Boris on Care: wrong words, right target

The corporate voice of the care sector is up in arms about the PM’s comments on care. Of course, his remarks about care homes, not following procedures were sly and clumsy, but he is right that the care sector should shoulder some of the blame for the virtual decimation of their aged residents.

Clap for carers was a touching display of community empathy for people in the front line but neither this outpouring nor the tragic deaths of care home staff should make the care sector itself exempt from criticism in the forthcoming debate on social care reform.

Just before this crisis started almost 17% of care homes were deemed by the Care Quality Commission as “Requiring Improvement” or “Inadequate”. This means that many thousands of our frailest citizens were already in homes with issues like understaffing, poor infection control and compromised dignity.

The seeds of Covid-19 landed on what was already fertile ground for disaster. It is this ground that now needs an honest exploration.

Among the many lines of enquiry is the issue of pay for frontline care workers, but also the values, incentives and rewards at play further up the management chain. Calls for a better funding settlement for the sector will not land well with policy-makers when they come from care sector leaders earning as much as £400,000 a year while their care assistants earn as little as £8.72 an hour (around £15,000 a year full-time). Why did they not lead by example and peg their own pay at six times that of the lowest paid in the sector, i.e. in the region of £90,000?

The broader challenge is to find a sustainable funding settlement that ensures dignity and protection to the most vulnerable. Back in 2017, Theresa May said that care was close to collapse and was widely mocked. All parties reached for cheap points about a “Dementia tax”. Instead of a debate about care funding, misinformation about people selling their homes for care was gleefully spread. It is a tragedy that campaigning points were put before solutions. How much more prepared for the current pandemic might we have been had we had a more mature and edifying debate three years ago?

Nye Bevan said that the Secretary of State for Health should hear a dropped bedpan echoing across Whitehall. Cries for social care reform are echoing more loudly around Whitehall now, but it is easy to blame the government for everything. We have all let our elderly down with the situation we have allowed to grow up.

* Ruth Bright has been a councillor in Southwark and Parliamentary Candidate for Hampshire East

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  • Nonconformistradical 8th Jul '20 - 9:40am

    Perhaps Boris needs to learn (belatedly) to engage brain (assuming one present) before opening mouth….

    Secondly I wonder just how much of the care sector’s problems are down to the organisations supposedly in charge (be they state or private) not talking to the people on the ground doing the actual work…? As usual….?

  • Barny Brain 8th Jul '20 - 9:59am

    What a lovely intelligent article that addresses the nub of the issue without stooping to mud slinging. I wish all of politics and that all politicians operated the same high standards that Ruth Bright projects herself.

  • Russell Simpson 8th Jul '20 - 10:38am

    Can we please stop referring to Johnson as Boris? He’s not my mate.

  • Jenny Barnes 8th Jul '20 - 11:00am

    The care sector problems stem from the privatisation agenda that has been followed for the last 40 years. Like the NHS, markets in this area do not work. Insurance based solutions lead to relatively healthy individuals looking at the costs and risks, and deciding not to insure, thus putting up the costs for those who do, leading to more excluding themselves, until only the uninsurable want to be insured. The obvious source for funding is from inheritance: I believe that inheritances should be taxed at the recipient’s marginal tax rate (possibly split over 10 or so years) rather than be subject to a totally separate tax scheme easily disparaged as a “death tax”.

  • Aside from the trivial matter of the incompetent and crass Johnson, the fundamental question about the privatised for profit (but financially fragile) Social Care system is the very nature of its structure. As a former Social Care Convenor (Cabinet Member) in local government) I witnessed a race to the bottom in terms of cheaper contracts with all that entails for employment and standards. The system needs a professional structure based on need – rather than on profit.

    Over the years I have come to the view that Social Care should be integrated within the NHS with all that entails in terms of employment contracts, professional career paths and standards. It should no longer be regarded as something to be done on the cheap and subject to ‘market forces’, property speculation and rich pickings for the owners.

    If government can spend billions on defence ‘to protect our people’, it should start with the basic principle of ‘protecting our people’ through social care for the elderly and by taking direct action to protect them in the later stages of their lives.

    If Liberal Democrats are to be taken as a serious political party with something distinctive and relevant to say then they should start with this. They should assemble a policy working group of people who really do know about the practical issues and who can advise on a credible future policy.

    Thank you Ruth for raising the matter.

  • Nonconformistradical 8th Jul '20 - 11:29am

    “If government can spend billions on defence ‘to protect our people’”

    And how often do those defence contracts NOT go way over budget?

