Integrated Care or Integrated Risk?

Integrated Care Partnerships are  being developed across the country. There is a particular danger posed by chains of care homes owned by hedge funds and speculators gaining  a say in our social services and our NHS. There are real risks involved with Integrated Care Partnerships. Only  small section of health and social care professionals know about them but they will affect us all. This is not about day to day healh care or social care which clearly needs some level of integration.

“It’s integration of management systems, of financial purses, and
organisations, and it’s at the expense of the integration of true delivery of coordinated care that’s been going on and did not need Simon Stevens or Jeremy Hunt to tell us to do it.” 

Do Labour Councillors and MPs  and trade unions representing the workers, really want to go down that road? Can they please learn from the PFI scandal, step away from Integrated Care Partnerships? Can Trade Unions, Campaigners and elected representatives together put pressure on the government  to fully fund NHS and  fully fund social care and to drop the  multi faceted privatising agenda?

Justin Madders MP, one of Labour’s Health team and a local MP, has published a criticism of Integrated Care Partnerships, especially their implementation without legislation going through Parliament or public consultation. The process  of forming Integrated Care Partnerships fundamentally changes Social Services and the NHS. They gives the private sector still more access to the taxes we pay to fund our care. They reduce public and patient accountability and invite the hedge funds into the planning of our publicy funded health and social care. Profit is invited in to planning for our most vulnerable.

Hedge Funds are “an offshore investment fund, typically formed as a private limited partnership, that engages in speculation using credit or borrowed capital.” Hedge Funds   are for speculation. Some of our readers will remember hedge funds speculation in Liverpool FC.

Now a chain of care homes is  under crisis again and not  a crisis through social care funding but from exposure to speculation. The Guardian reports

“US hedge fund puts Britain’s biggest care home operator up for sale

Four Seasons failed to pay off a portion of debt owed to H/2 Capital Partners”


The Care Home sector is attractive to capitalist speculators because it has an assured source of funding.  The profit motive has not helped  social care at all, despite the free market rhetoric. It’s not like a shop or other  kinds of investment, this one has long-term government or local authority  funding. Cash flow is secure. The funding that comes from patients and families  is reasonably secure too because local authorities often help administer this.  The cost  to the older person and their families can be huge. 

Families  can  be desperate not to have disruption. Changing a nursing home is a complicated task. On the basis of this very  secure funding stream, it would appear, the speculators  have  borrowed on these businesses to invest elsewhere. In Integrated Care Partnerships NHS and  Local Authority Social Care are being integrated  with other providers, so the private  sector are  involved in the ICPs.  The Kings Fund  reported that “Integrated Care Partnerships can include hospitals, community services, mental health services and GPs, while Social care and independent and third sector providers may also be involved”.

There are four  main players,  in ICPs, the NHS, Local Authorities, voluntary sector organisations  and the private sector. The  sectors become more and more integrated. The private care home sector get a seat at the table, knees under the table, a strategic say in the funding and structures, and therefore a still more secure stream of funding for its speculators. Meanwhile our beloved elders are pawns in this game.

Public money and decision-making  going into the private sector is not safe,  a sector owned by hedge funds, who have no obligation to the public good. These homes can close when they want to. Regulation on peremptorily closing such homes is very weak. Local Authorities  generally have to find new places for the residents. Many care homes have precarious financial situations Now the Guardian  has posted the story of  a hedge fund ordering the sale of  the largest chain of elder care homes

The weight of the obligations to the elders in these homes must be on the owners and their backers. The full force of the law must be used to make them face their responsibilities but the laws are, as yet, weak. But once Integrated Care partnerships  are in place it will be a shared risk. Investment is supposed to carry risk, tax funded services should not. The care home owners, US hedge funds, will be the partners in ICPs. We,  the public, will share the hedge fund risks.

The NHS is free at the point of need and is supposed to provide all the treatments a patient needs There is more on this  conflict here. The NHS is short of beds, the number has halved and this has contributed to the “winter” crisis.  The Winter crisis  is not caused  by too many old people. After all, we have known about these people since their birth was registered, up to 112 years ago.  We have known about increased life expectancy for years. Not planning for our elders is a sin of neglect on the part of governement. Its not  surprise.

It is a joy and an honour as a society to have our elders live long and happy lives.

The winter crisis  caused by  shortage of beds and shortage of  funds for social services. Social care is indeed in crisis. Unlike health care, Social Services provision  is  means tested until the person has lost nearly all their assets. Unlike the NHS there is no  obligation to provide comprehensive  services. Its a priced menu. You get what you can pay for.  Private sector provision is  planned  for what makes a profit. The main function, such as elder care,  can be subverted if there are  better ways of making money. Southern Cross proved this but scandals  have been swept under the carpet.

Many are familiar with the situation of older people needing medical care for age related illnesses, getting that from NHS but being charged for care for dementia because that does not count as medical need, but a social  need.

Despite dementia being a medical condition, the needs of people with dementiaare often seen as social care rather than healthcare needs. … Second, the design of the NHS continuing care system is not appropriate for people with dementia”.

This blurred boundary causes hardship It is reasonable to assume such blurring of boundaries will get worse under ICPs

There is a crisis in social care. It must be solved. But the money to solve that crisis must not come from hardpressed NHS budgets. It should come from general taxation, not NHS budgets.

Despite headlines that say  Austerity is over, Local Authority social care budgets  face the worst cuts yet .

An analysis by the Local Government Association (LGA) reveals that, overall, councils will have suffered a 77 per cent decrease in the government funding between 2015/16 and next year, dropping from £9,927m in 2015-16 to £2,284m in 2019-20.”

Social care is short of money. Social Care  Homes for the elderly were largely privatised many years ago. The iconic  image of the time  was of a little care home that a local GP might have set up,  but this has long been bought up by the big chains. Some people will remember Southern Cross,  where a whole chain went bust. Care homes can just close. Much of the private  care sector  funds come from Local Authority Social Services budgets, on a  patient means tested basis.  Other funds come directly from the old person and the family. The quality of care varies from brilliant to appalling

Care workers can be overworked under paid and over whelmed by the job. Full unionization and collective bargaining  to represent the interests of staff are long over due. A well paid, well-respected staff, who are allowed some say in how the care is delivered make for good experiences for the elders  in their care. When there are cut backs in funding the first people to suffer are the care workers

“the care workers absorbed the effects of the erosion in job quality and protected residents from its adverse effects” (p. 1001)

Much focus is on social care for the elderly but social care encompasses care services for children, and younger adults with physical disabilities or chronic illnesses. An activist and trade unionists conference  on the whole issue of social care  is planned in November

The system of care homes is not working in so many ways. Our campaign calls for a national care service fully funded from taxation but not to bail out the speculators

Care in the community for people with learning difficulties, and a variety of mental health issues have also been subjected to major funding shortages, and are largely outsourced, with all that means for staff  wages, training, professional education  and job security.

The staff of care homes, and in home care, are trained, managed and paid in a fundamentally different way from the NHS. Many of their staff have come from the NHS either by the original services being privatised or because they have chosen to move across. The staff development, which is the jewel in the NHS crown, is sadly lacking. Some staff perform duties, including  giving out medication, well above their pay grade and their education/ professional qualification level.

It is the efforts and dedication of the staff which has kept the NHS and the care system afloat, though the boat is now leaking. The workers in the private homes are by and large doing their very best. Those with elected power have a responsibility to  provide good care, quietly calmly and efficiently.

image Hedge Fund by Nick Youngson CC BY-SA 3.0 Alpha Stock Images



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