Before 1990, healthcare in the United Kingdom was provided by health authorities which were given a budget to run hospitals and community health services in their area. The National Health Service and Community Care Act 1990 introduced an internal market into the supply of healthcare in the United Kingdom, making the state an ‘enabler’ rather than a supplier of health and social care provision.
Care homes were then outsourced by local authorities to the private sector which employed large numbers of low-paid workers with weak representation by unions and professional organisations. Spending on social care is now below 2010 levels.
Gill Plimmer describes the way in which global private equity, sovereign wealth and hedge funds have piled into the sector in the past three decades, lured by the promise of a steady government income and the long-term demographics of Britain’s ageing population.
Three of the biggest chains — HC-One, Four Seasons and Care UK — are in the hands of buyout groups.
At the Four Seasons Whitchurch Care Home in Bristol (above), emergency buzzers went unanswered, some medicines were not dispensed and many of its frail and elderly residents had not been given a bath, shower or a wash for a month, an official inspector’s report found. A broken elevator meant residents on the second floor could not be taken to hospital appointments.
Problems are in part a result of:
- a long-term decline in fees paid to providers for social care,
- a state mandated rise in the minimum wage,
- a decline in state funding for local governments, which pay for 60% of their residents,
- short term investment and speculation,
- larger private equity-owned care homeowners have a short-term investment focus and complex structures, involving scores of subsidiary companies, many of which are listed offshore and
- the money to fund the trading coming from taxpayers or from middle class people running down their savings.
When Terra Firma (building better businesses) bought the Four Seasons chain in a £825m deal in 2012, there was still £780m of outstanding borrowings hanging over the business. Now around £1.2bn of interest-bearing debt and loans from unspecified “related” parties.
Nick Hood, analyst at Opus Restructuring & Insolvency, which has advised several care home chains, said “owners are playing with the debt and expecting returns of 12 or 14 per cent and that is simply unsuitable for businesses with heavy social responsibilities”
He adds that the watchdog — the Care Quality Commission — should require the entire corporate structure to be held within the UK
Jon Moulton, the private equity veteran who ran Four Seasons in the early 2000s recommends that care home chains should hold a certain amount of capital, just as banks are requited to do by the Financial Conduct Authority.
Toothless regulator/watchdog places all responsibility on Britain’s cash-strapped local authorities
Kate Terroni, chief inspector of adult social care at the CQC, says that for now it has no authority to introduce minimum capital requirements or to intervene to prevent business failure. “Our powers are to provide a notification to assist local authorities who are responsible for ensuring continuity of peoples care
Meanwhile, as Four Seasons “hurtles towards insolvency”, directors are paid lavishly and their care homes continue to close.
Recently Lesley Docksey sent this heartfelt reflection:
“The trouble is we know the problem, and it’s all very well George and Seamas saying we have to ban this, get rid of that and set up something else.
“But how do we actually do it, how do we the people force a break between the corporate power and politicians?”
Despite the poor record of service by the private sector in prisons, transport, energy and water, British schools and hospitals are loudly threatened with takeover, a slavish imitation of our special friend’s policies for schools and hospitals.
Anne sent this link to an article by Jon Stone about the fire hazard and other structural failings of Cumberland Infirmary in Carlisle, first opened in 2000 under the “private finance initiative”, under which the NHS pays a private company rent-like payments to make use of facilities. The UK now owes more than £222bn to banks and corporations for these Private Finance Initiatives, conceived by Conservatives in the 1990s and ‘embraced’ by New Labour.
Will this hospital be handed over to ‘the state’? In other words, farmed out to Capita, G4S or Serco?
In the FT, Gill Plimmer reported that the Official Journal of the European Union database, which records every public sector contract worth more than £115m, reveals that £20bn worth of government contracts is now handed to the private sector. About half of council waste management services and 23% of human resources, IT and payroll functions are now privatised. Tens of thousands of health, defence, security and IT workers have transferred to corporate employers such as Babcock, G4S, Serco, Capia, Mitie and Carillion. This continues, even though the reputation of the private sector in delivering public services has been repeatedly damaged – examples include the high profile failure of G4S during the Olympics and the legal action facing Virgin Care over its running of NHS and social care services in Devon. Monbiot’s devastating, fully referenced account of such failures may be read here and others have been written by Gill Plimmer in the Financial Times.
As all these services are transferred via the state into corporate care, the cities themselves are being coerced to follow the mayoral route – which, as Steve Beauchampé notes in the Birmingham Press -was soundly rejected by voters in Birmingham, Coventry and seven other cities.
Did Liverpool – which held no referendum – make the right choice?
Chancellor Osborne is insisting that powers must be devolved through the office of a regional mayor – so much easier to induce or threaten than a whole council – a puppet?
As economic geographer, Professor Michael Chisholm summarised the position more politely, “One could cynically say that the proposal for elected mayors is yet another structural diversion while the steady centralisation of power continues”.
Beauchampé proposes consigning this ‘mayoral hokum’ to its rightful place in the dustbin of history, rejecting the notion that in a democracy just one person can understand, represent and address people’s priorities, needs and hopes, creating and implementing a vision for our fast changing region and its youthful population. He sets out a ‘radical’ – because truly democratic – alternative as a draft proposal.
But, as Lesley asks, “how do we the people force the break between the corporate power and politicians?”
Proportional representation could be the first step.
G4S, Serco, Capita and the like have been flourishing – but is the friendly government worm turning?
Gill Plimmer reports that the Official Journal of the European Union database, which records every public sector contract worth more than £115m, reveals that £20bn worth of government contracts is now handed to the private sector.
About half of council waste management services and 23% of human resources, IT and payroll functions are now privatised. Tens of thousands of health, defence, security and IT workers have transferred to corporate employers such as Babcock, G4S, Serco, Capita, Mitie and Carillion.
The process continues, even though the reputation of the private sector in delivering public services has been repeatedly damaged – recent examples include the high profile failure of G4S during the Olympics and the legal action facing Virgin Care over its running of NHS and social care services in Devon.
In an earlier article, Plimmer notes that government has shaken the private sector companies by deciding to keep four out of nine prisons, due to be outsourced, in state hands because providers did not give ‘best value for money’; confidence has been further shaken by the decision that G4S will have to relinquish its Yorkshire prison contract because of inefficiency.
Read the full article here.