Private care homes' pursuit of profit is letting vulnerable people down. Any ‘National Care Service' should ensure homes are council run – Ross McKenzie
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In June of 2021, when news broke of plans to close five council-run care homes in Edinburgh, I saw the move in the context of a long story of creeping private sector dominance of long-term care. Four of those homes remain open thanks to a brilliant campaign from trade unions and campaigners, but one was closed: Drumbrae care home, the council’s most modern home, sits in a moribund state well over a year after it was shut.
The decision to close it was made in spite of clear evidence that such facilities are vital for the care of an increasing number of people who suffer from dementia in the city, but the building was wanted by the NHS, and it was assumed that private companies could pick up the slack.
From 1946 to 1979, responsibility for funding and providing long-term care was shared by the NHS and councils. Over a period of 40 years now, this responsibility has been almost entirely removed from the public sector and is now dominated by multinational corporations. In Edinburgh, over 70 per cent of long-term care provision comes from the private, profit-making sector.
I have worked as a carer and a staff nurse across the private, public and third sectors for over 20 years, and have seen a pattern of practice and culture in private care homes that leads me to believe that the pursuit of profit is not compatible with the delivery of decent care.
Profit margins have always been tight in care homes, which depend on the use of casual, non-unionised labour, with its corollaries of low wages, zero-hour contracts, agency staff and the absence of sick pay or training opportunities. The link between the pay, conditions and stability of the workforce, and the quality of the care provided, is clear to anyone who has worked in care or received care.
In 2012, I was working as a staff nurse in a care home run by a charity. At that time, the home had a stable workforce, with relatively decent pay, conditions and training opportunities. But when the money received for publicly funded residents was reduced in that year’s brutal round of Tory/Lib Dem austerity, the management changed approach rapidly.
Staff weren’t replaced, and instead there was an increasing reliance on agency workers. Residents who had been used to building relationships with their carers over time, found themselves receiving personal care from a different person each day. That is to say, it started operating like a private care home.
A further decade of austerity cuts has hit standards across all sectors, and for the large private sector operators, providing poor care with underpaid staff is no longer enough to guarantee profit. Increasingly, they have turned to complex and risky property investments to make short-term gains, leaving residents vulnerable to eviction.
Council-owned homes like Drumbrae were built to protect at least some people from the vagaries of the free market. The council should re-open it for that purpose as soon as possible, and any ‘National Care Service’ worth its name will take the same approach to long-term care.