Care: industrial scale or cottage industry?

There are, we are often reminded, 30,000 residents in Southern Cross’s care homes. There is an argument about to what extent it would affect those residents if Southern Cross’s approach to funding its expansion, which relied heavily upon property speculation during the boom, ultimately led to its demise as a company.

Some people say it wouldn’t make any difference to residents – if a care home is viable it will simply be sold on to another provider. The Association of Directors of Adult Social Services have emphasised the need for councils to continue sending residents to Southern Cross homes to keep the company afloat.

But if it makes no difference to residents whether or not the company stays afloat, then why does it matter if it continues to have enough ‘customers’? Whereas, if Southern Cross going bankrupt will make a difference to them, then it cannot be in an individual’s interests to be “sent” to one of their homes. 

Individuals are not commodities, to be traded by councils and care providers, even in the interests of what might be considered the greater good. Councils are under an obligation to individually assess older people and to support them to make the best choices about care for them. A blanket recommendation to push people towards a care provider which may not be able to offer stability is unacceptable.

I think it’s hard to maintain the argument that residents have nothing to fear from Southern Cross going bankrupt. In order to attempt to stay afloat, the company has just cut 3,000 front line caring jobs. In other words, here we have yet another situation in which rash decisions made in order to maximise profits result in negative consequences for people who had no part in those decisions. It was of course, those residents’ money (or in the case of those whose care was state-funded, taxpayers’ money), which was hived off in the good years into the pockets of bosses and shareholders.

The Southern Cross crisis, coupled with the Winterbourne abuse scandal uncovered by BBC’s Panorama, should initiate a pause for thought about the relative risks and benefits of industrial scale care and support. Is it right for a company to be able to take risks with people’s homes? Courts have established that if you live in any care setting for an extended period of time and come to consider it your home, then you have Human Rights Act protection to your private and family life. This means, for instance, that you can’t be moved against your will, simply to save money. Can those rights really be protected if Southern Cross goes under?

There is huge potential for expanding the capacity of lower-risk (and often cheaper and more effective) small-scale solutions, such as Shared Lives, in which an older or disabled person visits or even moves in with one of the UK’s 10,000 Shared Lives carers. Small-scale approaches are not without any risk, but by their nature, their risks do not affect 30,000 people at once.  

The counter-argument is that small scale approaches can never hope to replace care on the vast scale of Southern Cross. But many of the homes owned by large providers started out as part of small care businesses. Large providers don’t grow entirely by creating new provision. In many cases, they simply create new profit margins through gobbling up small providers. Perhaps residents would benefit from Southern Cross being broken up again, rather than simply transferred to another set of shareholders? The government could follow its own Big Society principles by helping residents and families to buy out small groups of homes.

Regardless of scale, introducing mutuality into the care sector would change the status of residents and families. Would Southern Cross have followed such a high risk model, and would it have then cut 3,000 caring jobs to reduce its costs, if a proportion of its 30,000 residents and their families had gathered together into an effective user group? If residential care costs at least £20,000 a year, then those residents together spend around £600m annually. What else could they have bought with that money, if they had been able to form a mutually owned organisation, without the need to produce profits for shareholders? Could they, for instance, have built up a business which they jointly owned and controlled, rather than one in which they had no more say than the customers of a supermarket chain?

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