It’s many years since my granny passed away. She’d spent her latter years in Stornoway, initially in sheltered accommodation at Kirk Care and then, when frailer, at the Bethesda Hospice. Similarly, my mother was briefly in supported accommodation with Bield before life lost its allure and she sadly faded away. The care though in all those residences was exemplary and they were all run by not-for-profit organisations.
Since then society has aged considerably, increasing both the numbers involved and the special needs of many. Demand for supported accommodation and care homes has therefore increased and, of course, where there’s a market, there comes the private sector. It has even been driven by government policy but it’s also been necessary as public and third sector care was all too often unavailable or at a considerable distance from home or family.
I’ve been in many care homes visiting as the constituency representative or meeting elderly friends or relatives. All, irrespective of ownership, I’ve found well run and staff remarkably attentive. You’d expect no less as the Care Commission has invariably been diligent and don’t hesitate to act if they’ve concerns.
But coronavirus has brought care homes into the spotlight. Something has gone tragically wrong as the mounting death toll testifies to. There’ll have to be a review, if not an inquiry. Lessons need to be learned, as the families are also entitled to no less. That though is a separate issue.
Ownership of care homes is also coming into question. Just who should run them and for what purpose, requires to be considered. The state, through financial pressures, has walked away from the service over recent years, ending up as the funder of a largely privately delivered service. As with some other critical public services, that raises problems.
The first difficulty, as indeed we’ve seen with privatised railways, is that the state ends up as the operator of last resort. If a train company isn’t making enough cash and doesn’t fancy continuing the service, then they walk away handing back the keys. The Government has then to move in as we’ve seen on the East Coast Main Line.
In some ways that’s mirrored in the care sector. Premises have been closed down in Scotland over the years, though thankfully just a few, and down south operators have shut saying they’re making insufficient profit to keep going. Who then takes over but the state, having to find accommodation and pay for it, as well as no doubt facing bed-blocking in the NHS.
Staff are also fundamental to the health and welfare of the care sector as we’re tragically finding with deaths of carers, along with residents. Legislative requirements and the demands of the Care Commission mean that standards of service are uniform irrespective of ownership or structure.
What that means, however, is that whether you’re for-profit or not, the only real variables are the pay and conditions of staff. Accommodation and supplies can maybe be tweaked through global supply chains but overall it’s marginal. The profit, given that there’s a set rate being paid by the local authority for most residents, can only come through a reduction in staff costs.
It’s the same with private prisons. The infrastructure and maintenance costs are pretty standard, but you can lower wages in the private sector. That’s why few leave the Scottish Prison Service to work for private operators.
In the care sector, local authorities have been trying to meet the living wage for employees. Many of the not-for-profit organisations have been likewise. That hadn’t always been the case across the private sector where pay historically was lower and even during this crisis conditions have often been poorer.
Hopefully, the lessons learned specifically from any review and more generally from this crisis will include the need to pay carers a decent wage. They’re entitled to no less. That needs though to be enforced across the sector and to become mandatory and uniform. It will have to be recognised in the rate paid by the council for the care provided.
But if that means that the private sector in some instances chooses to walk away, then so be it. Take them over and either have councils or preferably not-for-profit agencies run them. It needn’t be about nationalisation as there’ll still be room for those that wish to operate and, maybe as with education, they’ll do so for a few either able and prepared to pay more, or deliver in a specialist area.
This crisis has shown the necessity for state intervention. Let that apply in the care sector not just in ensuring decent pay and conditions for staff but in operating for the public good not private profit.
Kenny MacAskill is SNP MP for East Lothian