The FT has reported this morning that:
The extent of the crisis at Four Seasons, Britain's largest care home provider, was underscored on Thursday when it appointed advisers to carry out an emergency review of its finances.
And:
Four Seasons, which has 22,500 beds in 470 homes, is weighed down by annual interest payments of £50m and debts of more than £500m – meaning it is making less money than it needs to service bondholders.
So, we have another private sector out-sourcing disaster in the making impacting on an enormous number of vulnerable people and their families.
When will we realise that care of the elderly is not something for which the market has any easy solution whether it concerns care or pensions? Deep financialisation and the provision of essential social solutions just do not mix in either case. But I expect the same old excuses to be rolled out this time as in the past.
One day we might have a government with the courage to admit that this is a problem for all of us. Until the problems will keep on coming.
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Adult (and children’s) social care have been th most thoroughly marketised, and are closest to collapse. I wrote about it here several months ago….
http://www.civilsociety.co.uk/finance/blogs/content/19835/government_cant_ask_charities_to_compete_for_contracts_while_savaging_council_spending
Colapse much like the care given in many homes – uncare home might make more sense and whilst acts to protect such people are allowed to be ignored ie the MCA 2005 10 years on and authorities still cherry pick the Acts there to protect such care home residents little will change for our elderly
Much like giving notice to quit and blaming relatives
Relatives are the best free resource homes have but we are sighted as interfering and a nuisance to be avoided and evaded
errr my mother was given notice to quit from a FSHC
less than a year later its decided to close no reason given according to the LA CQC etc
Was it all the issues the authorities were aware of going back 18 months …..
My mother got notice to quit because I raised so many issues left unaddressed with photos of poor care matters that went on a year
Now I have been attacked with none of the legal help that a company like FSHC can muster and the CQC etc and yet the poor care my mother received and many others who die goes unpunished – I wonder how the shareholders and chief execs sleep at night perhaps on their cash
Staff turned on me accused me of abuse intimidation and harassment
The weapons of choice these days by many unscrupulous homes and carers and an easy deflection
To date no response from FSHC said they had addressed all complaints – they had not – matters raised with at least 8 or 10 persons at FSHC from the ground up to the top
Read the articles recently in private eyes re relatives being accused of all sorts to deflect avoid responsibility and accountability
If they treat relatives so appallingly and residents I hardly think they will be financially responsible….
Isnt this a kind of monopoly on care….
Why was this kind of deal allowed to be done with so much debt
Interesting to note on the what do they know CQC says FSHC only have about 360 homes registered with them under 80 odd different co names one person responsible for most of the homes easy to check
It states 470 above does anybody really know how many facilities they have do FSHC even know? it seems give or take a 100 is not a problem
FSHC had nearly 1500 safeguarding in a year reported to CQC not including the ones they did not report like my mothers and others its obligatory to report but no punishment if you don’t seems like a good game – NHS had about 10,000 safeguardings 2013/14 do the maths
In 2008 corporate manslaughter came in – to date just one care home has been charged according to what do they know cps – what about all the other needless deaths – seems a common response is they were old and going to die anyway no matter the misery they may have died in or how many times the risks were reported were not actioned before they died
If this were animals the RSPCA would be rushing in and prosecuting for cruelty to animals do we have the same values for the people who made this country – suppose there will be none left soon, so no one to remember the sacrifices and bravery of so many
many people do not want to put their families in a home but have no choice as not enough money and help to stay at home and care for them dementia really is a 24/7 job but even in a care home each resident probably gets about 3 hours of care a day
Care costs we all know that but the cost is often huge profits for care home owners they are in it to make money its a business and as long as care is a business I cannot see how things will change unless companies are forced to reinvest in the care they give a % of gross turnover no point on net as too many probably run at a loss on paper ….
It seems to have filed its last set of accounts about a week ago. On a going concern basis of course and no problem for KPMG.
The FT seems to think there are issues
…..so we may expect to see a few red faces at KPMG?
Will they be back in the spotlight again as they were with the Co op?
It does seem odd. For the last couple of months the press have been highlighting Four seasons ‘viability’ with a 26m loss in the second quarter and previously any profits before interest and tax only barely covering payments to bondholders. Not sure of the ins and outs but KPMG do once again look pretty stupid in my book.
So if Four Seasons is untenable as a business, where is the ‘superior efficiency of the private sector’ going to put these people? Are local councils, subject to huge funding cuts, supposed to look after them?
Or is the NHS, mired in financial and staffing crises somehow supposed to deal with these people?
How on earth does a company whose business model should emphasis stability and low risk end up with debts of over £500m?
Another example of the lunacy of market fundamentalism and over financialisation. Is the market, that wonderful market so beloved of the right, going to sort this out, or is the despised ‘nanny state’ going to be expected to pick up the tab?
