The Scandal of Care

If a country is judged by the quality of care it gives its older and more vulnerable citizens, then the UK is not scoring well.

Back in February this year a report from the NHS ombudsman, Ann Abraham, sounded a warning that the NHS is failing the elderly, with 18 per cent of complaints reaching her being about care.

The cases cited included failures in providing clean, comfortable surroundings, assistance with eating, adequate pain control, efficient discharge arrangements or communication with patients and their relatives.

Half those mentioned had not consumed adequate food or water during their stay in hospital, and there were examples among the more elderly of people left unwashed and in soiled clothing.

One elderly woman, transferred by ambulance from a hospital in Birmingham to a care home at Tyneside, arrived ‘strapped to a stretcher’, soaked in urine, dressed in clothes that were not hers, and accompanied by bags of laundry, much of which was not hers either.

It seems unimaginable that such things can happen in our country today.

They indicate a staff that’s either inadequately trained, unsuitable for the job, trying to work under impossible pressures or made indifferent and callous by their circumstances.

Depressingly, there is nothing new about this; and nothing new either about the apparent failures to learn from the past.

‘Underlying such acts of carelessness and neglect is a casual indifference to the dignity and welfare of older patients,’ said Ms Abraham.  ‘That this should happen anywhere must cause concern – that it should take place in a setting intended to deliver care is indefensible.’

As we all know, we are living longer and the numbers of us in need of specialised geriatric care is only going to rise in the future. We may wish for a fit and productive old age, but whether or not we achieve it is beyond our control.

There is, therefore, an urgent need to address these issues and the related one of what the age charities see as a negative attitude to the old that stretches right across society.

It is something that must and will change as people remain active for longer.

Simon Bottery of the charity Independent Age told Channel 4 News that there is ‘definitely a wider issue about how we treat older people’; they tend to be seen as ‘having passed their point of use’ in a society ‘obsessed with being young and appearing young …  People are often really surprised to discover that old people are happier. The statistics show that we are most miserable at age 46’.

A situation unlikely to add to the happiness, security or serenity of its elderly residents is the one at present beleaguering Southern Cross, the giant care-home provider, of which we will hear much more as this summer progresses.

Southern Cross operates 753 care homes across the country, containing 31,000 residents, and is now in turmoil. The way this has happened is an abject lesson in how not to go about providing a secure future for a growing elderly population.

One of the cornerstones of monetarist theory since the days of Mrs Thatcher has been that the private sector can manage these things perfectly efficiently without government interference.

We therefore have the right to ask how the situation has become so unravelled in this case.

Southern Cross has traced a root cause back to the time, five years ago, when it was owned by Blackstone, a private equity group, which saw the chance of a rich lode of ore to be mined through a sale-and-leaseback model, by which private landlords bought leaseholds on the care homes and then received rent from Southern Cross as the administrator.

Blackstone has naturally denied any responsibility for what has happened subsequently, and claims it left the company in a healthy working state.

Nevertheless, it walked away from the sale with profits of over £1 billion and laid itself open to accusations of operating as an asset-stripper.

Whatever the rights or wrongs involved, the weakness in the assumptions has been exposed by recession and cut-backs. To save on expenditure, local authorities have slowed down on their rate of referrals to care homes and have instead strengthened the policy of keeping the elderly in their own homes and familiar surroundings for as long as possible.

This is a desirable policy in itself, but the consequences for Southern Cross have been a lowering of income at a time when the costs of utilities have been rising  sharply and there are dramatic losses in the value of their shares on the Stock Exchange.

The shadow of insolvency looms for Southern Cross as they attempt to retrench by renegotiating rents to landlords, meanwhile withholding 30 per cent of rents due and putting in place plans to sell off 200 of their homes.

If Southern Cross fails to save its core situation and goes down, it is likely to take several of its landlords with it, unleashing the spectre of many care homes not only being sold on the open market but actually being closed, with all the consequent uncertainty for their residents and staff.

The City can only comment that all would have been well if it hadn’t been for the recession, which no one could have foreseen. One looks in vain for words of regret or compassion for the anxieties and fear of disruption in the lives of many hundreds of senior citizens, whose first priority in their well-being is to feel settled and unthreatened.

Everything in the vocabulary of the City pundits has to do with the market, leaving no space for any discussion of moral values.

The fact of the matter is that all this has been taking place against a background where the regulation of care homes is practically non-existent.

As Dr Ros Altmann of Saga forcefully told Channel 4 News recently: ‘It’s like the banks. There is nothing to put in place should Southern Cross fail. There is no mechanism for the care sector. I would argue that it’s even more important to regulate the care sector than the banking sector. We urgently need a mechanism to rescue failed homes.’

We also need to consider the proportion of our GDP that we devote to our pensioners, research having revealed that we spend less on their social care than almost any other European country. In the league table we are 17th with 5.8 per cent, while Italy and France stand at the top of the table, both contributing over 11 per cent.

This in itself is a matter for national shame.

Vince Cable should have it in mind during any investigation he conducts into the private equity ownership of public service providers. Certainly something has to change.

George Soros, the American economic guru and philanthropist, makes a strong point in The New York Review’s current issue where he writes on the free market v. government control debate: ‘We must come to terms with the fact that we live in an inherently imperfect society in which both market and government regulations are bound to fall short of perfection. The task is to reduce the imperfections and make both private enterprise and government work better.’

Mr Soros is writing about the present situation in the USA, where hard-line Republican conservatives disingenuously seek to shift the whole blame for the current breakdown in the economy on to government.

But his words have relevance for us here in the UK as well.

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