Wednesday, 14 March 2012

Public Service & Private Profit: The BIGGEST Elephant in the Social Care Room

There were a number of respondents who raised concerns over the business ethic of the care homes they worked for. These respondents felt the organisation and/or general management were driven by profit, rather than providing high-quality care” RCN – Persistent Challenges to Providing Quality Care 2012

If there is to be any resolution of the current care crisis and to ensure the provision of quality care for the most vulnerable adults in our society then the BIGGEST elephant in the room has to be tackled or, at the very least, talked about openly.

The majority of social care provision is delivered by private sector companies who do so in order to make a profit. Direct public sector provision has dwindled and continues to do so as more local authorities look to close or sell care homes.

The reason for this is relatively simply – it’s cheaper. By outsourcing care services local authorities save on administration costs yet more specifically the save on wage costs. Private companies are less bound by conditions that local authority employers have to abide by, particularly in terms of pensions and the myriad of different companies delivering social care means the workforce is fragmented, largely un-unionised which has allowed care worker wages to remain low at a national average of £6.71 per hour (Skills for Care NDMS Data). 

Undoubtedly the poor pay and conditions associated with working in social care contribute to the continual recruitment and retention problems which, in themselves, have an impact on the quality of care provision.

Now there is no doubt that what local authorities have paid in fees for social care provision has dropped, in real terms, over the last few years firstly by lower than inflation increases and more recently by totally freezing fee increases and there is equally no doubt that social care needs greater investment.

There is also the additional fact that many of those who have to pay for their own care provision are forced to pay a higher amount in order to ‘make up’ for the low fees paid by local authorities despite receiving exactly the same quality of care by the provider.

Yet the issue that has to be addressed is what guarantees are there that increasing fees will drive improvement in the quality of care or workers’ pay rather than line the pockets of those who run their companies for profit?

One solution by a respondent to the RCN survey was to suggest a cap on the amount of profit that could be made ensuring the rest was reinvested into the care of residents.

But to flip the argument a little, most people go into business to make money and any threat to the profitability of the care sector would discourage people entering it. With the demographics indicating increasing amounts of social care provision being needed there will be a demand for more suppliers. So what happens if the suppliers are not there? There will then be pressure for local authorities to take responsibility for providing care at the higher costs associated with the public sector.

There is no obvious or easy solution to the dilemma but it is one that has to be recognised as a major part of the debate on social care.