Long ago I was involved in local authority provision of services and care homes of different kinds was one area where increases were needed. It was not a simple business nor was it one that fitted neatly into management theory etc. Equally, while there were private homes, they may have dealt with cases that were chiefly residential quite well, when it came to the difficult ones and those with a range of disability and the terminal cases, these were the ones usually left to the local authorities and some charities. Necessarily, their cost per head was higher, often a lot higher, than the private provision for clear medical and support reasons. The privatisation policies ignored the difficult cases and assumed all costs could be driven down to fund the finance. So guess what happened.
I too was involved with rest homes for the elderly as a district nurse. Part three accommodation run by local authorities, it worked so well, costs spread around the country, each area looking after their own. Working in a seaside town with lots of retirees. The few private homes were in the main run well. A move to a nursing home if care became more involved, also mainly private, because the local geriatric hospital, valued but long gone. Dementia care is probably where costs are indeed higher, but such understanding care needed.
Care of the elderly must and should be properly financed and carers rewarded, it is damned hard work, good staffing levels at night also.
Yes it is expensive, very expensive. But we cannot just have second best for frail elderly who are in need. Is it so difficult to fund adequately. There seems to be a growing scrap heap of the vulnerable now. Bring back our NHS professionals you stupid Tories.
The fact that our society has reduced care of the elderly to such financialisation says it all. We here horror stories of ten minute, rushed visits, training of staff that lasts three days before they are handling cases and all that matters is shareholder dividend.
What more can one say?
Simon Q
I am approaching the age where this sort of care will be required ( I really hope I don’t live long enough to require it!). My feeling is that the old do not matter and if they (we) die in poverty and misery-so much the better as far as the 1% nay 5% even, are concerned. The narrative is, I suspect, that the young are having it so bad because of the greedy old people. I feel so depressed.
A decent local authority should have contingency plans for this kind of thing. It’s not ideal, but it isn’t a disaster either.
If adults want to live in a Four Seasons home, who can or should stop them?
This is the prevailing principle for local authorities in social care. I’m in favour, and it seems you are not.
Get real
There are no funds for such planning
What are you suggesting? Sleeping bags in the church hall?
No, other homes. And that assumes the people need to be moved at all, which would be the last resort.
We have excess capacity in our part of the country (north east) so it isn’t a difficult problem.
Nobody would be asked to use sleeping bags in a church hall other than in exceptional circumstances and as a last resort (eg if a village had to be evacuated due to a flood).
Moving older people isn’t easy or ideal, but we do have detailed plans if these things happen.
And it isn’t just a care home going bust. There can be other circumstances requiring it – such as a premises becoming uninhabitable because of (say) fire or flooding. These things do happen.
I know you think we’re a bunch of idiots, but hey ho.
I don’t think local authorities are idiots
I think they are constrained unnecessarily
Quite different
I’ve asked around the desks just now, and we all want to know: what unnecessary constraints???
We can’t direct adults where to live, and we have to act within the normal public law. But they’re constraints we’re generally happy with!
What else?
So you haven’t noticed cuts?
Come on…..
Adrian,
Having worked within a social work team conducting the largest resettlement of elderly people in Europe, I can tell you that you can’t simply move vulnerable people around with ease and without costs to their state of mind, quality of life, and also financial costs. You have to take their needs and preferences into account. They aren’t cattle.
Britain needs to wake up and get real about what should and shouldn’t be provided by the state. Care for the vulnerable cannot be left solely to the market. End of.
Thank you
Benzo, I did say it isn’t ideal to move people. I am well aware it takes its toll on the elderly and it is a last resort.
It isn’t easy.
But it is not a disaster either, and with good planning it should be done in an orderly and humane manner. I’ve worked on resettlements, not as big as yours, and we did it well.
If you worked on the biggest re-settlement in Europe, don’t you think that experience is a little atypical?
Adrian clearly hasn’t read the article referred to by Kathy Evans, the very first poster on this thread.
To help someone who appears not to know his *** from his elbow, I repeat the reference here:
http://www.civilsociety.co.uk/finance/blogs/content/19835/government_cant_ask_charities_to_compete_for_contracts_while_savaging_council_spending
Yes, it was atypical because it was meticulously planned using a fully thought out methodology and every single service user had an individual assessment of their needs and wishes.
It took a long time (over 2 years) and no single service user was rushed into moving. Because of the thought and effort put into each service user’s resettlement many were happier and better off having being moved into more appropriate accommodation.
However, what you are talking about is moving people on an emergency basis which is a totally different proposition. Local authorities do not have the capacity in their social work teams to respond to large scale resettlement occurring as a result of private healthcare providers suddenly going bust. It will impact on people’s health, wellbeing, happiness and dignity, and life expectancy.
This kind of care should not be provided by the market without a stringent safety net for the vulnerable if a provider goes bankrupt. Only the state can provide that safety net, which totally defeats the object of privatisation in the first place.
