Anyone in the third sector involved in elderly care will doubtless already have been following the investigation that the Equality and Human Rights Commission has been conducting into care for older people delivered in the home. Close to Home, the EHRC’s report, published today, is a bombshell and will have widespread implications for both private and third sector providers of elderly home care.
The starting point of the EHRC’s investigation has been the “quiet revolution” that has taken place in home care in just under twenty years — the shift from local authorities delivering care, to private and third sector providers delivering on their behalf. In 1992 just 2% of publicly funded care fell into this category; but by 2009/10 this had risen to 84%. And while the Human Rights Act provides safeguards for many vulnerable individuals and groups in a variety of care and service settings, the EHRC maintains that because of the way the courts interpret the HRA, the majority of care provided — because it is delivered by private companies or third sector organisations — is “almost certainly” not subject to HRA protections.
Commenting on the report The Independent says, “The EHRC found cases of people who were put to bed in mid-afternoon and left in soiled nightwear until morning. They were strip washed with no respect for their dignity and food was left out of reach so they went hungry. Some were systematically robbed of their money.”
The Guardian says, “Findings included carers neglecting tasks because councils paid for too little of their time. There was also a chronic disregard for older people’s privacy and a disregard for clients’ dignity when carrying out intimate tasks.”
At all levels, and in virtually all care contexts, we seem to be witnessing what might be called a crisis in compassion. Within just the past few months we have seen the Panorama expose of the privately run Winterbourne View special hospital in Bristol for people with learning difficulties and autism. And then between March and June 2011 inspectors from the Care Quality Commission conducted spot checks on the ‘dignity and nutrition’ of older people in 100 NHS hospitals which revealed shocking failures in basic care. In some hospitals doctors were resorting to prescribing water for elderly patients in order to ensure that they did not die of thirst.
Are these systemic, institutional failures? Or — with £1.3bn being cut from older people’s social care in the lifetime of just the present parliament — the consequence of a care system bucking under the pressures of demand, public spending cuts and market forces? Perhaps the increasing marketisation of care means that caring is no longer a vocation but just another job — and a badly paid one at that.
Or is what we are seeing really about failures in personal behaviour? After all, institutions — and companies, and voluntary organisations and social enterprises — are collections of people, and while the overall culture of institutions and “systems” may well set the values and standards that are expected, how these are upheld and enacted has to do with personal behaviour.
I don’t know the answers to these questions, but I’m sure that the EHRC report — published in advance of and clearly intended to influence the government’s white paper on social care in the Spring of 2012 — will mark the opening of a major new front in the struggle for “reform”.
Of course (and I don’t mean this to sound anything like as cynical as it will), for social enterprise and third sector providers of social care there is a clear market opportunity. If the ethics, values, practices and standards of “mutual” providers render such failures impossible, then now would be a very good time indeed to explain how and why this is the case — because make no mistake, irrespective of the state of public finances and the government’s cut-backs, the argument is about to shift from cost savings to quality. How and why “mutual” models of delivery safeguard the rights and wellbeing of clients and guarantee quality will be the territory that really has to be won.