Profiting from care

A new report ‘Profiting from Care – why Scotland can’t afford privatised social care’ was launched in Edinburgh today. Here we share a short summary of the report’s findings and provide a link to the PDF version. It’s well worth reading in full. We’d love to publish longer reviews of the report or short reflections on the issues it raises. Email us at edinburghjustrecovery@gmail.com if you’d like to make a contribution.

The report, commissioned by the STUC, finds that Scotland’s large private social care providers are associated with lower wages, more complaints about care quality, and higher levels of rent extraction than public and third sector care providers.

Written by Christine Berry, Sara Mahmoud and Mike Lewis, the research finds:

•                     Nearly 25% of care homes run by big private providers had at least one complaint upheld against them in 2019/20, compared to 6% in homes not run for profit.

•                     In older people’s care homes, staffing resources are 20% worse in the private sector compared to the not-for-profit sector.

•                     Privately owned care homes only spend 58% of their revenue on staffing, compared to 75% in not-for-profit care homes.

•                     Over the last six years, the public sector has paid on average £1.60 more per hour to care workers.

•                     The most profitable privately owned care homes take out £13,600 per bed (or £28 of every £100 received in fees) in profits, rent, payments to the directors, and interest payments on loans. This compares to £3.43 in every £100 in fees for the largest not-for-profit care home operators.

The report argues that a truly transformative National Care Service must be based on a not-for-profit public service, delivered through local authorities with an ongoing role for the voluntary sector. It calls for the Scottish care home estate to be transferred out of private ownership gradually over time – for instance, through a multi-year plan backed up by Barnett consequentials from the UK government’s NI tax rise, Scottish National Investment Bank loans, ‘care bonds’ or capital borrowing. With ‘financial leakage’ in the region of £100 million per year, the report argues that, for the most extractive providers, this could pay for itself within a matter of years.

You can read the full report here .

Updated Campaign Statement

Over the last few weeks we’ve been working on an update to our campaign statement. This version was approved at the campaign meeting on 9th June 2022. (You can download the statement here).

Another Edinburgh is Possible

It is time to end the cycle of cuts to vital local services in our city.  Austerity, outsourcing and privatisation has been legislated by Westminster via Holyrood and implemented by the City Council for too long.  

Edinburgh has the lowest expenditure per capita on local services in Scotland.

Since 2012/13, Edinburgh City Council budget cuts have amounted to more than £300 million.  If nothing changes, more huge cuts will inevitably follow over the next three years.

The cuts have already had a terrible effect on essential services.  The most vulnerable, already exposed to cuts in social security benefits, have suffered most. 

Covid19 added to an already bleak picture with increases in unemployment, child poverty, mental distress and the long term effects of Long Covid.  The pandemic shone a harsh light on the gaps in local services and underlined the importance of key workers and provisions for health, social care, housing, and education.  

Now huge increases in gas, electricity and fuel prices and the rapidly rising cost of living are tightening the screw further.  This is not sustainable. We can’t go on in this way.

There is money to fund the services we need. The Westminster government paid more than £30 billion to private companies during the pandemic for outsourced services and equipment that was mostly wasted.  Westminster, Holyrood and Edinburgh are all committed to outsourcing services to private providers who then rake off a large percentage of our local and national taxes to pay dividends to their wealthy shareholders. We need an end to outsourcing and the rebuilding of publicly run and democratically controlled local services. The wealth generated by our workers, service providers and service users could be sustainably invested to rebuild our city’s essential infrastructure.     

For too long our city has been undermined by Westminster and a compliant Holyrood parliament with cuts meekly implemented by Edinburgh City Council.  We call on elected councillors, MSPs and MPs to join us in linking the local with the national picture and campaigning for a reallocation of resources to transform lives and livelihoods for the better.

Council Elections 2022

The elections for Edinburgh City Council take place on May 5th. You can find the list of candidates on the council website.

