IT used to be a joke that someone would sell their granny – but that is literally what we as a society are now doing! The elderly, the vulnerable and those with profound special needs are being put at risk for financial motives.
The events surrounding at Southern Cross care homes and Winterbourne View hospital highlight the dangers of privatisation of our social duty of care and allowing the market place to make profit out of desperate human need. These latest examples cast serious doubts about how civilised we are as a country and how we treat those least able to help themselves, in particular older people.
Surely our politics and priorities are capable of embracing a more enlightened and ethical view of what 21st century care should look like? Is it not about time that we had a debate about whether we can trust the private sector or the market place or the profit ethos, in its current form, to be involved in the provision of care?
Making rich rewards out of the most vulnerable is a price that David Cameron and his ideologues seem willing to pay but for any progressive democracy this is not acceptable. For far too long, our political parties have allowed themselves to be brow-beaten into seeing virtues in privatising, commercialising, franchising services for the most vulnerable.
Yet there are huge limits to the market in social and healthcare and, in contrast, there is a much better case to be made for the ‘public good’. The public seem to have a better instinct for what is morally acceptable and have little appetite for more private-sector involvement in social, personal and healthcare. We seem, though, to lack the confidence, passion and belief to make the positive case for public or not-for-profit provision.
Recent events, where care-home provision has become a multi-million-pound property business, and a hospital for adults with special needs has become what has been described as the highest-paid torture facility in the country, are horrifying. What is also deeply depressing is that we allow private care to make profit out of the vulnerable while relying on the state to pick up the pieces if there is any trouble. As usual, it is the taxpayer who pays for the excesses of the market.
Surely this is the tipping point for a rethink. Fundamental questions have to be asked and many of the myths put forward for the involvement of private care and market thinking have to be challenged and dispensed with.
Certain myths have been accepted as “common sense” and permeate our public versus private debates. First, competition drives up standards – where is the evidence for this? Second, private care is more cost effective – but ‘least cost’ is not the same as value for money and, again, where is the evidence? Third, private care is more efficient – but what is the value of measurement and again ‘least cost’ is not an efficiency criterion. Fourth, public services need to shed costs and cut staff – but what about not-for-profit alternatives, new and innovative thinking in the public sector and different forms of working?
These myths show private care to be more of an ideological cause than a civilised or productive way of dealing with the vulnerable.
The other great weakness of private-care provision lies with the work of the regulators. Over-challenged, understaffed and with a near-impossible job to do, there is no guarantee that they can do anything beyond light and superficial regulation. At Winterbourne View hospital, the Care Quality Commission was culpable of sleeping on the job.
But how do you regulate private companies that are out to make money and have a hundred different ways of achieving this? The simple answer is you don’t. It is ‘mission impossible’ as the regulators are constantly informed by the private-care owner that they have businesses to run and need the minimum of interference.
This brings into focus the link between making money from the vulnerable and conditions within private care where we find poorly-paid and poorly-trained workers operating in poor conditions of understaffing and inexperienced management and a range of care needs which are far beyond their skills or capabilities. Why do we put people willingly and knowingly in such peril?
This raises the question of accountability. Who are private-care providers accountable to? Despite some weaknesses in the public sector, there is a clear line of political and administrative accountability which is known and transparent and is also subject to public scrutiny. This is a world removed from private care where accountability becomes largely meaningless. Shareholders and those who seek to profit have little interest in the quality of care.
Despite much of private care being profit-driven and firmly rooted in the market place, the public purse – central and local government – is a huge investor and income provider. This raises the question of why central and local government, the NHS, not-for-profit sector, the voluntary sector and the private citizen or user and families, should not come together and build new forms of 21st century care with new institutions and innovative care and cooperative concepts which dispense with private care and profit-making and any form of exploitative commercialisation.
It is little wonder we have a crisis on our hands. The public good demands a civilised society which values each individual, young or old, and seeks to provide the best possible conditions for meaningful and enjoyable lives to be lived without the risk of being exploited, abused, mistreated or humiliated. Dealing with vulnerable older people and those with profound special needs means their dignity, pride and role in life must be safeguarded.
The limits of the market and the search for profit make private care, in its current form, unfit for purpose. The explosion in the number of older people now only a few years away only adds urgency to finding new and better ways of making everyone feel important and cared for.
Politics is about choice and priorities. Spending should not be caught up in technicalities and dogma but be based on ethics and values. The public good is more important than the market place.