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Lansley’s health and social care problems now as much about social care as health

Posted on 2 June 2011 | 11:06am

It is somewhat unfortunate for Andrew Lansley that the legislation on which his reputation and legacy will depend is called the Health and Social Care Bill.

Up till recently, it was the health part of the equation that was causing the Health Secretary difficulty, and which led to the intriguing new constitutional development known as a ‘pause’ in the legislative process.

But now the focus is also on the social care issues. This is thanks in part to BBC Panorama’s genuinely shocking film about abuse in a centre for people with learning difficulties, and also because of the financial problems facing Southern Cross, a private sector company looking after 31,000 vulnerable people, many on behalf of local authorities.

The ideological cornerstone of the health reforms is the idea that outside providers are likely to deliver service as good as, or better than, that provided by the institutions of the State, particularly is the profit motive and the notion of performance-related pay (the current bugbear of the BMA) are thrown in.

There are no doubt plenty of good people providing good social care in the private sector. But politically, this has a bad feel to it, and will require very careful political handling. That is one department where even Mr Lansley’s colleagues would recognise he has not covered himself in glory since introducing his Bill.

Number 10 seem to be taking a close interest in both sides of the equation. They are right to, because both are beginning to emerge as problems that will require a lot more than the time, effort or intellectual rigour the Prime Minister thus far appears to have contributed.

  • I may be wrong, but perhaps it is better to have the state responsilble for care. The goal of any private sphere is to make profit with the least amount of expense. Care is also about humanity, dignity and respect. The elderly who have contributed by working most of their lives for the state should in return be cared for by the state.

  • Richard

    Remind me, was Southern Cross enabled to grow and thrive under the previous Labour Government? Were the abusers filmed by Panorama all appointed since the coalition was formed. I think not.
    Cross Party agreed social policy change is essential. Why does Red Leader not use that as a cornerstone of his policy review. The public would undoubtedly buy into it, as everyone has family members who are going to be swept up or aside over the next generation , as the ageing population strains public resources to breaking point.

  • Sandra46

    three key words …. time, effort, intellectual rigour P.M. has one of those and no prizes for guessing which one it is!!  Care of the most vulnerable is our society shows what type of society we are, or the BBC films shows what type of society we could become.  I am every day saddened and angered by this government and its lack of any humanity to those most in need.

  • ambrosian

    I’m always baffled that anyone who has dealt with the privatised utilities, phone companies, train companies, outsourced council tax collection, banks, etc would believe in the superior efficiency of the private sector.

    Perhaps one reason is that politicians delegate those frustrating hours that the rest of us spend on the phone to call centres to their secretaries, PAs or wives.

    I agree with Richard’s comment (!) that it was the Labour Government that privatised great chunks of the State sector. It’s now a bit late for Labour to start arguing that certain State responsibilities in the areas of social care, penal policy and employment support are incompatible with the profit motive, not that there’s any sign of them doing so.

    I was very shocked a few years ago to find that most children’s homes are now privately owned and run as commercial operations. If you have a spare million or two, you can buy a children’s home complete with its incumbent residents. The difference between its operating costs and the sums paid per child by the local authority is your profit, giving every incentive to minimise things like staffing costs and food costs. The same commercial imperative must apply to the care homes and private hospitals for those with learning difficulties currently in the news.
    As a Guardian writer says today, this has mostly happened beneath the public’s radar. And much of it happened during 10 years of New Labour. The last Government effectively dug the grave in which the Tories are only too happy to bury a publicly owned and operated welfare state.

  • MicheleB

    Southern Cross went plc about five years ago @ £2.20 per share.  They are now valued at 9p … yep, nine Ps ……
    That drop has not all happened in the last year.

    Inspection standards were changed and workloads increased (inspector staffing levels reduced) ….. last October. 
    That has.

