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