Hi Andrew
I guess I don’t take articles from industry lobby groups at face value in the same way you do. They’re paid to write this sort of stuff. We deal closely with organisations like these (e.g. VCS organisations) and this is part of the conversation. I’m not sure what she’s saying other than ‘give us more money’.
Yes, we all want more money. I want more money. Kathy Evans wants more money. Join the queue, Kathy. But we had an election in May and the party with the cuts won.
The points I am trying to make are these:
1) As long as you have willing suppliers wishing to supply accommodation and willing adults wishing to buy it (and living where they want to live), you have a market of sorts. If a person can’t grasp this concept, they’re not dealing with the world as it is.
2) In those conditions it is impossible to eliminate all risks. Going bust is one of them. The home could have CQC issues. It could become uninhabitable. It could be a family business where the owner dies or becomes seriously ill. Stuff happens, that’s life, and thankfully these problems don’t arise all the time.
3) Getting rid of the freedom of supply and purchase is not a price worth paying to eliminate these risks, in my opinion. Adults must be free to live where they want.
4) The role of the local authority is to manage those risks through monitoring and contingency plans.
5) In my view, by and large this is done conscientiously by experienced professionals who know what they’re doing.
6) As Benzo correctly points out, by its nature it can be a messy business — it’s a world of persuasion, cooperation and compromise in unique situations dealing with unique people. It is not a fantasy world of predictable command and control as Richard appears (???) to want.
Anyway, have a good weekend.
Adrian
I come to the conclusion that you are only here to be both petty and vindictive
In doing so you hopelessly misrepresent me, and others whilst thinking those occupying your desk and those around it have a complete world view
Please don’t call again until you have a) opened your eyes to a wider horizon b) learned some respect for others
Richard
I am not being petty and vindictive. And I am not saying anything controversial.
I am simply pointing out that local authorities can’t and won’t tell adults where to live. It’s the status quo and I support this principle.
I feel I am the only one in this conversation pointing out this fundamental issue.
As soon as that point is accepted, some people might choose to live in a home conducted by companies like this. That’s life.
And if it goes pop, the local authority goes in to sort it out. That’s our role.
Often the problem can be sorted without anyone having to move. But Benzo has obviously experienced a big one.
I’m sorry Adrian but you have failed to grasp the issue.
You claim to be in favour of a status quo in which you are comfortable where you claim adults have the right to choose which home they live in. However, this status quo only allows that choice if the home makes a sufficient profit for its shareholders even when subsidised by public money. When that is no longer the case than the choice disappears, as in this case.
There may well be a degree of spare capacity in parts of the North East where you appear to be located. Unfortunately, the North East is neither typical of the whole country or the centre of the known universe. In many cases, where homes close elderly residents end up even further away from their relatives resulting in less contact, particularly when considering the context in which those working relatives are expected, purely as part of your wonderful status quo, to be infinitely flexible in terms of working location, patterns and length of day/week etc.
You also seem to have left off your list of possible reasons for homes closing examples such as the need to get people out in order to knock down the premises because it is more profitable to redevelop the site by building houses. Which is really one of the reasons why many of these places suddenly fail to meet standards and “need” to close – as is happening to someone I know.
So cut the crap. You are not really interested in free choice per se. Only when it coincides with your own political prejudices.
“If adults want to live in Four Seasons home, who can or should stop them?
Well in this case the shareholders, bondholders or whatever you want to call them are stopping them from living there on the grounds that they are not sufficiently profitable because their care needs are too expensive. So much for the principle of choice which is ony available if some minority can extract value from it, otherwise tough shit. A situation you seem comfortable in accepting. Perhaps you need time to ponder and consider which of these two conflicting options you want to go with, because you can have one or the other but not both.
Whilst we are at it perhaps you could also explain how LA’s cut to the financial bone are able to effectively pick up such burdens without taking services from other users because you seem very complacent and blasé about a situation you describe as not a disaster. Try telling that to those affected affected and their families who invariably have to travel further to visit and maintain contact with their relatives,
If you are representative of management in LA’s it is little wonder everything is falling apart at the seams. It certainly explains a lot of what many are experiencing up and down the country.
Four Seasons has been (over)loaded with debt for years. http://www.telegraph.co.uk/finance/newsbysector/banksandfinance/6744486/Four-Seasons-Health-Care-lenders-to-write-off-800m-of-debt-in-exchange-for-stake.html (c.£800m write-off in 2009, after it was sold for £1.4bn in 2006).
Looks like Terra Firma’s equity has been wiped out now, like the Qatari’s was before them.
Remember Southern Cross, in 2011? http://www.telegraph.co.uk/finance/newsbysector/epic/sche/8936464/Southern-Cross-care-home-collapse-could-happen-again-MPs-warn.html
Has the welfare state helped stop families looking after their elderly relatives? For example, as is the norm in many cultures? Isn’t this the bigger scandal?
