Social care reform continues despite Southern Cross warning
13 July 2011
There was an irony to the government's publication of its Open
Public Services white paper this week. As Prime Minister David
Cameron spoke about the paper, which paves the way for greater
private sector involvement in public services, care home provider
Southern Cross said that it was transferring control of its 750
care homes to others and would be wound up. Not the greatest advert
for private sector involvement in social care. There was nothing of
great surprise in the white paper - held up since February due to
internal governmental wrangling - and little in it is new. It
includes outlines for the expansion of personal budgets, a move to
give people a "right to choose" their services and plans to consult
over giving greater opportunities for communities to run services
at a hyper-local level. But one of the biggest proposals is to
outsource more services to the private sector, charities and John
Lewis-style mutuals, although no one sector would be favoured over
any other. This is an extension of what has been happening for
years. Councils have long commissioned services from outside
providers, and the more recent advent of the personalisation agenda
and individual budgets has given people the chance to buy services
from any provider they choose. This move just gives the private
sector and charities a better footing to compete. But my worry
about the way that social care services may be opened up to more
competition is that it will increase the risk of service failure -
and that the government may no longer be obliged to step in to prop
them up. According to the Guardian, research by civil servants
warns that although markets are susceptible to failure, costs could
in fact rise unless a true market is created in which some public
services are allowed to collapse if they are unsuccessful. In the
Southern Cross case, residents have all been assured that they will
not become homeless - there has been time for the company to make
arrangements with its landlords to take over the running of some of the homes -
although there remains concern that some residents may eventually
have to move to other homes. . But even this might not be the case
in other businesses, and there is the risk that care home residents
could find themselves homeless with little notice to find somewhere
else. That's assuming somewhere else is available. Of course, this
could be disastrous for the service users involved. To be uprooted
from their home for reasons they may not understand and moved to
somewhere else, away from what and who they know could severely
impact on their health, wellbeing and independence. There is also
the worry that profit will take priority over quality of care -
although the government maintains that competition will drive up
standards. Dave Prentice, leader of the trade union Unison, has
warned of a "race to the bottom" with workers pay and conditions
cut to ensure that services appear more attractive to private
buyers. While the regulator, the Care Quality Commission, will be
there to ensure that minimum standards are maintained, the recent
case of Winterbourne View in Bristol, where staff allegedly abused
residents with learning disabilities, has cast doubt over its
effectiveness. Nevertheless, this white paper signals the
government's direction of travel, and that - and the existing
predominance of the private and third sector as providers - renders
wholesale arguments about whether the private sector has a place in
social care moot. The private sector is here to stay. But the
government has to have safeguards in place to ensure that if
businesses go bust, the most important people in the system -
that's service users, not shareholders - do not suffer as a
consequence. If anything is to be learned from the Southern Cross
case it is that service users' needs have to come first and that
contingencies must be in place if a business goes bust. The
full Open Public Services white paper can be found here
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