  • Olli Issakainen

    It is totally unacceptable that the poor and most vulnerable should pay the price for the greed and incompetence of bankers and banks.
    This is morally wrong!
    Has the unstable, destructive capitalism proved that Marx was right?
    Handouts to banks and punitive cuts to social services appear to prove the point.
    And “working class” is growing around the world.
    Capitalism is inherently prone to crisis.
    Frankfurt school of critical theory was based on sociological and culture-theoretical works of Adorno, Horkheimer and Herbert Marcuse.
    The idea was to try to find out how ideology works, how ideological hegemony is established.
    In the US the “American Dream” of human fulfilment through consumption and wealth has exerted a pull on workers. But consumerism is banal.
    People in consumer capitalism are living in a state of permanent alienation. Excess, consumption and obsession with growth are not sustainable.
    The crisis is not only about bankers or politicians – but of all of us. Yes, it is a crisis of global economy, deepest for 80 years.
    But no alternative governing philosophy has replaced the now bankrupt neoliberalism.
    The state guaranteed full employment in the postwar social contract. The contract was embedded most firmly in the social democracies of northern Europe and social market economies of Germany etc.
    But things have changed. No full employment, living standards are falling and social protection is under threat.
    We need now moral economy instead of neoliberalism that states that unhindered rationally calculated pursuit of individual self interest in free competitive markets is economically efficient and also morally right.
    We are being told that the ultra-rich are morally entitled to their riches. They are the “wealth creators” who “add value”.
    The indifference to the greed of City bonus hunters is testimony to the hegemony of neoliberal moral vision.
    But now the neoliberal hegemony is over. It is not business as usual. We now face a new financial crisis.
    But we, people, are also part of the problem. Hyper-individualistic, materialistic hedonism of the entire culture is a problem.
    Global economy remains unbalanced. Financial sector is unreformed. The euro area is in problems. Oil prices are high and greenhouse gas emissions up.
    Vince Cable has mentioned the bad structural problems of British economy. North Sea oil is not helping as much as before.
    We still have the same MINDSET as before the financial crisis.
    Between 1917 and 1979 British wealth ceded some power, opportunity and money to the working classes. Now this is over.
    The rich and rightwing press talk about cheats, addicts and layabouts. They want to divert the attention from those above to those below.
    But benefit fraud is only £1.6bn. Fraud in finance industry is £3.6bn. Tax fraud is £15bn, tax avoidance £70bn.
    Tony Blair declared that we are all middle class – but we are not. There are 8 million people in manual jobs.
    Aspiration and social mobility are the useful mirage, as Polly Toynbee wrote in the Guardian. We are witnessing the demonisation of the working class.
    And those who created the “mess” are being left off the hook while they are planting the seeds for the next crash.
    When do we learn?  

  • Yonks

    Forget who was responsible for the mess; if the unions had co-operated a bit more perhaps it would still be run by the state.
    I have personal experience of my mother being pushed from pillar to post by privatised social care; you couldn’t blame the staff but the simple fact was their employer wanted to make money.
    It should not be in the private sector full stop!

  • MicheleB

    ………Were the abusers filmed by Panorama all appointed since the coalition was formed. I think not ……………..

    Lots of care workers are agency temps; I daresay plenty of them work properly when they are in residences with good management.  How their performances are assessed on a continuity basis is anyone’s guess.

    In the Q&A I listened to today a participant expressed concern about the 31,000 that, at worst, could become homeless.  Person representing the defence said that that could never ever happen.

    Now this man sounded older than me so I don’t know how he could make such a defence.  I remember what happened in the early 80s when not4profit homes were emptied and sold on, patients definitely were on the street.

    Very interesting discussion: the ‘golden years’ for people setting up private care homes were ’83-’85, the good times and easy money rolled on until ’95.

    I hope you remember which Tory Govt it was during those years that claimed it was putting right all that they had inherited?

    It was the same one that designed the irresistible double-tax relief pension plans that could only pay their way while the huge majority of  their members were working, not drawing.

  • MicheleB

    Care home privatisation took place throughout the 80s.

    Yes, by ’97 there was so little not4profit provision that Labour had to commission from the private sector; chicken and egg.

  • MicheleB

    Yep, I should read a full post before I reply to part of it. 

    However, re your point borrowed from the Guardian, I’m afraid they have got the dates wrong (or at least incomplete).

    I know for sure that by 2001 there were no public/not4profit children’s homes throughout Greater London (35 boroughs at that time).  I know that even then some bills were over £5k per week per child. 

    I learned that a lot of those homes were owned by people that had previously worked at council-owned properties, the closure of which in the previous two decades gave them two choices – work for other bosses or become providers themselves.

