Editorial: The care home sector must be taken out of the hands of corporate pirates

Editorial 29.05.20

More than anywhere else in the country, over the past few weeks Skye has been made cruelly aware of the deadly defects in our nursing home system.

When this pandemic goes away, leaving local and national government with time to concentrate on other things, the Scottish health secretary Jeane Freeman must be held to her pledge of a full investigation into reform of care for the elderly and frail.

Ms Freeman should go further. In England an independent commission has been set up to investigate “serious breaches of human rights” in nursing homes.

A price has been paid which demands immediate attention.

The current dire situation originated, like so much else, in the privatisation infatuation of the UK Conservative Government in the 1980s and 1990s.

There had of course been private care homes in the United Kingdom before the 1990s. But especially in Scotland, they tended to be small eventide homes operated by families, and were often under the experienced and caring supervision of a retired nurse who never expected or intended to make a fortune from his or her new vocation.

The majority of care homes were operated by local authorities and by the local National Health Service.

In other words, they were part of the public service sector and not for profit.

The Community Care Act of 1990 threw open the door to long-term care homes to the private sector. Within a few years most such institutions were devoted not to social service but to the accumulation of money for shareholders and senior executives.

For a while the old, small, family-run independent care homes continued, as a small number of them still do today.

But before long most of the provisionwas by large speculators, who also built new facilities on virgin land, and in the words of Glasgow’s former head of service for older people Nick Kempe, “Finance rather than health became central to the provision of care to Older People.”

In the manner of the unregulated free market, the corporate ownership of care homes became a free-for-all.

One predatory provider mopped up another.

By 2018 the behemoth of this sector, which we should never forget is profiting from the plight of the most vulnerable in our society, was a seven-year-old company which took its name from the words “health and care”.

HC-One quickly consolidated its position. By early 2020 the HC-One group employed 22,000 people. It is a tax-dodger registered in offshore havens. Between 2017 and 2019 the company paid dividends of more than £50 million.

The salary of its chief executive was almost a million pounds a year.

Its home care staff, on the contrary, were among the lowest paid workers in the nation.

HC-One operates 329 care and nursing homes. One of them, as most of the country is now aware, is at Home Farm in Portree on the Island of Skye.

HC-One and its equivalents are supposedly supervised by the Care Inspectorate. In theory the inspectorate’s powers are limited; in practice they are virtually toothless.

They can recommend improvements, some of which are put into practice but others, as was recently the case with Portree’s Home Farm Nursing Home, are ignored.

We can sympathise with the Care Inspectorate. They are faced with a business whose ethos has become cutting corners and penny-pinching – how else to pay dividends of £50 millions?

On top of that, with so much of the care home sector in the hands of conglomerates which are now – HC-One most of all – pleading poverty, one can only imagine the chaos if much of the industry was to evict its inhabitants and shutter its doors.

Where would they go? Who would care for them?

No doubt Jeane Freeman’s investigation will contain recommendations as well as apportioning blame.

It will need to do so. Scotland, and in particular the Highlands and Islands, has an ageing population whose needs in the forthcoming years will grow rather than diminish.

There is only one solution which is both realistic and moral.

Scotland’s care homes must be brought back into the public sector. We have no objection to a few specialised private homes continuing to exist, but the huge corporate industry which has grown around accommodating the vast majority of our most vulnerable has proved itself to be exploitative and inadequate at best and fatally incompetent at worst.

If we are to believe its executives, despite all that tax-dodging, all those zero-hour contracts for non-unionised workers, and that large and expanding market, it cannot even make a profit.

We neither need nor want more greedy and irresponsible HC-Ones. Whether it is part of the NHS or an independent public body, we need a responsible, caring, accountable and properly resourced national care home sector.

As with so much else which has been proven by the coronavirus pandemic, that is something which only the state can provide.