Care Home census data reveals 'increasing dominance' of the private sector 6

Care Home census data reveals ‘increasing dominance’ of the private sector

Three out of every four care home places are now provided by private companies, according to new data which reveals the growing privatisation of care.

The new figures, published by Public Health Scotland, show the gradual growth in private care homes over the last decade. 

The number of residents in care homes for older people run by local authorities and health boards has fallen by 1,269 in ten years, a drop of 29 per cent. 

In care homes for older people specifically, the private sector increased from 69 per cent in 2011 to 75 per cent in 2021.

Commentators said there were many reasons to be concerned about this growing trend, arguing that it could impact on the quality of care available for older and vulnerable people. Unions claimed it fed a “race to the bottom” culture in terms of pay and conditions.

In total the private sector now provides 78 per cent of all registered places in care homes – an increase from 74 per cent in 2011.

Meanwhile, local authorities and health boards now provide 10 per cent of care places, down from 12 per cent 10 years ago. Not-for-profits provide 11 per cent of places, according to the statistics, a drop from 14 per cent a decade ago.

The total number of care home residents in Scotland also decreased by 4,158 to 40,632. This included a reduction of 1,391 (five per cent) in the private sector, 1,359 (25%) in not-for-profit organisations and 1,408 (31%) in local authority/health board run care homes.

We know that a large majority of standards failures during the pandemic have been in private care homes and that there has been a race to the bottom in terms of pay and employment conditions.  

Roz Foyer, general secretary of the STUC

Nick Kempe, former head of services for older people at Glasgow City Council, told The Ferret there are “a number of reasons to be very concerned about the increasing dominance of the private sector in the care home ‘market’.”

He explained: “The greater loss of local authority and voluntary sector care home places means there are now fewer care home staff who are properly paid and trained. That has implications for standards of care, where we know that the private sector performs worse than the voluntary and public sectors.”

In a damning report  – published by the Common Weal think-tank  – Kemp laid out a number of concerns about the governance and regulatory failures during the care homes crisis at the beginning of the pandemic.

Kempe called on the Scottish Government to establish a National Care Service which is “not-for-profit” as this is “the only way we will stop money leaking out of the care system”.

Two-thirds of residents in private sector run care homes are at least partly funded by local authority cash. The amount councils are paying private companies for care home places has increased by more than inflation since 2015, according to the new census data. 

“As the quality of care reduces, we are paying more for it because as the relative strength of the private sector increases, so does its bargaining power,” he added. “Unless fees are controlled and there is a clampdown on unfair contracts, the Scottish Government’s current proposals to increase the rates of free personal and nursing care to self-funders will simply enable private providers to increase their charges even further.”

Quality of private sector care

The quality of private sector care provision has faced scrutiny since the Covid-19 care home crisis. One privately owned care home, Home Farm on the Isle of Skye, was bought out by NHS Highlands for £900,000 after the owner, HC-One, had its licence revoked. It had repeatedly failed Care Inspectorate inspections and received a damning report from the regulator which revealed repeated management failures. Ten residents died from a Covid-19 outbreak at Home Farm in between April and May 2020.

Care home outbreaks have been linked directly to larger care homes, with private providers operating much larger care homes than average. HC-One – which remains the largest private provider of care homes in Scotland and the UK, with 55 care homes still in operation in Scotland – averages 50 beds compared to a UK-wide sector average of 36. Chronic low pay among the predominantly female workforce has also been blamed.

The latest data from the Care Inspectorate on quality of care across all care homes shows the private sector is consistently rated below the sector average in Scotland.

 ‘Unsatisfactory’‘Weak’Adequate’‘Good, very good, or excellent’
Private sector0.3%2.8%13.7%83.2%
Local authority0.1%1.0%8.9%90.1%
Health Board0.0%4.3%17.4%78.3%
Not-for-profit0.1%1.8%9.8%88.3%
Sector average0.2%2.2%11.8%85.8%

National Care Service

Initially, the Scottish Government’s plan to introduce a National Care Service before the end of this parliamentary term appeared to be related to concerns about the role of the private sector in the care homes crisis. Since then, the Scottish Government has continued to compare the National Care Service with the creation of the NHS, but plans have focused on changing the system for commissioning care provision, rather than the ownership of the sector. 

The independent Feeley Review, led by former NHS chief executive Derek Feeley and published in February 2021, opposed the idea of nationalising social care, arguing that it would not necessarily improve the quality of care provision, and would be costly and time-consuming to deliver. Feeley recommended that the National Care Service should procure services “from local authorities and third and independent sector providers.”

The public consultation on the National Care Service finished on 2 November, with the analysis of the consultation set to be published in the first quarter of 2022. The Scottish Government has faced criticism from the Scottish Trades Union Congress (STUC) for commissioning the accounting giant PriceWaterHouseCoopers (PwC) to conduct the analysis of the consultation, after PwC was also commissioned in October to work on the design of the National Care Service.

Speaking to The Ferret, Roz Foyer, general secretary of the STUC, said that the new census data reinforces the “major concern” of Scottish trade unions “when it comes to the design of a new service”.

“These figures indicate that the nature of care home delivery is moving in completely the wrong direction,” Foyer said. 

 “We know that a large majority of standards failures during the pandemic have been in private care homes and that there has been a race to the bottom in terms of pay and employment conditions.  

A 2017 Competition and Markets Authority care homes study found that the big private providers in the UK can expect to make profits of up to 21 per cent. The FT reported last year that HC-One paid out at least £4.8m to its owners in 2000, despite receiving additional government support worth £19.8m from the UK Government to support it through the pandemic. 

HC-One, which is majority-owned by private equity firm Safanad, is just one of many private providers in the UK owned offshore, with the parent company and several subsidiaries based in the Cayman Islands. The Ferret reported in 2020 that dozens of private sector care home buildings in Scotland are owned offshore.

A spokesperson for Scottish Care, a member organisation for private sector care providers, told The Ferret: “70 per cent of care in Scotland is funded by the public purse, the composition and delivery of care across the country is therefore determined by commissioning and procurement practices of local Health and Social Care Partnerships.

“The move to a National Care Service could offer better data collection and analysis which may further support commissioning decisions to ensure that people get the right care in the right place at the right time regardless of who is providing that service.”

A Scottish Government spokesperson said of the census data: “While the number of care homes has fallen, the estimated number of care home places available has remained relatively stable. This reflects our policy of supporting people to live at home for as long as possible.

They added: “The proposal set out in the recent public consultation from August to November 2021 is that introducing a National Care Service will end the postcode lottery of care provision which exists currently across Scotland, ensuring quality, fairness, and consistency of provision through the setting of robust national standards and guidelines to support local delivery. 

“Social care providers across Scotland, from the independent, third and public sectors, would be subject to any new standards and guidelines.”

Photo Credit: iStock/Heiko 119

This story was published in tandem with The Sunday National on 16 January 2022.

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