  • Gilliebc

    You are quite right Mark in what you say.  But, to me at least it begs the question, why is it that “the state” in this country are so bad at running anything?  I don’t know what it is like in other countries but in this country “the state” no matter what shade the government of the day, seem to make a complete hash of it.  From the little that I do know, they don’t seem able to keep control of their budgets and are largely seen as a soft-touch by over-spenders like the NHS.  I’m aware this is an over simplification of a very complex issue, because quite frankly I wouldn’t have a clue how to even begin sorting it out.
    Perhaps other countries are doing a better job? and maybe we could use some of their ideas and models?

  • ambrosian

    In fairness to the Guardian, they didn’t mention children’s homes at all.
    I accept that some children’s homes may have been run by people who had previously worked in the local authority sector and I’m sure the privatisation of such homes took place over a long period that pre-dated 1997.

    What shocked me when seen on TV once was that children’s homes are advertised for sale in specialist property publications and can be purchased as going concerns complete with residents. I know this also happens with nursing homes but it seems particularly offensive where young and often troubled children are concerned.

    And I bet that a poll would show that most of the public believe that all children’s homes are run by local authorities or government.

  • MicheleB

    I posted elsewhere Gillie about a discussion I heard (I seem to be like a sponge these days …..) between people for and against a state health service of any type anywhere …. it included discussion about the situation in America.

    Our PCTs, part of a humungous buyer like the NHS, were buying pacemakers from the American manufacturer at one fourteenth of what American hospitals pay. 

    Buying power matters, especially in an industry that is forever evolving and offering new products whose development costs have to be amortised very very quickly to bring down prices.

    I don’t agree that state provision is bad by default.  The leaps and bounds achieved, albeit with some compromises having to be made (like renting from private sector builders) and despite the kicking and screaming by GPs and other Hippocratic Oath owners (initially against Mr Milburn’s methods) have been mind boggling.

    Same for schools and their equipment and application just of some sheer common sense ….. but that’s a whole ‘nother story.


  • DM

    I liked your post Ambrosian, but I have a slightly different take on some aspects of what has happened.  The narrative that the Tories are keen to promote at every opportunity is that the public sector are the problem, while the private sector are the solution.  In my opinion, there is the public sector carrying the nations risk, and the greedy sector aiming to take the profit.  Unfortunately, I still believe there is a way to go before the true failure of the grand experiment of privatisation is shown to have been far worse for the nation than some high profile collapses have yet revealed.  Rail Track is but one example, the banks being ‘too important to fail’ is another and perhaps now social care is the latest nightmare coming home to roost.  I wonder where the next place will be where we see the money being quickly creamed off, before a carcase is discarded and the public sector then being expected to put humpty dumpty back together again – GP consortia perhaps?.  For the NHS, Tory plans mean packaging up profitable bits for their buddies and leaving the unsexy bits to flounder and be blamed on the public sector.  It amounts to little more than privatising profit and nationalising risk.  Labour needs to get a grip and quickly and robustly address this. 
    If large parts of privatised social care start to go belly up, will Cameron or Osborne blame fats cats, bloated structures and inflexibility in the greedy sector?  No, I very much doubt it.  Somehow, they will probably switch to their default setting and try to blame the public sector.  They’ll quietly prompt a pet, (and supposedly ‘independent’) body to pipe up and “set the record straight”.  We may for example be told by their lobbyists, (who laughingly refer to themselves as a ‘think tank’ e.g. ‘the Policy Exchange’) that some stats clearly show that blame lies with the public sector.  Still, it must really annoy the Tories to know that large swathes of their beloved greedy sector will always ultimately be beholden to the public sector, because when the crunch comes, the nation still needs to grind on, and bailing out those bits which make up our national infrastructure will mean nationalisation and the public sector making up for where the greedy have once again run out of things to screw up. 

  • MicheleB

    I think you’re using an emotive interpretation with your ‘complete with residents’.

    It doesn’t mean actual individuals, it’s about capacity.

    *** forbid that any home should think for a single moment that its residents are individual permanent fixtures; they’re hopefully each there n a temporary basis and for no longer than essential.

    Sorry if I’m misunderstanding you on that point, re the one about there being no room for the profit motive, absobloodylutely 🙂  Every penny being spent should be on input (and as little medication as possible).

  • “Lots of care workers are agency temps”….spot on!, and of course it is difficult to build a caring relationship with a carer who is here one minute and gone the next. I found the night carers to be the most mobile and the most uncaring!