What about those without relatives?
Or who have relatives with no spare rooms
Or (as one of my relatives does) require 24 hour supervision which is why we realised she could not live with us as was once our plan?
Your comment is, politely, stupid
Of course in times past women did the bulk of caring for aged parents, now women work. It is not uncommon for children in their sixties and more to be caring for parents in their eighties and nineties. A lot of singles now without children so a complex society.
I think you may find that in the cultures where some families look after elderly relatives that their health service doesn’t keep them alive quite so long. Have you ever tried looking after a seriously demented person for 24/7?
And in case you haven’t noticed we are all now required to work, whether we have young children or old relatives – the welfare state no longer supports families take on caring roles – tax credit cuts / bedroom tax etc. etc.
Not only are you required to work in those circumstances you are also required to work anywhere in the country your employer requires following the never ending management empire building known as reorganisation and unsocial flexible work patterns.
Try looking after elderly relatives when the choice is either move to the other end of the country or lose your job.
Some people just do not know, and do not want to know how the real world the copers (to cope means to manage) have created actually works in practice.
THE FOLLOWING COMES FROM A CARE HOME OPERATOR
I SOUGHT THEIR PERMISSION TO MAKE THAT CLEAR – Ed
________
I’m not quite sure what contributors think is happening here. I don’t have any personal knowledge of Four Seasons, but why do you think £500m is a ‘massive’ debt? How much are private houses worth today? For the number of rooms within Four Seasons, this works out at £21,000/bedroom. How many bedrooms in your homes? Would you sell your home for £21,000 per bedroom? They may have raised the capital differently from the way you raised your own mortgages but I bet you would expect considerably more than that! They look after 22,500 people. It’s incredibly good value – and far cheaper than a hospital! I’m a nurse who trained in the 70s; those geriatric wards stank, the beds were too close together, there was no privacy. If you were no longer able to live in your home would you want to live – for ever – in a hospital ward, or your own bedroom in a well run care home?
If you want something different for older and vulnerable people then you have to pay more tax or expect the state to spend less on something else. The state pays the private sector (very cheaply) to care for those who fall within the means-tested criteria – and generally, they do not pay enough. The state (national and local government) has increasingly relied on self funders (by which I mean anyone with a house to sell – probably people like most of us) to pay extra to subsidise the shortfall in the actual cost of providing care. This includes accommodation, meals and meal preparation (as well as the commercial kitchen, chefs and other catering staff), personal laundry service (as well as the commercial laundry machines and staff to run them)deep cleaning and daily general household cleaning, window cleaning, gardening, maintenance, redecoration, refurbishing with new furniture and carpets as required, utilities, activities, insurances, health and safety compliance, staff training, HR personnel for all the staff employed, bookkeepers, accountants, and all this even before we begin to quantify the costs of quality care and nursing staff. All this requires skilled management to ensure compliance with CQC and local authority requirements. In my county the local authority pays care homes (without nursing) £390/week – or £2.32/hour. (£399 for dementia – an extra 5p/hour – you can’t provide much quality care for specialised dementia support with that). Any home dependent on state funding will not survive at these sorts of rates.
Just think about it!! How many contributors here expect their local authority to keep their council tax as low as possible – or freeze it maybe? What about paying more taxes while you are working to ensure a more stable future in extreme old age? It’s your vote!! And it’s your future. If you are lucky enough not to have died young.
Mary, while that narrative matches that of a long term client of mine, I’m not sure what point you’re trying to make.
The argument presented comes across as blaming local authorities for the low room rates they pay but completely ignores the mega cuts in central government funding inflicted on LAs in recent years. As a result, the article could be interpreted as the writer attacking the softest target, the LAs, and therefore as an attempt to divert blame away from those primarily responsible for it, the government.
The final paragraph is, I believe, a perfectly sensible but somewhat incomplete since it excludes from any blame our government’s ideological determination to make the state as small as possible and turn everthing over to the private sector with, in this case, little evident care for those in need of care.
As I see it, the problem for private care homes is that they’re being squeezed from both ends. As described in the piece, the rates they are forced to accept are simply uneconomic and therefore their income is constrained. But they have been simultaneously been hit with additional costs that they are forced by law to absorb. While no-one in their right mind could disagree with the principles of a (proper) national living wage and auto-enrolment pensions, the imminent application of both policies will inevitably force the private care sector into an even worse financial situation. Goverment mandated decisions to cut funding to LAs, and therefore to care homes and then apparently fail to forsee the impact of the cost increases they are inflicting demonstrates a monumental strategic failure to understand the implications of its actions, the cost of which, as matters currently stand, can fall only on the end users, the elderly in need of appropriate care and their families, if they have them.
