The new inspection and regulation regime for care homes will
mean a major shake-up of the sector. It will also cast light on the
efficacy or otherwise of private public partnerships, says Yasmin
As readers of this occasional column will know, I approve of
inspections, standards, and strong actions that can lift care and
social services out of the pit. They have too long been
undervalued, underfunded and underdeveloped.
A rich society such as ours must be judged by the way it treats
those most in need. We fail this test utterly. To turn this round,
we must think creatively and boldly about how an intelligent
strategy using rewards and criticisms can revitalise and enthuse
these services so that people who care enough to work in them feel
a new sense of mission about who they are and what they are doing.
Personal and national aspirations (plus proper resources obviously)
could transform the sector.
The National Care Standards Commission (NCSC), which has been
set up to inspect and raise standards in care homes, is an
important step in that direction. Such forensic information may
also help to make better judgements about whether ubiquitous public
and private partnerships actually do produce better services or
whether the government’s ideology of no ideology (pragmatism is the
new mantra) is zealous blind faith. I remain deeply sceptical of
this miracle and the assumed and presumed excellence of anything
run by the private sector.
Many other people out there, (not all of them “forces of
conservatism” as Blair once described those who oppose New Labour
policies) are unconvinced too. Roy Hattersley has come out strongly
since the election with a barrage of intelligent questions. (It is
interesting though that during the election campaign he and I
argued on Radio 4 about the use of the private sector for public
services and he was completely and passionately on side with New
Labour. Such a good tribal chap, Roy.) The fact that a number of
care homes privately run but contracted to local authorities are
closing down or are threatening to do so because of the new
standards makes me even more wary.
Yes, imposing impossible standards with little additional money
is neither wise nor fair. But if, as Chris Hume of the Department
of Health and a key supporter of the NCSC, claims: “The aim is not
to cause chaos in the sector but to provide minimum standards below
which people cannot operate.”
Why should any care home owner find that so impossibly
difficult? And what would that tell us about the levels of care in
that home? I have long wondered about how it made any business
sense to run care homes especially for older people. Yet, many East
African Asians I know have made good doing just that. Some of them
are very honourable people and I cast no doubt on the places they
run. I have visited some and the residents were obviously happy and
felt that they were respected – Asians are brought up to respect
the old, a habit we are sadly losing.
But the money that a number of others have made in this business
worries me. The residents are not rich; the local authorities
demand Best Value. Your investment has got to deliver, otherwise it
is not a business. During the 1980s the mosque was rife with talk
of profitable sectors. Small hotels in London and care homes were
always top of the list then and money was clearly made by
enthusiastic entrepreneurs. I suspect these people will not be
warmly welcoming inspections and a scrutiny of standards.
Inspections could demand to know: are there enough workers? Are
they paid decent or even minimum wages? Is training and progression
part of the contract? Falls, deaths, and other events need to be
audited too. How free are workers and inmates to complain? The
physical environment, activities and ambience matters hugely to
older people. In some of the privately run homes, there is minimal
attention paid to these.
I remember taking my mother to visit a friend in a privately run
care home for older people in Southall, in west London. I was
horrified. The residents were all sitting completely silently in a
stark room with formica furniture and peeling floral wallpaper. The
television was on and two Polish workers who spoke 10 words of
English and none of the Asian languages were serving tea. The
owner’s Mercedes was parked in the driveway.
National care standards will hopefully close homes like this.
They may provide evidence to counter the government’s current
obsessional commitment to private public partnerships.
Or they may show that such partnerships can deliver Best Value
and best practice if standards are imposed. If so I will eat my
Yasmin Alibhai-Brown is a journalist and