Nationalise Care Homes – ARM

Author: Giancarlo Bell

This is the fifth of several pieces arising from the ARM 2019, explaining our positions on the debates which occurred there.

Motion 90 ARM 2019.

Britain should nationalise its extensive network of private care homes so that the vulnerable residents of these establishments can benefit from the improved standards of care afforded by the staff and systems of the NHS. Nationalisation could also provide better regulation, improved working conditions, and higher pay for the millions of workers in the social care sector, as well as offering better integration between social care and NHS medical care processes. This was the crux of Motion 90, submitted by North East Regional Council at ARM 2019. While the Broad Left was firmly supportive of this motion, the room at ARM was divided, with many representatives questioning whether bringing social care into the NHS was the right strategy to improve falling standards. Despite the strength of the opposition presented at ARM, the Broad Left are delighted that the motion passed in all parts.

Before the recession, care homes were regarded as bulletproof investments for private equity firms. The British population was ageing, and so thousands more elderly people could be churned out into the private care system every year with a premium hanging over their heads – profit for the care home bosses. This perceived stability provoked increasingly risky financial investments and a series of reckless economic expansions, subsidised with the money of taxpayers and the savings of our elderly population. No company better embodied this story than Southern Cross, formerly the UK’s largest social care provider with a peak of 31,000 residents in 750 homes [i]. They followed the tried-and-tested pattern outlined above, with a constant cycle of buying and selling new properties and pushing into new markets. After the credit crunch, Southern Cross was hit by rising rents, decreased expenditure by councils, and falling property prices. They responded by squeezing employee pay and decreasing the quality of care provided to postpone their inevitable decline [ii].

Our elderly friends, loved ones, and colleagues should not be at the mercy of neoliberal market forces. We are a wealthy country, and we should guarantee a basic standard of living for everyone. While doctors in general, and BMA members especially, believe in a publicly funded NHS which is free at the point of delivery, these values are more contentious when it comes to social care. There has been something of a shift in the Overton window in this instance. While almost 200,000 of the half a million care home beds in the UK were operated by the NHS or local authorities in 1990, this number has dwindled to about 30,000 [i]. The public accepts the dogma that the state provides health care; while the private sector provides social care.

By bringing care homes into the public sector we can equalise the huge variation in standards of care seen across the care home industry. The private operators’ main motive is profit; the care of their residents is a secondary priority. As such, we have seen dwindling standards of care, and a growing incidence of neglect and abuse at care homes across the country [iii]. At ARM, opponents of Motion 90 argued that the care homes which scored most positively under the scrutiny of CQC review were small, privately run establishments. This may work out nicely for the people who can afford to live in such homes, but the working class are left to fend for themselves in those cheaper, often poorly run care homes with low-paid, overworked staff, because staying in a top-quality care home when nursing care is required can cost as much as £55,000/year [iv]. We would not accept such inequality in healthcare.

Employees in the care sector are at breaking point. They are working longer hours, for less pay, and with fewer benefits than their colleagues working in NHS hospitals. They also receive less training and are frequently employed on unstable zero-hour contracts with little in the way of career progression [v]. By bringing care into the NHS, we can employ care home workers on humane terms, with the pay and conditions they deserve, which will subsequently improve the standard of care they are capable of delivering.

Medical wards in NHS hospitals across the country are burdened with the complex issue of ‘acopia’ and ‘social admissions’. There has been fierce debate about the validity of these terms and about how to solve the issues underlying these admissions, but nationalising care homes could be an important step towards a solution. If care homes were provided on a universal, free basis like healthcare, and their staff were part of a wider, integrated NHS system, then elderly patients who are unable to cope at home could be admitted to somewhere to truly meet their needs, rather than taking up a costly hospital bed. This could save our NHS a significant sum of money.

Now that this motion has made it through ARM, the BMA should be unerring in its support for nationalising care homes. We must show that we believe in a humane standard of care regardless of class background, that we stand for health and social care which is comprehensive, universal, and free at the point of delivery. We must show solidarity with the workers in the care home sector. Our elderly population, and the workers looking after them, deserve better than to be treated as pawns in the games played by private equity firms.

