Author: Giancarlo Bell
This is the fifth of several pieces arising from the ARM 2019, explaining our positions on the debates which occurred there.
Britain should nationalise its extensive network of private care homes so that the vulnerable residents of these establishments can benefit from the improved standards of care afforded by the staff and systems of the NHS. Nationalisation could also provide better regulation, improved working conditions, and higher pay for the millions of workers in the social care sector, as well as offering better integration between social care and NHS medical care processes. This was the crux of Motion 90, submitted by North East Regional Council at ARM 2019. While the Broad Left was firmly supportive of this motion, the room at ARM was divided, with many representatives questioning whether bringing social care into the NHS was the right strategy to improve falling standards. Despite the strength of the opposition presented at ARM, the Broad Left are delighted that the motion passed in all parts.
Before the recession, care homes were regarded as bulletproof investments for private equity firms. The British population was ageing, and so thousands more elderly people could be churned out into the private care system every year with a premium hanging over their heads – profit for the care home bosses. This perceived stability provoked increasingly risky financial investments and a series of reckless economic expansions, subsidised with the money of taxpayers and the savings of our elderly population. No company better embodied this story than Southern Cross, formerly the UK’s largest social care provider with a peak of 31,000 residents in 750 homes [i]. They followed the tried-and-tested pattern outlined above, with a constant cycle of buying and selling new properties and pushing into new markets. After the credit crunch, Southern Cross was hit by rising rents, decreased expenditure by councils, and falling property prices. They responded by squeezing employee pay and decreasing the quality of care provided to postpone their inevitable decline [ii].
Our elderly friends, loved ones, and colleagues should not be at the mercy of neoliberal market forces. We are a wealthy country, and we should guarantee a basic standard of living for everyone. While doctors in general, and BMA members especially, believe in a publicly funded NHS which is free at the point of delivery, these values are more contentious when it comes to social care. There has been something of a shift in the Overton window in this instance. While almost 200,000 of the half a million care home beds in the UK were operated by the NHS or local authorities in 1990, this number has dwindled to about 30,000 [i]. The public accepts the dogma that the state provides health care; while the private sector provides social care.
By bringing care homes into the public sector we can equalise the huge variation in standards of care seen across the care home industry. The private operators’ main motive is profit; the care of their residents is a secondary priority. As such, we have seen dwindling standards of care, and a growing incidence of neglect and abuse at care homes across the country [iii]. At ARM, opponents of Motion 90 argued that the care homes which scored most positively under the scrutiny of CQC review were small, privately run establishments. This may work out nicely for the people who can afford to live in such homes, but the working class are left to fend for themselves in those cheaper, often poorly run care homes with low-paid, overworked staff, because staying in a top-quality care home when nursing care is required can cost as much as £55,000/year [iv]. We would not accept such inequality in healthcare.
Employees in the care sector are at breaking point. They are working longer hours, for less pay, and with fewer benefits than their colleagues working in NHS hospitals. They also receive less training and are frequently employed on unstable zero-hour contracts with little in the way of career progression [v]. By bringing care into the NHS, we can employ care home workers on humane terms, with the pay and conditions they deserve, which will subsequently improve the standard of care they are capable of delivering.
Medical wards in NHS hospitals across the country are burdened with the complex issue of ‘acopia’ and ‘social admissions’. There has been fierce debate about the validity of these terms and about how to solve the issues underlying these admissions, but nationalising care homes could be an important step towards a solution. If care homes were provided on a universal, free basis like healthcare, and their staff were part of a wider, integrated NHS system, then elderly patients who are unable to cope at home could be admitted to somewhere to truly meet their needs, rather than taking up a costly hospital bed. This could save our NHS a significant sum of money.
Now that this motion has made it through ARM, the BMA should be unerring in its support for nationalising care homes. We must show that we believe in a humane standard of care regardless of class background, that we stand for health and social care which is comprehensive, universal, and free at the point of delivery. We must show solidarity with the workers in the care home sector. Our elderly population, and the workers looking after them, deserve better than to be treated as pawns in the games played by private equity firms.