In summary, the narrative you have presented is that of the small private care home owner, the person who will be forced to accept the financial consequences of reduced income and higher costs, however dire they might be; and I sympathise completely with this view, as far as it goes. Whereas, the hedge fund financed large companies will, if previous experience is any guide, be bailed out by their mates in this government of nincompoops, with the bail out funded by the rest of society.
Of course, it might be your intention to simply add to the prevailing government propaganda based narrative, ie demonise someone, anyone else, in this case the LAs, and run away from accepting any resposibility, in this case the LAs. If that is not your intention, I apologise.
In case you hadn’t noticed James G there are vast swathes of people who are having to work two or three jobs to keep themselves and their families heads above water. Who has time to take care of a relative with complex needs? No matter how much we may love them.
Also, there are very many people who already do look after their elderly relatives but only receive a pittance to help them do it. These people save the government millions but get very little in return.
Totally agree
Another public/private sector disaster in the offing……
http://www.theregister.co.uk/2015/10/23/hmrc_signs_up_bain_for_aspire_mega_deal_migration/
Adrian uses the typical right-wing technique; when you have totally lost the argument, simply try to deflect the argument in a different direction.
Sadly, this often works.
Learned at the feet of his masters, Stevo!
I am a commissioning consultant working in Scotland and have a number of comments which might help put the discussion into a broader context:
1) The Southern Cross crisis was created by financialisation of care home provision and in particular through the separation of care home assets from operating companies. Public money had of course played a large role in the creation of those assets (through payment of care home fees) but Southern cross was then in effect asset stripped by the city. Here is a brief history:
1996 founded
2002 bought by West Private Equity – £80m
2004 bought by Blackstone -£162M along with NHP (property investment)
2006 floated stock exchange £423m and large sell off freeholds (sale and leaseback)
2007 Blackstone (made £600m – £2bn in all) and Directors (£35.8m) sell final shares
2010 paying £248.3m rent to owners of properties (often registered tax havens) and contracted to pay regular rent increases above inflation. “Value” drops £1.2bn to £11.9m
2011 business collapse — politicians reluctant interfere market and sell off to a number of successor Providers including Four Seasons Health Care.
The key point about this is the trading in assets only benefits the bankers. Local Authorities in effect are being forced to pay for the same assets time and again. This is very poor use of public money. One solution to this very relevant to readers of this blog would be People’s Quantative Easing to purchase the assets. But Councils would also have paid a lot less in the long-term if they had been allowed to borrow on the market. So, alternative economics is very relevant in considering current Four Seasons crisis. There are already models of private care home providers operating from council owned homes – city of Edinburgh for example.
2) After the Southern Cross crisis work was done in England to consider what arrangements the state might need to put in place to reduce potential harmful impact of such crises in future. This resulted in the Care Quality Commission being given a limited role in monitoring financial viability of providers. This is described in “Market Oversight in Adult Social Care” http://www.cqc.org.uk/content/care-homes. Its about warning local authorities who now have a specific legal duty in England to make sure people continue to receive care if services close – the duty extends to self-funders. The CQC seems to produce no public information on the current level of risk and it would be interesting to know if it has alerted local authorities about the situation at Four Seasons – their current framework only obliges them to do so when Homes are about to collapse. In Scotland there are no monitoring arrangements in place at present, although there were recommendations to do so in a report produced in 2014 http://www.gov.scot/Publications/2014/02/6217 and some plans are being progressed to do this.
3) In Scotland there is a National Care Home contract – which I was involved in developing (my involvement ceased about three years ago). After the Southern Cross crisis we created some new contractual mechanisms in an attempt to reduce risks. For example we created requirements for Care Providers operating in buildings owned by others to provide information about lease arrangements and any changes and we also tried to introduce much stronger requirements before councils agreed to assignation of contracts (the threat being if new dodgy provider bought a service without meeting council requirements the council might hold back finances – it being totally undesirable to move people from care homes). We also created step-in rights for councils to take over services which were failing to protect residents. None of this however has been properly tested. Now may be the time.
4) In Scotland too as a result of cross party political support fee payments/increases for Care Homes this year were linked to payment of the living wage. A key initiative to address workforce problems in the sector but also important in increasing levels of demand in the economy. The problem at present though is that this is being financed by the public sector without the private sector giving anything back (ie its not dependent on financial practices of providers changing).
5) One way forward to enable proper partnerships would be to require all care providers to be not for profit and increase the proportion of voluntary sector care provision (which has collapsed in the last twenty years). There is a precedent for this in Scotland for foster care services which by law are required to be not-for-profit. Unfortunately though the current law for foster care is not enforced and there is at least one for profit provider from England which runs non-for profit subsidiaries in Scotand and then transfers profit out through internal charges – another theme of Richard’s blog. Indeed on this theme many of the holding companies for the larger care home providers are based in tax havens.