[i] https://www.socialist.net/britains-care-homes-in-crisis-nationalise-them-now.htm

[ii] https://www.theguardian.com/business/2011/jul/16/southern-cross-incurable-sick-business-model

[iii] https://www.independent.co.uk/news/health/abuse-care-home-cqc-autism-learning-disability-whorlton-hall-police-a8969026.html

[iv] https://www.moneyadviceservice.org.uk/en/articles/care-home-or-home-care

[v] https://www.independent.co.uk/news/uk/home-news/care-home-workers-half-leave-jobs-within-year-staffing-levels-problem-report-communities-and-local-a7658281.html

Pay and BMA Surveys

The BMA does not have the best track record with surveys, or their response to them. We have been accused in the past of subjecting our members to death-by-survey, and of hiding results, or ignoring them where they are not convenient. It is difficult to know what is true without being on the inside.

Now, however, we have great need for a survey. At the Annual Representative Meeting, the BMA was instructed to ‘identify actions to reflect the feeling of the profession’ on pay.

When the government made the pay ‘award’ last week, the need to survey our members and their willingness to take action became even more apparent.

In order to do this well, we need to explain the effects of prolonged pay restraint and the current offer, then suggest actions and ask if members would be willing to take that action.

We also need to show some leadership – by educating our members, who have had a slow-acting pay cut of around 20% over recent years. To add insult to injury, the latest pay cut offer is less than half of its apparent value. All doctors will lose out due to inflation, and the lack of backdating makes us suffer more. This year’s NHS staff survey has laid bare the realities of working life for doctors in the NHS, as detailed in the latest report of the Review Body of Doctors and Dentists Remuneration (DDRB):
• 80% of medical staff report regularly working unpaid extra hours
• 60% of doctors don’t feel they have enough time to do their job properly
• 30% of medics report their work is making them sick

We should say that we were disappointed by the DDRB recommended rises of 2% to doctors’ pay, which was wholly insufficient to address pay erosion across all doctor groups. Our confidence in the DDRB’s continued independence and utility has been shattered. We are further dismayed that the government has – in bad faith – gone further and halved the DDRBs miserable recommendation. The situation is untenable. We need to officially assess what our members are willing to do about it.

The survey sent via email to members this evening to has failed to do that. Only asking questions that are already asked via the NHS Staff Survey and we already know the answers to. It is embarrassing that the BMA feels the need to ask members if they are angry. As this survey was not run past elected Council representatives before it was sent, we have been left out of the strategic planning of the BMA’s response to another real terms pay cut.

 

We are demanding better, perhaps with a further survey, but definitely with a clear call for genuine action in response to the DDRB and Government failings.

Here are the kind of questions we would like to be asking you now:

 Would you:
  • write to your MP asking them to support the DDRB recommendation?

  • want the BMA to disengage from the DDRB and negotiate directly with government?

  • take action short of a strike – working to contract, refusing overtime and refusing to fill rota gaps? For how long?

  • take action short of a strike – refusing to collaborate with coding practices to damage the financial flow of the hospital without affecting patient care? For how long?

  • take half-day or late-start strike action? For how long?

  • take strike action to end elective treatment? For how long?

  • take strike action to bank holiday cover? For how long?

  • take all-out strike action for just your Branch of Practice (allowing other BoPs to cover)? For how long?

  • take ‘rolling’ strike action where your branch of practice takes strike action one day, and another branch of practice does the next day, and another the next day and so on? For how long?

  • take all-out strike action alongside other branches of practice? For how long?

We recommend members fill out the survey and use the free text comment box to tell the BMA what action you would be willing to take. Lobby Council members and branch of practice reps for a determined response to the pay offer.

Email us at broadleft[at]doctorsbroadsheet.org  if you’d like to get more involved in our campaign.