  • Two brief illustrations of the financial fragile tangle of the privatised care sector relating to the Four Seasons group :

    Four Seasons is owned by H/2 Capital Partners, a privately owned hedge fund based in Stamford, Connecticut founded in 1999. It is a major creditor of Four Seasons Health Care in the UK and has substantial investments in senior living and similar nursing homes in the United States.

    The company had been acquired for £1.5bn in 2006 by Three Delta LLP, an investment fund backed by the state of Qatar, and further expanded. The acquisition was funded by debt which was readily available in a market where investors saw rising property prices and continuing demand for care for the elderly, much of it paid for by the public sector. However, the company was unable to pay its debts and with a downturn in the property markets was unable to refinance and the owners walked away, losing their investment.

    No sort of base on which the elderly can reasonably have confidence in during their remaining years….. the only guarantee being that they might be bailed out in emergency by cash strapped local authorities….. something which, I’m afraid, the Liberal Democrat Party had no small part in during the implementation of austerity.

  • Russell Simpson 8th Jul '20 - 11:45am

    Let’s just do what’s easier then shall we? Surely the equivalent of “the Queen” would be “the Prime Minister”? I thought the Queen’s surname was Windsor rather than Saxe-Coburg-Gotha-Schleswig-Holstein-Sonderburg-Glucksburg

  • Barry Lofty 8th Jul '20 - 12:10pm

    Would it be so wrong for everyone in the country, who is able, to contribute in some way to the care of our older citizens, the disabled and other less fortunate members of our society through some form of taxation aimed solely at this on -going problem. The treatment of our care homes during this present crisis has been nothing short of criminal but saying that the care for these people before the pandemic arrived did not fill one with confidence. Too many people making exorbitant profits at the expense of carers and recipients. At the end of the day we will all benefit.

  • David Evershed 8th Jul '20 - 12:19pm

    Coronavirus was transmitted to nursing home residents by the care staff and in the early days by visitors.

    Care home staff have to take much of the responsibility for the failure of hygiene discipline. Public Health England should also take responsibility for weak guidance to care homes in the early days.

  • Lorenzo Cherin 8th Jul '20 - 1:07pm

    A very sensible piece from Ruth, revealing, insightful commentary.

    Although much Jenny and Davis convey is correct, we must not, as opinionated ideologues, denounce,markets.

    Get what you are given, and be grateful, is the unkind statism of the top down system we have in the past and yet do, in public service delivery. It is what the DWP do much of.

    There have always been scandals in the NHS, some of them under Labour stalwarts.

    There is nothing wrong with specialists in care or health or education, making a profit from good works.

    Why is it ok for starmer to have an hourly rate of seven hundred pounds as a lawyer in a practice with such fees, but a private company in other areas cannot b e tolerated?

    Is criminal justice not as important, why no minimum wage slaves there?

    We ought to have a social market, regulated, and with taxes and profits, costs and rewards all in a harmony.

    We ought not to have hedge funds spinning a yarn that means they moonlight as diversified rip offs, no Virgin healthcare, but yes to Nuffield or bupa, not for profit or not, where they are private, and , yet, good practitioners.

    There is no room for knee jerk left right dogma in such things, we should favour a case by case flexibility, not top down statism or capitalism, in this area.

  • Lorenzo Cherin 8th Jul '20 - 1:08pm

    I referred to Jenny and….David….!

  • It is incorrect and unfair to infer that a CQC assessment “requiring improvement” means that the care provided to residents is below standard. From personal experience of looking for care homes for relatives and friends, in many cases this is the result of minor and short-term inadequacies in paperwork. Certainly, being “inadequate” is a matter for concern.

    The current CQC practice of rating care homes ‘inadequate’ for minor shortcomings and leaving that rating in place until the next inspection – often long after the shortcoming has been remedied – makes it more difficult to identify which care homes provide good overall care and which do not.

  • I need to correct a typing error in my previous post – in the second paragraph, I meant to say: rating care homes ‘requires improvement’.

  • On the one hand you have capitalist blaggers losing money from their “investments” in care going bust, on the other you have owners minting money? Care homes, by their very nature, tend to be horrible places and to be avoided if at all possible. For once agree with David Raw that they should be integrated into the NHS though they are only viable when carers are on minimal wages, given ongoing increases in NHS spending and disappearing govn revenues, there just ain’t the cash but perhaps offering free accommodation within the home for the many of the carers (those from abroad mostly) would mitigate their minimum wage status (and make it easier if a repeat lockdown is needed).

    The dismal lack of fiscal innovation from the govn so far does not inspire much hope in their reform of the sector, though, but you never know…

  • “though they are only viable when carers are on minimal wages” ….