Over the last eighteen months Another Edinburgh is Possible has been developing a list of actions and ideas which we think would contribute to the transformation of public services in the city. We’ve turned these into a series of pledges (see below) which we are asking candidates to consider and sign up to. The list of pledges doesn’t cover every area of the council’s activities, it’s work in progress and we welcome your contributions.

We are also holding an online hustings event on Thursday 21st April from 6.30am until 8pm – register for the event here. We are aiming to make this event as participative as possible – we want candidates to hear your voices. We’d like to group questions together by topic, so while there will be the possibility to ask questions on the 21st, priority will be given to questions notified in advance. If you have a question for the candidates please email it to edinburghjustrecovery@gmail.com and let us know whether you’d prefer to ask the question yourself or to have it read by one of the co-chairs.

Pledges

Introduction

Tonight, in one of the wealthiest cities in the world, children and families in Edinburgh will go to bed cold and hungry. The Edinburgh Poverty Commission reports that in some areas, 27% of residents are officially designated as living in poverty. Meanwhile, according to Oxfam, global billionaires increased their wealth by $5 trillion during the pandemic. In the same period, the collective wealth of the ten richest men in the world doubled. Clearly, we are not all in this together.

Another Edinburgh is Possible is a grassroots campaign linking up community activists, trade unions and Edinburgh Trades Council to build public support for defending and extending local government services. Campaigners have come together to oppose privatisation and wealth flight out of our city. We have surveyed the Edinburgh public on what they think their Council’s priorities should be. Our results showed a clear demand for elected representatives to be closer to the people who elect them, and for officials to be accessible and responsive to residents’ concerns. 

We support a rent cap on private rented properties and a windfall tax on energy companies making tens of billions annually while avoiding taxes which could pay for a move towards sustainable provision. We argue for bringing local government services back in house. We want elected Councillors, not unelected quangos such as the Edinburgh Joint Board, to make transparent decisions on care that affect families, residents and staff across the city. We argue for restoring democratic accountability to the running of our city’s infrastructure.

We argue for the extension of free transport, the maintenance of places for parks and people and not commercial activity, and for care to be removed from the marketplace and made freely available to all in need. 

The Pledges below summarise the key commitments we hope and expect candidates of all parties standing in the May 2022 elections to sign up to. They have been developed from the responses to the OU City survey which we conducted at the beginning of 2021 and at the meetings that we have held over the last 18months.  They do not represent a completely comprehensive list or represent the entirety of our ambition for the city. They describe the least our communities should expect. The Pledges are based on values we think the provision and running of Edinburgh’s services should be firmly based on. If these Pledges are consistent with your ambitions for our city, we would ask that you show your support by putting your name to them.

Local government finance

If elected 

  • Will you commit to reviewing the regressive council tax with a view to replacing it with a progressive alternative? 
  • Will you support calls to in-source services to ensure wealth created in Edinburgh stays in Edinburgh? 
  • Will you commit to building a campaign to force Holyrood and Westminster to provide a settlement consistent with the needs of our city?
  • Will you support calls to end out-sourced public services and to severely limit the use of, and expenditure on private sector consultants?

Transport

If elected

  • Will you campaign to extend free public transport?
  • Will you limit the number of tourist on/off buses allowed to operate?
  • Will you retain & maintain ‘Spaces for people’ as introduced during Covid?

Green spaces

If elected

Will you argue for stopping use of public spaces and parks for commercial activities?

Will you argue for disincentivising and controlling the hard surfacing of private green space i.e. garden space?

Hospital parking

If elected 

  • Will you commit to ending parking charges for all staff, patients and visitors in hospital carparks

Save our care homes

If elected

  • Will you campaign to keep the four threatened council run care homes open?
  • Will you argue for the council to borrow from the Public Loans Board to finance a first-class care service in Edinburgh?

Social Care

If elected 

  • Will you argue that social care is a public good?
  • Will you campaign to take profit out of care?
  • Will you commit to Improve pay & conditions for workers in social care?
  • Will you commit to making care local & accountable?
  • Will you campaign to ensure adequate funding for social care in Edinburgh?
  • Will you commit to making care a free service?
  • Will you commit to campaigning to enusre that the proposed National Care Service is based on the principles outlined above?