  • Susie246

    I don’t agree that the state are necessarily bad at running any service. It’s that thing that good systems ‘disappear’ when things are running smoothly, and you only get media interest when things go wrong.

  • ambrosian

    Yes, it does mean actual individuals. The documentary I saw several years ago showed homes changing ownership with some of the same children in them……………they don’t empty, close and then re-open. In the same way, my grandmother’s nursing home changed owners while she was there.

    Of course, the residents may be totally unaware of the change in ownership and most of the staff may remain in place.
    Maybe, I’m being over-sensitive about this. But I dislike the idea of someone with sufficient capital saying “this looks a good investment, let’s buy this children’s home that’s for sale.”
    Hope potential buyers have CRB checks, by the way!

  • ambrosian

    Agree with everything you say.

  • Robert

    Supervision and inspection are always going to be minimised or kept under pressure:

    They cost in terms of the inspector’s salaries – dead money spent.

    They cost in terms of the recommendations that show improvements are required (which cost money).

    They are lose lose in a wholly cost driven business.

    (As opposed to external consultants who are paid to tell the shareholders and the board what the executive management want to do anyway – so it’s OK to pay them lots of cash – they help in the power play.)

  • Chris lancashire

    Presumably Cameron needs to apply the same intellectual rigour on social care as Mr Blair did on the economy and foreign wars.

  • MicheleB

    More here about the ways that the much-vaunted higher investment is being targeted (some of it ‘disgracefully unethical’ according to BMA)


  • MicheleB

    Another snippet about Southern Cross.

    When they went plc about five years ago @ £2.20 per share they owned the properties their clients were housed in.  Those properties have subsequently been sold and stayed open by being rented back (and as we know that rent is not being paid).  I;d imagine there was an agreement for the leasebacks before the sale.   The reporter said there is no info/record yet of who decided to sell (which sounds as if it wasn’t mooted to shareholders).  Shares yesterday were at 9p; it would be worth hearing if the capital from the sales had been ploughed in to patient care but I rather doubt it.

  • MicheleB

    He’d better get off to Boot’s then and look for the vitamins labelled ‘Intellectual Rigour’.

  • Ehtch

    It is unfortunate that some of those that end up in caring work at such places, are unsuitable really, but maybe had to take up the usual low paid job, or not get any benefit. Suppose the average jobcentre would just be glad to get another one off their books, no matter what. The system is all to cock, in that way.

  • Hey,nice post.well written article.I will appreciate your writing skills.Its great.There are no doubt plenty of good people providing good social care in
    the private sector. But politically, this has a bad feel to it, and will
    require very careful political handling.

  • New Mexico. Since 2004, NHI has instituted

  • Loquitir

    It might be something to do with the fact that the Cabinet probably all have private medical insurance. That’s not unusual a lot of labour party members do to like myself. It’s life insurance policy you need under a Tory government.

    I grew up in Scotland under the Thatcher and Major governments and witnessed family members die prematurely from heart problems, cancer and other problem through poor access to health care following the cuts and under funding of 4 Tory governments. I thought when I am 18 I need to get private health care which I did and never used until 1999 when I needed heart surgery and intensive support. Tony Blair promised physicians they get more help in terms of doctors, nurses and technology. He delivered progressive change and it was impressive.

    That increase in care standard is now eroding fast since May 2010.

    There is real concern. Hospitals are under strain, under invested, waiting times are going up and access to technology is being denied.

    Private insurance is essential again because the NHS is being asset stripped against by the VCs (vulture cabinet) – venture capitalists. The asset portfolio is being opened up to cherry picking to increase wealth of private medical and venture capitalist companies in the interest of boosting political relationships and private profit.

    If your in the cabinet why would you be concerned about the community interest in the health of population and reshaping NHS in the public good when you have no personal dependency on the NHS for your or your family’s security of health. You can’t show empathy with people who need this basic security when the Tory party’s purpose is to promote the interests of business and not to have a constitution firmly anchored in the community interest. Health is not a profit industry and competition should have no part in the NHS.

    People have started dying again because of these free Market policies and nobody seems to want stop it.

  • Having a health care insurance can be our way to secure our health needs just in case we need it. It would be a big advantage for us to have this kind of insurance.