    And what do you base that on, Mr West ?

  • There has been plenty of work done on possible ways forward and no shortage of models from other European countries. The blockage must be political. It may be helpful to reflect on the role of “pre-care home pensioners” – people like me who the received wisdom says politicians should not upset because we are rather good at turning out to vote or sending our votes in. Come what may it is unlikely that any one party of government can initiate sustainable reform without seeking cross-party agreement.

  • Cllr Mark Wright 8th Jul '20 - 5:15pm

    Good article. The bizarre knee-jerk response I saw yesterday from many people, suddenly claiming that the elderly care industry is amazing when we’ve been saying for years that it’s in crisis, was embarrassing.

  • Matt (Bristol) 8th Jul '20 - 5:40pm

    Yes, as someone working in this sector I totally agree.

    Something that has been missed on an almost daily basis since the start of lockdown is that – because it is institutionally easier to deliver care in this way to protect NHS and social care staff from risk of infection – lockdown has been a placing of community rehab and reablement services into mothballs, with many older and disabled people who would have gone home for rehab after treatment for whatever need, being effectively forced into care homes, whether self-funded or funded by the NHS and local authorities, driving up the number of people in institutional care settings, and reducing the likelihood of their longterm recovery of full ability, and rendering them more susceptible to infection in the longrun.

    This enriches those who make profit out of care homes, but does little to secure the working future and enhance the skills of staff.

    Part of the problem is that the NHS and social care in some areas only moved to a ‘risk-positive’ model (ie encouraging people to take responsibility for their own care choices, be less risk-averse) when there was less funding available. Now these vital actions that extend life, are being seen as penny-pinching cost-cutting.

    Mass investment in community services is screamingly needed. If any reforms in care funding line the pockets of the care home industry and see no other benefits, it is a failure.

  • Graham Evans 8th Jul '20 - 10:29pm

    It’s all very well blaming the care sector for its shortcomings but you get what you pay for. Providing social care is extremely labour intensive, particularly in the case of those with dementia, but the amount of money which local authorities are prepared to pay is totally inadequate. Even with the cross subsidy from self funders there simply isn’t enough money going into the sector.

    I don’t know the details of the care organisation whose chief executive the writer quotes, but I’d be prepared to guess that if he were to reduce his pay by 90%, and the money were redistributed to those at the sharp end, the extra money they would receive would be minimal.

    You can argue that high pay for senior executives is unfair, but it usually has marginal impact on the finances of a business.

  • Steve Trevethan 9th Jul '20 - 8:40am

    Might secure, visible and regulated connections between those at the bottom and top of the “financial feeding tree” of an organisation result in greater financial and socio-economic efficiency?
    Might shareholders and the like be included?

  • This is an interesting discussion. I suspect that there is little disagreement between contributors – at least it is not what it seems.
    The problem seems to me our attitude towards not so much what is called capitalism, but the rules that we have for companies. We should really be debating the companies act rather than call an attempt to present an opposition to exploitation as a support for socialism – oh and Venezuela!
    In fact the financial processes at work in the care sector are similar to those in many schools with Academisation. There have been many press reports of very high salaries paid to those who control them, but no evidence that overall performance is better than the rest.
    My view is that what is needed is good managers. Our present education system with the continuous measurement of the largely irrelevant does not encourage this. Instead it encourages the production of people prepared to fit in, just as it did in the Victorian days. We need to look at how we should work together to create a society which has an honest and open approach to how other people’s money is used.

  • David Evershed 8th Jul ’20 – 12:19pm….Coronavirus was transmitted to nursing home residents by the care staff and in the early days by visitors…..Care home staff have to take much of the responsibility for the failure of hygiene discipline. Public Health England should also take responsibility for weak guidance to care homes in the early days…..

    That is just a more polite reiteration of Boris Johnson’s ‘blame game’…

    In early march there were fears that the NHS could be overwhemed by Covid cases and on 17 March, NHS England wrote to trusts telling them to “expand critical care capacity to the maximum” by freeing up beds. Trusts were told to postpone all non-urgent operations and to “urgently discharge all hospital inpatients who are medically fit to leave.” There was no requirement to test all patients being discharged from hospital into a care home (until 15 April 2020) so they weren’t tested even though many could have been in the early stages of infection.

    There was a chronic shortage of PPE even in front line hospital care and the care home sector, always a ‘poor relation’ had to make do with what it could get in a crowded, expensive market.