Council Housing

If elected

  • Will you commit to improving the system to help prevent the formation of mould, damp and condensation in tenancies?
  • Will you monitor whether the new resolution team is improving the complaints procedure and if not commit to further action in the interests of tenants? 

Housing

If elected 

  • Will you campaign for the return of council housing at volume with a focus on warm, well-ventilated homes, for the reuse of empty homes and for tax policies that encourage the repair and reuse of old homes?

Climate action

If elected 

  • Will you commit to rebuilding a direct works workforce that is well trained and secure and can take the lead on home insulation, retrofitting and district heating?
  • Will you ensure that regulations for new building in the city requires that new houses are built to passive house standards?

Local Democracy and accountability

If elected

  • Will you campaign for the reintroduction pf the public petitions committee?
  • Will you commit to the council ensuring that its systems for responding to the public are fit for purpose? (In response to the Our City Survey many people reported difficulties in making contact, lack of response and failure to deliver on commitments made)

Ventilation in schools and other public buildings

If elected

  • Will you ensure that the council develops and implements policy on healthy working environments so that CO2 monitors, filter systems and good ventilation is the norm?

Cost of living – day of action

Saturday April 2nd is a day of action over the cost of living crisis. There will be protests and actions around the UK. Another Edinburgh is Possible has taken the initiative in calling a mass leafleting and petitioning event at midday outside the St James Quarter. We hope as many people as possible will come and join in and get the message across to a wider audience that we don”t have to suffer and pay the price for the super profits being generated by the oil and gas companies.

We’ll be there until 2pm – even if you can only join for part of the time your presence will be really helpful. Bring a placard if you have time to make one.

Edinburgh TUC meeting

Edinburgh TUC is convening a Zoom meeting which will be attended by Councillor Ricky Henderson who is chair of the Edinburgh Integration Joint Board (EIJB). The EIJB is responsible for the provision of Social Care in Edinburgh. In 2022 it is going to consult with the public on the future of the four Care Homes in Edinburgh and the future of the Social Care Service in Edinburgh. The Zoom meeting will be held on Thursday 20th January 2022 at 6.30pm. It will finish at 8pm. The meeting will be chaired by Carmen Simon, Vice Chair of Edinburgh TUC, who is a social care worker. The meeting will be introduced by representatives of local authority trade unions and myself as Secretary of Edinburgh TUC. Councillor Henderson will then respond to the issues that were raised in the introductions. His response will then be followed by questions from the attendees of the meeting, and Councillor Henderson’s response to these questions.The link to the meeting is: https://us02web.zoom.us/j/84839483672… Meeting ID: 848 3948 3672Passcode: 140481

Outside all four threatened care homes today

Another Edinburgh is Possible

Press release – for immediate distribution

16th December 2021

SAVE OUR CARE HOMES

Earlier this month campaigners rallied outside Ferrylee, one of the four publicly run care homes that remains under the threat of closure.  Today the campaign 
raised a banner outside all four homes, Ferrylee, Fords Road, Clovenstone House and Jewel House to send a message to the Edinburgh Integrated Joint Board (EIJB) that we need the homes, we need public and democratically accountable care services, and we won’t be going away.

The EIJB had originally wanted to make the closure decision at its meeting in June 2021.  Resolute campaigning has pushed this back and it now seems likely that there will be no decision until after the local authority elections in June 2022.  In the meantime, residents and workers are left in limbo.  Access photos of today’s protests at https://www.flickr.com/photos/petepolitics/albums/72157720241687474  or via the campaign Facebook page https://www.facebook.com/anotheredinburghispossible

Keeping up the pressure on the EIJB

Drumbrae has been closed. The decision about closure of the other four publicly run residential care homes has been postponed until after the local authority elections in 2022. Had there been no campaign the homes could be already gone. At the last ‘Another Edinburgh is Possible Meeting’ we agreed to keep up the pressure on the EIJB. On 7th December, we organised a solidarity rally outside Ferrylee, one of the threatened homes, to coincide with the December meeting of the board.

