Opinion: The Great Home Care Scandal

I prefer not to think about how I would die. I like the idea of dying peacefully in my sleep, not knowing what had happened, and ideally at a time when I have no great plans left for the future. I don’t suppose the percentage of > people who die like that is particularly high.

I have made a decision not to have children, but I wonder if I will regret it from a purely self-interested point of view when I am old. For it is perhaps more likely my death will follow a pattern familier to many; increasing illness, disability and reliance on others. And who will be these “others”? Those employed by the home care system, which was starkly exposed by the recent BBC Panarama programme.

It was shocking. It was an absolute disgrace. Care workers who were poorly trained, barely earning more
than the minimum wage, given little or no information on the people they were seeing, constantly on the phone about the next appointment whilst attempting to care for their current appointment, and only given a fraction of the time they were supposed to have with that person. People got injured, their quality of life was appalling and their deaths were hastened.

It was no surprise to me, but it was shocking to see. The suffering was terrible. It reminded me of Kinnock’s warning about voting in a Tory goverment: Make sure you don’t get ill. Only this is during a Labour Government, of course. How did it come to this?

One word stands out; privatisation.

Central government is putting pressure on local government to keep down costs. And whilst it costs local authorities £22 per hour to treat someone, the private sector puts in bids for £12 per hour on average. On Panarama we saw one case of companies bidding against each other, and going down to £9.95. In some places, whoever puts in the lowest tender won the contract. That is the main criteria.

Economic Liberals would argue that such low costs are acheived through greater efficiency. Panarama revealed the truth. Care was cheap because it was substandard. The regulators were interviewed and were tight lipped. For whatever reason, they were clearly not doing their job.

Maybe the philosophy of “light touch regulation” is not just the curse of the City, but a fundamental flaw in all government policy? The moneymen were also interviewed. I was rather shocked to see Justin Urqhart-Stewart for the first time. Normally I hear his voice on the BBC Today Programme discussing what is happening in the City. I wonder if he feels he was set up by the BBC on this one. He was saying what a great investment opportunity Elderly Home Care is. Logically he was right, given our aging population. Clearly he hadn’t factored in the human dimension and the potential for public uproar when we find out what is going on. Maybe he had and figured there is still lots of money to be made regardless.

It is amazing in one sense. It is the elderly who are more likely to vote, and are more likely to be a member of a political party. They ought to have more influence than they currently do. Admittedly those in care are less likely to vote. And it is also true that the elderly are more likely to be right-wing for two reasons; 1) Elderly people who live longer tend to be well off and therefore more likely to vote Tory, and 2) Many admired Thatcher for her disdain for the cultural shift in the 1960s which caused the generation gap.

However we should all be concerned about how we treat the elderly – many of us can expect to find out what it is like eventually. It was noticable in the Panarama program that the trade unions were not interviewed – no doubt many of the care workers are simply not members, and Panarama had to locate a retired care worker who was prepared to speak out about what the current practices are. No one else would dare put their job on the line. What she said was appalling.

Also missing was the politicians. What a disgrace, where were they? I hope the Lib Dem website will contain a response to the program soon. For there is a very hard truth we have to confront as Lib Dems. As we know the Lib Dems have watered-down their policy of cutting public spending by £20 billion in order to fund other spending priorites and tax cuts.

Part of the reasoning for the previous policy was that Labour had been reckless in increasing spending on the NHS. The implication was that to correct that policy we would cut NHS spending. If we were to formally propose that at the next general election, I would suggest we would be crucified by our opponents. Even if it is true that New Labour has wasted the extra spend they have made, it is also true that we have an ageing population and NHS costs will inevitably go up anyway.

As for Home Care policy it was very clear. You get the service you pay for. The solution to the problem is clearly “tax and spend” or “throwing money at the problem”. In other words these phrases that come easily to economic liberals, but in fact deliberately belittle what public spending can sometimes achieve.

Unfortunately councils will have to pay more, and there is no obvious economic benefit from investing in homecare, unlike in say education where a better educated person can contribute more to the economy. So more has to be spent. Maybe there are not many votes in it, no neat ideas. But you may find you are very grateful in your dying years if more money is spent and you get better care.

* Geoffrey Payne is a Liberal Democrat member in Hackney.

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5 Comments

  • Andrew Duffield 18th Apr '09 - 7:18pm

    “The regulators were interviewed and were tight lipped. For whatever reason, they were clearly not doing their job.”

    There’s your problem Geoff – nothing to do with “privatisation”. We’ve seen care as bad in NHS institutions recently too. And you’re also right that it comes down to money – as much as love and respect.

    Of course social Liberal justice requires sustainable Liberal economics. Social Liberalism and Economic Liberalism: indivisible and complementary partners in the change we need. I just wish you could get your head around that fundamental Liberal truth.

  • Matthew Huntbach 18th Apr '09 - 10:26pm

    People complain about paying tax. With local authorities in particular, people say “council tax is rising above inflation rate, yet we see no improvement – it must be because councillors are evil people who squander our money”.

    The growing number of very elderly in our society, and the cost of caring for them, which falls on local authority social services budgets, is a major factor in the rise in local authority expenditure. It doesn’t get seen – most of the population just don’t realise it is an issue. Councillors seem to prefer throwing insults at each other rather than seriously accept this is an issue and tell the public about it.

    We get what we deserve – cut corners in care for the elderly, you can keep the council tax down, and that’s what the punters vote for.

  • Matthew Huntbach 19th Apr '09 - 10:01pm


    The solution for campaigning and reforming L/D`s is to make certain as Andrew Duffield rightly points out, that humane social policies are paid for from sound economics.

    Meaning? How would they be paid for by unsound economics?


    Our local G.P.s are all too often opting to make telephone diagnosis,instead of personal home visits to our Elders living in Residential Care as they are no longer under a contractual obligation,since 2004,to make those all important home visits.

    Yes, this is cheaper. It brings costs down. Isn’t that “sound economics”?


    As people live longer in greater numbers,as reported recently in `Social Trends’,420,000 over 90 year olds now in the UK : there must be greater vigilance and government control over the potential for `Elderly Abuse’

    There are some who regard the height of liberalism as being opposed to government control.


    Our local community care programmes must insist on the recruitment of well paid,socially motivated,principled, professionally trained care staff.

    Well paid? How? More taxes? Recruited? How? If there aren’t people willing to do it, people aren’t going to be recruited. We’ve had it drummed into us for the past 30 years that anyone with ambition goes into being an entrepeneuer or banker or something like that, and only saddo losers would even contemplate public service.


    There is a constant roulette weheel turning on the plethora of private contracts being bid for, purely in the name of rampant profit and not for and sense of altruism and humanity.

    Isn’t this what people have said is “sound economics”? Put it all out to the market and you will get the best. It means choice, it means ending the lazy state providers who lack competition and hence will do a rotten job.


    I ask are the `fast buck’ Care Companies solely intent on rampaging profits from a growing market of our Elderly wants and needs, without scant thought about concern for their welfare

    But Patrick, our economic liberal friends assure us this will lead to the best – they will quote Adam Smith et al (or at least the bits they like) to us, to show that when everyone is in free competition trying to make the best profit, standards will rise. It’s because they are out to make profits that they will do a good job, they want to do the best to earn the best.

    Some of the above may be intended to be a bit sarcastic.

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