    Contrary to your claim I’d suggest that care home staff and visitors were more likely to be infected by care home patients rather than vice versa. In such closed communities, with vulnerable patients, it is small wonder that so many deaths occurred. Testing, post April 15th, was a classic case of stable doors, bolts and horses..

    Ruth, you are right in your assertions about care homes but to dignify Boris Johnson’s remark by linking it to the long term issue of care home ownership, funding, etc. was, IMO a grave mistake; the two are separate.
    One is fixable; Johnson’s crassness and mendacity aren’t!

  • Chris Perry 9th Jul '20 - 10:04am

    Prior to 1980 private residential and nursing homes were only available to those who could afford to pay. Means Tested residential care was provided by Local Authorities under Part III of the 1948 National Assistance Act and State Nursing Homes provided by the NHS. In 1980 Margaret Thatcher extended choice by enabling people to have their fees in private and voluntary homes paid for by the then Benefits Agency subject only to the availability of a place and a means test. The cost escalated to billions which Sir Roy Griffiths termed the “perverse incentive” as the money was not available for home care and it was thought there were people in residential care who neither wanted nor needed to be. The money was transferred to Local Authority Social Service Departments, by the 1990 National Health Service and Community Care Act, which had to carry out an “assessment of need” and “verification of wishes”. For some reason Sir Roy included Nursing Homes in this, which had always been a health responsibility, so that for the first time they became the financial responsibility of local authorities. And what had been an “open-ended entitlement” became a “cash limited allocation” with Social Service Departments charged with “managing the market”. The majority fixed their “contract price” below the cost of their in-house provision (so much for the level playing field) which meant that private and voluntary homes have struggled financially and have had to subsidise local authority placements from the fees of private residents.

    As a result of the Griffiths reforms of the 1980s the majority of care homes and home care providers are now in the private sector. See my article “Reform of Health and Social Care without further top-down re-organisation” – LibDem Voice 28th May 2020

  • Chris Perry 9th Jul '20 - 10:07am

    Many of the structural problems in health, social care and the railways stem from the Griffiths reforms of the 1980s – see my article “reform of health and social care without further top-down re-organisation” – LibDem Voice 28th May 2020.

    Care Homes are not, and were never intended to be, hospitals and their residents are just as entitled to hospital care, if that is what is required, as the rest of us. That older people have been dying in care homes is shameful. As soon as residents exhibited coronavirus symptoms they should have been tested and, if positive, admitted to hospital where access to oxygen, ventilators and intensive care might just have saved their lives. Admissions to Care Homes should have been stopped when, or before, relatives were stopped from visiting. Instead the Government issued instructions, as late as March, to discharge older people to care homes to free up hospital beds for coronavirus patients.

  • Nigel Jones 9th Jul '20 - 11:10am

    Baroness Altmann (Conservative) was scathing last night on Newsnight about this government’s lack of action on Social Care. Geoff Reid says it needs cross-party support, as Lib-Dems have said for nearly ten years, but the attitude of this government so far suggests there is no chance of an all-party solution. I agree with David Raw’s call for a professional structure based on need. David Haslam, chair of Church Action on Tax Justice, has paid particular attention to social care recently and has called for reversal of the privatisation of the sector. He has compared MHA (a non-profit major provider) with HC-One, the UK’s largest care home group. MHA have a good record of provision, while HC-One has a poor record of provision as well as being set up with a tax avoidance structure based in the Cayman Islands.
    Will the Conservatives do what is needed to invest in a system led by the public sector ?

  • I do so wish Ruth Bright and Chris Perry would get on the phone to the parliamentary party and start briefing them…. and even better, drafting a new policy direction for the party to get out of the present mess. It would complement Katharine Pindar and Michael Berwick-Gooding’s plea for a new social contract.

    Good question about integration, Ruth. Simple answer, you just do it as a matter of political will. I’m sure Simon Stevens could find a way…… and it’s interesting to compare his £ 190,000 (after a voluntary pay cut of £ 20,000 to set an example) with the near half a million in the private sector you quote. The fact she’s a woman doesn’t make it any better….. there are fat cats of every gender.

  • If there was anything crying out for a cross Party solution, our care homes would be it. Can the Conservatives bear to consider bringing them back inside the NHS? Tougher regulation will not help because of the pressures. There is also the staff training to consider if they are to be part of our public health response to future global health emergencies.

  • Ruth Bright 13th Jul '20 - 1:20pm

    As a Councillor who tried to be part of the effort to clean up Council care homes in the 90s I have always felt equivocal about bringing them back in house. But like Peter I wonder whether that is now the only option left.

    Interesting that the government has kept care work out of the new immigration points system.

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