In the photos you can see Brian Robertson from Unite making a deputation to the online board meeting.

Brian asked:

Which meeting of board saw the papers and made the decision to consider closing 5 out of the 9 publicly run care homes in Edinburgh?

Is it within the powers of the board to borrow from the Public Loans Board to finance a first class care service in Edinburgh?

The notes for the meeting mention 1000 new care support workers. Is this the number for Edinburgh? Who will they be employed by – the council – the NHS – others?

Reference is made to capacity – are we to understand that capacity in residential care is to be reduced while home care capacity is increased?

The chair declined to respond to any of the questions.

You can watch the whole of the public session of EIJB meeting on the council website

Let’s recognise care as a social good

The campaign for a National Care Service in Scotland: a contribution to a discussion. By HILARY HORROCKS (Edinburgh trades union council delegate). This article was first published on the People and Nature blog. We repost it here with the author’s permission.

Health is a devolved matter in the not-so-United Kingdom, and that has allowed successive Scottish governments to bring in progressive measures that are missing in England, such as abolition of prescription charges for everyone and free personal care for the elderly.

The Scottish National Party (SNP) government certainly sought to distance itself from Westminster during the first stages of the Covid pandemic, when it seemed to follow scientific advice more carefully, and kept the public better informed with daily briefings by the First Minister.

Between the first and second waves of Covid last year the virus was just about eliminated in Scotland – but like Westminster, the government at Holyrood failed to use the summer to bring in mitigating measures to reduce infection. So in the autumn, the return of schools and universities, coupled with the loosening of restrictions, led to a rise in cases similar to England’s.

Mask wearing has remained a legal requirement in Scotland, including for all secondary school pupils, and is generally well observed – but cases remain worryingly high, particularly in poorer areas.

Here, as in England and Wales, the terrible toll of deaths in care homes at the beginning of the pandemic brutally exposed the disastrous policy of freeing up NHS beds by transferring elderly hospital patients to care homes with no proper testing.

In the aftermath, the Scottish government commissioned an independent report on Adult Social Care (the Feeley Report), which recommended setting up a National Care Service (NCS).

In addition to the care homes scandal, social care in Scotland is beset with problems, exacerbated, as they are everywhere, by deindustrialisation and consequent social deprivation; decades of austerity; and the loss of skilled care workers because of Covid and Brexit.

Edinburgh Campaigners protesting at plans to close publicly run care homes (2021) Image by Pete Cannell CC0

Nowhere is the crisis more painfully clear, perhaps, than in the tragic rate of drugs deaths among young people, now at a record high.

The Scottish government has put out a long document listing their proposals for the NCS. These formed part of the SNP manifesto at the Scottish elections in May, in which it emerged the largest party and now governs in a working coalition with the Greens. Their proposals, designed to cover those with mental or physical disabilities, the elderly, those with dementia, recovering from alcohol or drug addictions, the homeless, children and families needing support, will, they say, be implemented within a year.

The guiding principles in the document sound promising at first sight: ensuring that care is person-centred, human-rights based, and is seen as an investment in society; nurturing and strengthening the workforce, and giving greater recognition to and support for unpaid carers.

The title of the plan – a National Care Service – is obviously designed to evoke parallels with the setting up of the National Health Service in 1947 and its radical reform of state welfare. However, it is anything but. Crucially, it fails to recognise the devastating impact of cuts to health and welfare and of the inroads of privatisation; and, in general, it does not move the debate beyond a neo-liberal framework.

The proposals are out for public consultation. The public can give its views in an interactive version of the document. However, you are restricted to giving responses to set questions, many of which don’t address the substantive issues. But unions, community groups and others are responding with their own independent contributions.

What follows is a summary of their most important criticisms, and is designed to open a discussion, not only in Scotland.

The role of care in society

“Care needs to be recognised as a social good”, Mark Smith, a researcher of social care, has written. “This is compromised by continuing to locate it within an economic system the primary motive of which is profit maximisation.”   