LangBuisson currently provide lots of useful information about the care market – at a cost – but their work has developed on the back of financialisation and comes from the perspective of the city (so the collapse of Southern Cross has actually been described by them as a success for the market because all the Southern Cross Homes were taken over, even though the situation at Four Seasons suggests it is more likely to be from frying pan to fire). What I think is needed is an alternative social care think tank/task force that could develop alternative approaches which were not based on the neo-liberal model and could produce some practical ways that the ideas of Richard and others could be applied to and improve the way we provide care. There are lots of reviews of social care but they have all avoided this challenge and in doing so have failed to address how we can make care provision first and foremost about people, whether the people who need support or the staff who actually provide it on the ground.
Thank you
Just read Adrian’s cheery response to my criticism of him, I can only agree with Richard’s pointed dismissal.
Adrian’s clearly a believer in the unfounded legend of “General Equilibrium Theory”, that El Dorado of economics, wonderfully skewered in the observation that “a believer in General Equilibrium Theory is one who would say, that if your head is on a furnace, and your feet in a deep freezer, “on balance” you must be comfortable – such being the flawless grip of such believers on unmediated reality.
So, you too have a good week-end, Adrian, and don’t call me, and I won’t call you.
Andrew, it has nothing to do with that!
The law allows service users to choose live where they want – like the rest of us. It’s a good law.
The result of this is that nobody lives in a risk-free environment. It doesn’t exist. That means the risk of the problem Richard has identified may happen from time to time. That’s life.
If you can’t understand that, just keep scratching your head saying ‘how can this happen’. Let’s leave it at that.
Richard, I hope you don’t delete me, I should have a right to reply to Andrew.
Adrian
Your view is utterly and completely disingenuous, naive, stupid or nasty
Dob’t pretend this is about choice
This is about councils now not providing such services
And underpaying for what is needed
To claim this is choice in many cases is just not true
It’s making the best of a bad situation made worse by profiteering
‘How can this happen?’ is because people like you facilitate it
Richard
Answer the question Adrian.
The ersatz choice you put forward does not exist because the need for profit by a minority trumps the choice of the majority. You have clearly indicated you are comfortable with that. Pretending the issue is one of free choice reveals that, if as you imply you are employed in an LA to deal with these matters, you are not fit for purpose in your duties and responsibilities to the citizens you are supposed to be serving.
“Rinse” – my son uses this expression often – extractive capitalism is rinsing us. Nick Kempe describes its application to Care Homes. Our sick and elderly relatives want and need CARE, and not to be treated as commodities in a rigged market. The process of privatisation – marketisation/financialisation – wealth extraction – transformation to a rentier model puts the cost back on local authorities and the sick. Osbornomics talks about cutting the [welfare] budget to save ‘taxpayer money’ – whilst Osbornomics is all about a rentier economy. Just consider the recent ‘locked-in’ deal for expensive nuclear energy supply with China and France state aided suppliers. Non-sense.
Extractive capitalism – sometimes I think the adjective ‘render’ is more appropriate. Upton Sinclar’s book –The Jungle– explains the rendering process applied to the pig, “all that is not taken is the squeal”.
Typo the ‘verb’ – render.
‘The law allows service users to choose [to] live where they want — like the rest of us. It’s a good law.’
Aside from the fact that most people have an increasingly constrained choice of where they can live, (frequently if they are under 25 with their parents), if ‘service users’ are using public money then it seems only reasonable that they *not* have the option of living in grandiose property based pyramid schemes, no?
And let’s not forget the bedroom tax
Dave H
1) Service users say where they want to live and if they are eligible for funding, they get to live there, assuming the provider is willing to accept them (e.g. if there is a vacancy, if the home is capable of dealing with complex needs etc.).
2) We even get cases where the Council actively says ‘don’t live there — it’s not fit for purpose’. And we still get service users wanting to live there.
There was this case here from Wolverhampton which made the news: http://www.expressandstar.com/news/2009/07/31/care-home-threatened-with-closure/. I’ve been involved in similar cases which didn’t make the news. So the Wolverhampton one is not a one off, but probably rare.
I have no idea why service users make decisions like this, but they do. Perhaps you can explain.
If there are service users who are content to live in a place that is unsafe, I suspect they (at least some of them) won’t be too bothered by the financial structure of the care home owner.
Maybe I’m wrong. Set up a website that does financial assessments of providers to give service users warning about the financial health of their providers, so they can make informed decisions about where to live. Nothing stopping you. Go for it.
Jody A
I’m not sure what you’re on about.
Someone in your city or county who wants residential care looks through the list of care homes in the area. Some Councils may run an emarketplace system so service users can do it online. There will be a range.
If the service user chooses a more luxurious one (and some do), the Council pays up to the tariff, and the service user (or the family) pays a top up.
In setting the tariff, the Council is legally obliged to take account of the true cost of care with proper consultation. It’s the law — as set by the Sefton case.
