Private care limits

Care homes are closing because their owners
are saying that local authorities are not paying enough for
residents. But should the private sector be running care for older
people, asks Alison Taylor.

In March, Rose Cottle, at 102 older than the
Queen Mother, had to take up the cudgels to save her retirement
home from the bulldozers and herself and other residents from
eviction and possible homelessness. The home’s owners claimed to be
losing money hand over fist and said they could not remain in
business without a significant increase in local authority
financial support. Their decision to close and sell to property
developers was apparently prompted by having to absorb the extra
financial burden of meeting new conditions set by the National Care
Standards Commission.

In one respect, this sorry tale exemplifies
the grave risks of relying on the private sector to provide care
when that sector is, by definition, looking to turn a profit on its
business activities. But unless income regularly exceeds outgoings,
this is impossible. However, in north Wales at least, the projected
costs of meeting NCSC conditions have had a corresponding impact on
local authority provisions, with two councils already insisting
that closure of some homes for elderly people are inevitable. Plaid
Cymru councillor Emlyn Thomas is horrified: “It’s well known that
when older people are moved out of long-term care into another
place they can die from shock.”

As a body with the power to set and enforce
standards, the NCSC is long overdue. But since its inception it has
been blamed for the financial woes of local authorities and private
sector organisations perhaps wishing to divest themselves of
unprofitable enterprises. Liam Fox, the shadow health secretary,
said of Cottle’s plight: “It is a dreadful case but not unique.
There has to be a change in the system because there is a
catastrophe on the way.” Arguably, that catastrophe has already
arrived: Britain has the world’s fourth largest economy but, for
the nation’s needy, it is a bleak, frightening place where their
welfare is sacrificed to the market place. For too long, private
enterprise has dictated market place values to successive
governments and on to public sector service providers. The outcome
is confusion, conflict and enormous wastage.

A civilised state must take upon itself the
responsibility for providing and maintaining those services that
are too important to be left to the vagaries of market place
economics. Aside from health and welfare, these include
communications, transport, utilities, defence – in other words, the
nation’s vital infrastructure. The UK’s infrastructure appears to
be collapsing about the ears of its citizens, while they suffer one
of the world’s heaviest burdens of direct and indirect
taxation.

Where does all the money go? A few years ago,
the government pledged to put the billions raised through tobacco
tax directly into the NHS – more than enough to resuscitate the
entire system. Was that promise kept? The government has vowed that
the welfare state is “safe in its hands”; soon, at the present rate
of destruction, the welfare state will have been consigned to
history.

Because so many people now live longer, by
2030 the government plans to raise the retirement age to 70 in
order to reduce pension demand. Already, some private sector
companies have responded by axing their own final salary pension
schemes, alarmed by the prospect of funding the extra decade for
their workers. Old age looks set to be an even grimmer state than
it is at present, with a new army of dispossessed pensioners
chasing non-existent jobs. There is another vast army of
job-hunters lurking in the shadows: it is now being suggested that
less academic children should leave school at 14.

Having turned around the fortunes of the New
York subway, American Bob Kiley was brought in to oversee the
restructuring of London’s public transport system. Much to the
government’s chagrin, he opposed Labour’s public-private
partnership initiative to rebuild the Tube. He said it was
unworkable, a recipe for disaster and rife with irreconcilable
conflicts, for at the heart of the arguments about public or
private service provision were the issues of money and profit.

The private sector must make money in order to
attract investment otherwise it becomes non-viable. The public
sector can afford to sustain loss-making enterprises because its
funding does not depend on performance but on compulsory taxation:
the matter of cost-effectiveness is entirely separate.

Alison Taylor is a novelist, a former
senior child care worker and the winner of the 1996 Community
Care Readers’ Award.