A fundamental criticism of the Scottish government’s proposals is that no amount of government directive can make a difference, and that root-and-branch reform is needed.

“Most insiders in the profession recognise that the social work system is pretty broken”, Colin Turbett, a frontline social worker in the West of Scotland for nearly 40 years and author of Doing Radical Social Work(2014), says.

In the past few decades, he continues, the role of social workers has become restricted to the performance of statutory public protection duties, instead of the broader preventative welfare role they performed in the past.

“They only become involved when the situations of the people they work with might be beyond help, their skills being largely spent trying to mop up when earlier involvement might have prevented escalation.”

Social workers typically spend most of their time behind  computer screens, rather than engaged with the individuals who need their help.

A public service

Critics of the NCS proposals insist that it should be a public service, completely not-for-profit, and principally delivered through local authorities. The Scottish government, in contrast, envisages a continuing role for the private sector, currently owners of 80% of care provision in Scotland.

This, despite the fact that the private sector is leeching funds out of care provision into property speculation or offshore tax havens; and that the record of privately-run care is far from good.

One of the major providers, Advinia Health Care, who own 11 care homes in Scotland, were second on the list of those homes that saw the most deaths during the first Covid wave.

The Scottish government and the health authorities directed the evacuation from hospitals to care homes, apparently blind to the fact that the care providers most likely to accept patients were those most motivated by profit.

Advinia Health Care is ultimately owned by a company registered in the tax haven of Gibraltar and has been the subject of an attempted financial investigation by the regulator in England. The Care Inspectorate reported in May of this year that they had found in one Advinia home unsafe disposal, storage and management of clinical waste, including PPE, while staff had not been given the correct PPE or shown how to use it properly. 

The commitment of the Scottish government to the private sector in the context of its NCS proposals was confirmed, alarmingly, when it emerged recently that the £100,000 contract for the initial design of the proposed new care service had been awarded, even before any consultation has been concluded, to the Edinburgh branch of PriceWaterhouseCooper.

Scottish TUC general secretary Roz Foyer commented: “While this is only a small contract, beginnings matter. South of the border, the past year has seen the continued growth of the consultancy gravy train with massive contracts awarded to companies with clear interests in private-sector provision of public services. We do not want this replicated in Scotland.”

How can a National Care Service be funded?

The Scottish government points to the inadequate provision of social care by local authorities, completely failing to acknowledge the harm inflicted by decades of cuts to council funding. 

Only with proper funding can local authorities build up the infrastructure that would allow them to absorb, in a National Care Service, not only the current private/third sector provision of social care in the medium term, but also the increasing demands on social care in the long term.

The government, say campaigners, should ring-fence resources to provide good-quality care and fair pay and working conditions to carers, who should be respected as skilled workers. Collective bargaining must be set up immediately to agree national pay and conditions between a National Care Service and trade union representatives, and to provide regular high-quality training.   

Common Weal, a Scottish-based “think-and-do tank”, argues in its Manifesto for a National Care Service that private providers should be bought out, as happened when the NHS was set up, but over time.

Given the parasitic nature of private care, isn’t there an argument for a more radical move? Private providers could be offered a role in a publicly-funded system, subject to stringent checks, but they should not be offered compensation.

Free at the point of need

On charging for care, the Common Weal Manifesto says: “All charges for care would be abolished. The National Care Service should be funded from the public purse, either from tax or a new national insurance scheme based on a universal “pooling of risks” with all contributing as per their income, irrespective of the care they may or may not receive.”

In accommodation-based services, Common Weal argues, “people would be expected to contribute a portion of their income […] [they] would no longer be required to sell their assets to pay for residential care.

“The funding shortfall should be met through a more equitable system of inheritance tax, in which the rich pay more than those who bought their council houses, or through other taxes.”

What about local control and accountability?

The Scottish government proposes that under a new care service, local councils would hand over ALL their current social care and social work responsibilities to management bodies called Integrated Joint Boards.

These have already been in place for some years, and they have been proved not to work. Elected councillors do sit on them, but in practice get overruled on local decisions.  