And your local care homes (or their association) will be watching your Council like hawks to make sure it does this properly.
If your Council doesn’t do it meticulously, they’re off for a judicial review. So if your local Council isn’t doing this properly in light of the Sefton case, they’re not being too clever.
You are welcome to the view that our elderly shouldn’t have the choice of where to live. But it isn’t a mainstream opinion within adults’ social care commissioning.
Adrian –
That’s a very concise and, I’ve no doubt, accurate snapshot of how the market for eldersly residential care works. Nobody would argue with your understanding of the system – and there are some things in your summary that I wasn’t aware of, so thanks for that.
The reason people are so incensed at your view of things is that you seem to be condoning the current system, purely on the basis that adults should be allowed the choice of where to live. Can’t say I disagree with that as a principle, but there is the bigger issue that has people’s backs up… namely that the market relied upon by the current system is not stable or competent enough to ensure the continuity of dignified care that our elderly citizens deserve. If it was, then Four Seasons would surely have been seen as “too big to fail” and would be rescued by the state. Apparently not.
The system you are apparently defending is one which can see people forced to move around – yes, like cattle – because their home (that they may or may not love) is being closed due to market forces. These aren’t numbers on a spreadsheet or viable debts or good/bad market choices we’re dealing with here… it’s people. Old people, often vulnerable, amongst whose number I fervently hope to count myself one day (as I’m sure you do too), wot with it being better than the alternative.
So, describing the way the system currently works and saying “there’s consumer choice, so that’s alright then” is not going to fly. Pensioners are people, not assets or liabilities, not costs or profit options, not bl**dy Stock On Hand… they are valued and respected members of our community who deserve a hell of a lot more respect than they’re currently being shown by the market.
Once you’ve had a chance to think about how market forces have let these people down, and continue so to do, I’d welcome your thoughts on whether the current market led system is the best we can offer. Regardless of who won the election.
Hi Geearkay
Thanks for this — I was puzzled why I was getting everyone’s backs up — it wasn’t my intention.
I largely agree with you.
Of course, moving into a care home that is in a financially precarious position isn’t a wise move. Nobody wants that.
But the point which I have been clumsily trying to say is that people sometimes make choices that you and I might not think wise, and perhaps even stupid. People smoke. People drive too fast. People move into care homes where the staff don’t know how to administer medicines properly.
And we can warn them all we like, but they will go ahead.
So it isn’t a risk-free activity. Our best bet is to monitor things, warn, and then solve the problems when they occasionally arise.
Flat out banning private care homes (in all their shapes and sizes) isn’t going to happen. Forget it.
People choosing where to live is more than a principle — it is sacrosanct, especially for the elderly who often feel denied the say in their lives that the rest of us have. Far from viewing our elderly as stock, I view them as people with rights to say exactly what happens with their lives.
A number of Councils I know of have toyed with the idea of a ‘Trip Advisor’ type website for care homes. These were usually about the home’s quality — its financial health didn’t come into it (maybe it should???).
The problem for Councils is the risk of being sued by the care home if the assessment on the website is inaccurate, out of date etc. No Council (as far as I know) has wanted to touch it for this reason.
Maybe there’s a gap in the market for the private sector (it might already exist for all I know).
Sadly we can often wait over a year for our council to actually pay providers for a client. This is seriously not unusual even if it is not the ‘norm’. So financial viability and likelihood of collapse, or poorer standards which is linked to cash flow, is itself directly linked to how many state funded clients we might have, never mind the level of fee agreed. That doesn’t often get factored in to media reporting. We’ve even been advised by CQC to raise delays in contracts being provided (leading to non-payment), or disputes between health and the local authority as to who is going to be responsible, as a Safeguarding, as it threatens the home and wellbeing of all service users in the home regardless of funding sources. Hence it is ‘safest’ to aim for a self funded market. My contention is, if standards are poor, analyse the funding. If funding is appropriate to meet the needs of the clients we look after, then shoot the provider; however, if funding is NOT adequate (or hasn’t arrived) then shoot the commissioner. It’s quite simple really.
The most common accusation I hear about Adult Social Care in local authorities is that they are just middle men/women who take their cut as enablers of the provision and then essentially wash their hands of the client as they hand off to the carer.
They (Councils) habitually – as commissioners of services – pass on all the risk to the third party (or parties) providing the care. So really what we have is an adversarial system between commissioner and provider with very needy people in the middle. I do not see a lot of co-operation/partnership working and the sharing of risk which would put trust back into the system. It’s unacceptable.
Not so long a go the budget cuts meant that the contracts to local private providers who were providing housing with care were revised down. This led to loads of landlords just exiting the system and threatening to evict the vulnerable tenants.
I have been involved in the re-provision of accommodation for young adults with severe levels of physical and learning disability and I see the same things there – these problems are not just confined to care for the elderly.
