needed to do it. Of course people should be inherently wanting to work but I don’t believe that people don’t want to – it is just about fitting the type of work to the person and punishing people in a time of high unemployment for not working. There need to be changes that work on the expectations and the equal or rather, more equal access to opportunities alongside changes in the welfare systems.

Yes, the money is running out. Yes, there need to be cuts. But unemployment benefit or rather jobseekers allowance should be about encouraging rather than penalising and stigmatising. The problem is that by creating a negative narrative around people who are unemployed and broadening that out, as the government are, and have done to people who are unwell (on ESA) and disabled by labelling people are ‘lazy scroungers’ the government is actively creating a more isolated section of society for the readers of the Daily Mail to scoff at. Until they lose their own jobs. Or are cursed with ill health such that they are not able to work.

I don’t think there is anything inherently wrong in wanting to reform the benefit system but encouragement to work has to be more whole-hearted and resting the blame of a recession on those who lose their own jobs seems to me, more ‘sinful’ than turning down a job that isn’t suited to a particular unemployed individual’s skill set.

But as an agnostic , I’m particularly poorly placed to make a judgement on sin. I don’t want my government to do it for me.