Social Care Services

Debate between David Anderson and Anne Marie Morris

Tuesday 17th May 2011 Westminster Hall

[Mr Anderson]

The privatisation of home care services in this country has been a complete failure and a nightmare. I have represented home care workers for many years and have seen the service deteriorate. We had a dedicated work force who had a set list of clients whom they went to see day in, day out. They built a relationship with that person and their family. When those jobs were contracted out, it was said, “We will send worker A on this day and worker B on that day.” The home care worker lost that direct link with not just the family but the wider team within the authority. That team would work together and take a holistic view and work better for the person concerned. It is clear that services are being contracted out to save money. If we save money, services will not be as good.

It is clear that we will see problems being stored up if we lose public sector capacity in home care services. At the moment, some 31,000 residents are being taken care of by Southern Cross Healthcare. Their homes now hang in the balance as a result of reckless business practices and local commissioning, which has allowed the organisation to become so dominant in the market. Southern Cross and Four Seasons—the big two in residential care—have operated casino-style finances, and both are now teetering on the brink of collapse. A toxic cloud, formed by irresponsible borrowing, weakening demand, council cuts, the slump in care home property values and the collapse of favourable credit facilities, now hangs over the heads of frail elderly people and their families at a time of insecurity and when they need real security.

How has it come to this? How has RBS, a state-owned bank, become the biggest shareholder in Four Seasons in exchange for writing off debts of £300 million? Would taxpayers’ money not be better spent directly on care homes run by democratically accountable councils, rather than being tied up in byzantine financing arrangements?

Across the social care market, research by Community Care suggests that one in five providers expect to go out of business in the next financial year. The regulator describes the home care market as a cottage industry of small, often barely viable providers alongside a few giants such as Care UK, whose chairman kindly provided £21,000 to fund the personal office of the Secretary of State for Health—perhaps that is one reason Care UK is doing so well.

If Southern Cross, Four Seasons or indeed local providers collapse, how will local authorities find new homes for people when they no longer run them? When home care providers default, as they often have and might in future, how will local authorities fill the gap if they have scrapped their own home care teams, which is happening up and down the country?

What about the quality? Care Quality Commission data show that privately provided care services are less likely to be rated “good” or “excellent” and five times more likely to be rated “poor”. I know that the Government do not like targets or standards, but when their own commission is saying such things its message should be listened to. Private providers consistently score lower on a range of indicators of quality and safety. When we look at the employment practices of some providers, we cannot be surprised that home care workers do not stay in their job. They are not paid for their travel time between visits, and they have to provide their own mobile phones and pay for their uniforms. They suffer from underpayments; they often have zero-hour contracts; and they sometimes have to pay towards the cost of administering their own time sheets. No wonder people do not see it as a job for the future or a career that it is worth investing their time and talents in. We need real regulation of employers to stamp out employment practices that have impacted so badly on home care users and, through them, on staff.

Where are we today? We have a Government who want more from staff for less; who want more work by fewer staff, because they are making 500,000 public sector workers unemployed; who want more pension contributions from less pay and for poorer pension provision; and who want people to spend more time at work by making, in particular, women work until they are 66 years old, with less time at home and in retirement.

What did we get last week? The Chancellor has a new red tape initiative. What is he going to do when people are losing their jobs? If there is a chance of redundancies being managed sensibly, what does he talk about? He wants more chances of people being sacked, with less chance of real support by limiting the time to consult. People will have more chance of being made redundant and less legal support to challenge decisions taken by their employer.

The CQC sees a vacuum in regulation and in the checking of safety and quality of care. The CQC’s risk-based approach is resulting in a dramatic drop in inspections. A freedom of information request by Community Care found a 70% drop in CQC site inspections in the past year alone, at a time when more people are in need of care.

[Anne Marie Morris]

I thank the hon. Gentleman for being so generous in giving way. The statistics are interesting, but care homes in my constituency of Newton Abbot complain that more visits are being made. I spoke to the CQC just this week and it said that it was making on-site visits to every home within its purview in the south-west. There might be a regional difference, but in the south-west, where there are a huge number of elderly people, the number of visits is going up, not down.

[Mr Anderson]

I thank the hon. Lady for that. More inspections are good: we want inspections that work; otherwise, we will get into the problems that my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) mentioned.

Staff and service users fear that there is an over-reliance on provider self-assessment and secondary sources rather than direct inspections. There are fewer indicators and data sources for adult social care providers than there are for NHS providers, yet the methodology is common. Alongside a “lighter touch” approach from the regulator, local authorities are cutting quality assurance departments, which, as Community Care showed, means fewer local checks on the quality and safety of care being provided.

Some of the changes that the unions and workers at the CQC would like to see, which I agree require serious and urgent consideration, include reinstating and strengthening the requirements on the types of incidents and issues that must be reported to the regulator. These should again include medication errors, significant injuries, accident and emergency admissions, safeguarding referrals, matters where staff are subject to disciplinary action or dismissal and unusually high staff turnover. Those are all indicators of things that might be going wrong, but they are not being recorded as they should be. A minimum frequency should be set for how often a service is visited.

I have no doubt that the hon. Member for Newton Abbot (Anne Marie Morris) is correct about the experience in the south-west, but it should be replicated across the country because it would give people greater confidence that things were being done properly. There should be a greater range of tools so that service users and employees can make their concerns known to people who can affect outcomes. We want to encourage people who want to blow the whistle where necessary, and give people whose relatives are in care confidence that, if they make a genuine complaint, the care will not be reduced.

I hope the Minister will look at my points, provide answers on the failures of private adult social care providers and say whether anything can be done to make the CQC more representative. For years, adult social services have been regarded as the Cinderella service, which is a disgrace. People are in care not because they want to be but because they have to be, so I hope we will work together to try to make adult social care something this country can be proud of.