And the government’s new care service would be ultimately accountable to a government minister, meaning more centralisation and less ability to create and administer services at a local level, where they are most effective.  Common Weal describes the government’s NCS as “an attempted power grab by central government and a further assault on local democracy”.

Campaigners envisage an NCS run by local authorities, as the existing democratically elected and accountable bodies, but also call for a further devolution of care services to local community hubs, which “can actively involve service providers, those needing care and those with lived experience to create local, flexible, inclusive services”, as the Edinburgh Trades Union Council (TUC) response to the government’s proposals put it.

The idea of community hubs as centres for public service delivery and voluntary activity has been revived during the pandemic. “Notions of community empowerment already enshrined in law”, Common Weal says, “ought to be compatible with the decentralisation of public services and bottom-up community partnership and control. The National Care Service that Scotland needs could be managed and delivered at local level through community hubs.”

Above all, providers, workers in the service, and users, have to be involved in the planning and management of social care. “People in Scotland deserve far better”, says one of the Common Weal team, “but we will not get that so long as those responsible for the current system are responsible for redesigning it”.

Outcomes of the EIJB meeting

The Edinburgh Integrated Joint Board, which organises integrated health and social care in the city, met on Tuesday 28th September. The meeting time and date had been changed twice at short notice. You might think that the board was trying to evade protest. In the event there were rallies outside the City Chambers, both in the morning at 9.30 and again at 2.30. The campaign to save public care homes has had an impact. But despite the opposition the board proceeded to confirm the closure of the Dumbrae home – which they intend to transfer to the NHS as a more specialised facility. From the outset the board, and the City Council have tried to exclude Dumbrae from the list of homes scheduled for closure – continually referring to four homes slated for closure. Our view has been simple – there were nine publicly run care homes in Edinburgh – if the board gets its way there will be four. That’s five closures however, you dress it up.

So what about the other four homes? The board talks about a ‘comprehensive consultation’ on the closure of the four homes, but it is not going to happen anytime soon. The EIJB will discuss it again at their October meeting and will consult with the City Council and Lothian Health. At the board meeting there seemed to be agreement that there will be two parallel and linked consultations. One will be on the four homes closure issue and the other will be on the overall social care provision in Edinburgh up until 2030. Once the nature of the consultations have been decided they will will last three months. There will then be a period of evaluation (perhaps a month according to officials) followed by the writing of a report for the EIJB. It seems that the EIJB is going to postpone an actual decision on the four homes until after the local authority elections in May 2022.

In these circumstances it’s really important to keep up the campaign in the context of a vision of a publicly run and democratically accountable service that meets the needs of Edinburgh residents. We will discuss next steps in the campaign at our meeting on Thursday October 7th at 6.30pm.

Unison issues this Press Statement following the board meeting

Care home closure is ‘slap in the face’ to Edinburgh’s most vulnerable, says UNISON 

UNISON, the union for carers, has expressed deep dismay at the decision to close an Edinburgh care home. The decision was passed by the Edinburgh Integration Joint Board (IJB) – which commissions health and social services from the City – at a meeting yesterday (Tuesday). UNISON, Scotland’s largest union, has been campaigning to prevent the closure of five council-run Edinburgh care homes, including Drumbrae. A further four council-run homes – Ferrylee, Clovenstone, Fords Road and Jewel House are all being earmarked for closure but subject to public consultation. Tom Connolly, UNISON Edinburgh City branch secretary, said: “The people of Edinburgh can feel very let down by this decision to close a much-needed local service, not least the elderly and vulnerable who reside in the care home and now face an uncertain future. “UNISON will continue its campaign to save public sector-run care homes and prevent them going into private hands. People need to come before profit and UNISON will continue its fight to save Edinburgh’s public run care homes and call for all private run care homes to be brought into the public sector.”Greig Kelbie, UNISON regional organiser, said: “The decision to close Drumbrae was made without any public consultation and is a real slap in the face to the most vulnerable people in the city. “UNISON understands there is a substantial waiting list for homes in the area, so if the need hasn’t gone away then why should the services?”