It is true that central government funding has declined steeply and has not helped matters but some of the decisions and behaviour of the very often highly paid commissioning officers I have seen has been dire. For example I have seen people with special needs placed in general needs housing with some frightening results when they should be in institutional care. The people who have made such decisions have been promoted.Care in the community is being abused badly as a concept.
As a local Government officer, I can tell you that there is a lot of chaos within LAs at the moment and judging by the ambitions of this Government things can only get worse.
Adrian,
I think the reason people are getting upset with you in this thread is that you have a fundamental belief that a market system approach is the correct approach. This is why, for example, you end your most recent comment with the suggestion that “maybe there’s a gap in the market for the private sector”.
I can appreciate that you really do believe that market-based solutions will bring about the best outcomes. You do come across as sincere in this.
Where I think it might be going wrong for you is that you don’t accept that market-based solutions are failing. This is a systematic problem. So, the suggestions that you’re making — which are essentially a plea for more time to find market-based sticking plaster solutions — are falling on deaf ears. The country has been going in the current financialisation direction since at least 1980. There is plenty of evidence that it isn’t working.
Doing more of what hasn’t worked in the past is unlikely to lead to good outcomes in the future. It already isn’t leading to good outcomes, even as we speak.
Where it gets ugly is that a lot of already rich people are making a killing — in some cases literally — from the dismantling of the country’s social structures. Whether you intend to or not, your activities are supporting such activity. Maybe this is just coincidence, and you really didn’t realise the likely effect of the arguments you have been making. If so, I hope that my calling attention to it will prompt you to reassess your approach.
Best,
Max
Thanks Max
I’m not sure how you can conclude some ideology on my part about the ‘Tripadvisor’-type site. I told you the reason we won’t touch it — we’d get sued. So unless the private sector picks it up, it won’t happen. No ideology there.
“I can appreciate that you really do believe that market-based solutions will bring about the best outcomes.”
Who has a ‘best outcome’ in life, whatever that means? Do you? I don’t think I do.
One thing I know is that I am profoundly unqualified to work out what is the ‘best outcome’ (such as it is) for another person, particularly a stranger. I can’t do it, and I have never met a person who can. The best person to do it (and it is not an exact science) is the person himself/herself, assuming sufficient capacity.
Our host Richard has said it succinctly: it is hard to pinpoint ‘rationality’ in the choices we make for ourselves. What hope to make choices for others?
As I’ve said, I’ve had live cases where service users with full capacity refuse to move out when the home can’t dispense medicines properly. Work that out. But if you respect the dignity of these people (as I do), then who are we to argue with them? It just isn’t our place.
The case had a profound effect on my thinking.
What would you have done – I’m genuinely interested.
I don’t know what is so doctrinaire about believing in the market, except to say that ‘exchange’ is something people have done across societies since year dot, and will continue to do to. And for better or worse, that’s a market. If Councils started offering care homes, there would still be a ‘market’, just with a new entrant. If you stop at the pub for a pint on the way home, you’ve had an exchange — you are part of a market. Am not sure what’s the big deal — I’m not saying anything unusual here.
I am a little lost with the thread of the argument across this post generally. First it was issues regarding insolvency (OK, a problem, but a fact of life).
Then it has moved to adequacy of care tariffs — it’s pretty hard to argue with people who aren’t aware of the Sefton case.
Then it has turned to care homes being owned by private equity/the rich or whatever other villains in the class war.
What is it you want to stop? Please say.
Cheers
Adrian
The mantra of choice in healthcare provision is an attractive Janus-like concept with two faces.
In a well funded service individual choice can be met; in a system that is under financial pressure like the current NHS and its associated services, choice will be very expensive indeed because of the limited ability to meet it in every case. Individuals will clash with these constraints.
Therefore choice in the current context of health provision is nothing more than a mechanism to create dissatisfaction with a service that leads to the creation of consent amongst service users for privatisation and the introduction of the profit motive.
Can I recommend this article about choice from a recent edition of the Guardian which examines some other downsides of ‘choice’?:
https://www.google.co.uk/search?q=choice+guardian&sourceid=ie7&rls=com.microsoft:en-GB:IE-Address&ie=&oe=&gfe_rd=cr&ei=n2svVpzhEIff8gfA75CoBw&safe=active&gws_rd=ssl#
The article is good but ignores the fact that we can only rationally handle simple choice: rich tea or digestive stuff.
When it comes to complex issues with many variables e.g. a new car, pension or child’s school, we go on gut, not rationality
So choice is invariably not as economists think
Yes I’ d agree with your last comment Richard – the neo-lib world view of the ‘rational person’ – always calculating to get the best deal for themselves is just as illusory as the so called rationalism in the financial sector as a whole which is meant to control excessive and corrupt behaviour but frequently does not.
Human beings are driven by emotions – not necessarily logic.