Why is the EIJB discussing care in private?

This post from Councillor Ross McKenzie is the first in a series which we place to publish on the social care crisis in Edinburgh.

The ‘Edinburgh Integration Joint Board’ (EIJB) also known as the ‘Edinburgh Health and Social Care Partnership’ (HSCP) was established in 2015 to oversee the planning and delivery of newly integrated health and social care services. At that moment the Council delegated to it significant functions and resources in relation to its responsibilities for social care. This meant a substantial dilution in democratic accountability of a large chunk of the Council’s budget and the running of these crucial services. 

At its last meeting, the EIJB discussed a paper on NHS Lothian’s ongoing inability to discharge people from hospital in cases where people require further care upon discharge from hospital – whether that care is ‘care at home’ or whether it’s care in a ‘care home’. The discussion was held in private due to ‘commercial sensitivities’ – an absurd decision give the report had been circulating around trade unionists and journalists for days prior. 

When the contract for the delivery of the Christmas markets was discussed in a private council session, there was a queue of councillors and journalists asking why. On Tuesday, the EIJB discussed something far more important in private, yet very few saw fit to ask the same question. The delivery of social care in this city is somehow beyond politics, beyond basic democratic accountability. 

Compared to the rest of Scotland, Edinburgh has a particular problem with delayed discharges – it’s an outlier. And it’s no coincidence that Edinburgh is an outlier in another area: Edinburgh is an outlier in the extent to which social care is dominated by the private sector, both in ‘care homes’ and in ‘care at home’. For the most part, provision is determined not by need, but by profitability. 

The only serious solution to NHS Lothian’s problem with delayed discharges is the expansion of publicly provided social care based on need. But that isn’t the solution being discussed by the EIJB. Instead, members are being asked to consider proposals to cut the number of hours of ‘care at home’ that people receive, and to approve the expansion of the use of beds in private care homes – private care homes that more often than not provide a very poor standard of care, and almost always provide disgraceful pay and conditions to their staff. 

If it wasn’t so serious, it would be laughable to think that less than a year ago the EIJB was trying to close council-run care homes. At the time we heard the argument that the care homes weren’t needed anymore because people wanted to be cared for at home, and new technology would make it easier for them to do so. Yet now we are told that two thirds of delayed hospital discharges are due to a lack of beds in care homes, so we’ve apparently got no choice but to purchase more beds from the private sector.

Meanwhile, there’s a recruitment crisis in ‘care at home’. Again, the solution being proposed is not to expand public provision, it’s not to offer people decent pay and conditions, the solution proposed is to cut the amount of care that people receive. 

All of this is apparently beyond politics, beyond democracy, beyond accountability. 

That can’t be allowed to stand. Campaigners and trade unions stopped the EIJB from closing the care homes last year by putting the decision into the public eye. The decisions of the EIJB were not able to withstand public scrutiny when it came to closing care homes and I believe the same will be true of any attempt to cut the hours of care that people receive at home.

The privatisation of social care has failed, even on its own terms. Public provision of social care based on need is the only solution to delayed discharges, and it’s the only solution to the wider crisis in the sector.