Wednesday, 1 June 2011

The Winterbourne abuse scandal provides a stark warning against NHS privatisation

This week's Panorama about systematic abuse of patients at Winterbourne View private care home was shocking and uncomfortable television. Yet behind the fear of the patients, routinely and daily abused by their carers, was a story to be told about how private companies operate in social care. And it is a story we must pay urgent attention to as our Government looks to open up mainstream NHS treatment to 'any willing provider' - exactly what has already happened in social care.

What truly shocked me about the Panorama programme, wasn't just the terrible individuals metting out suffering to vulnerable young adults, but the complete failure of the Care Quality Commission to identify the abuse. CQC is the Government regulator of social care providers, it is meant to ensure that private health providers that win Government contracts ensure that quality of service does not come a lowly second to a profit motive. Yet during three inspections of the unit the CQC did not uncover any inappropriate behaviour and, even more worryingly, it failed to act on three emails it received from a highly qualified nurse who used to work at Winterbourne which detailed the abuse at the unit. The question is: how many other units have passed a CQC inspection are also hiding dark secrets?

Whereas social care has already been opened up to private providers, the health service is still largely nationalised. Yet the Government's controversial Health and Social care bill wishes to allows 'any willing provider' such as private companies and charities to compete for health contracts. The Government will be reliant on the CQC and 'people power' to ensure these providers are of good quality.

Lansley in speaking with the Guardian in February believes that people will 'vote with their feet' and go elsewhere if the health service they receive is not good enough. I've doubted this is possible since I heard this claim - a person's ability to maintain family life and jobs relies very often on accessing local health care regardless of its quality. But the scandal of Winterbourne shows that very vulnerable people cannot exercise a choice at all. Which would leave them at the mercy of the CQC to ensure "quality and safety" from their health provider - if the CQC is already struggling to identify problem providers can it really be trusted to do so in the future with a vastly expanded portfolio of providers to oversee?

Moreover, while the Panorama programme caught the nation's attention over extreme abuse, it would be terrible if we saw a patient's basic safety as the only target to aim for. The documentary also showed that the patients, in the words of an expert, 'had nothing to do' day in and day out. Disgracefully the Government pays £3,500 a week for each patient to live there but other than basic carer supervision there appears no programme of activities or experiences that might enable a person to learn how to gain independence and move out of the institution. Where is the quality or value for money there? Winterbourne is meant to be a therapeutic environment yet one can only imagine that once Castlebeck, the company behind Winterbourne, creamed off its profits there was only enough money left for basic care.

The same day the Winterbourne scandal hit the nation's papers the alarm was also sounded on the financial fragility of Southern Cross, a provider of care homes for 31,000 elderly residents. City analysts believe that a series of poor decisions taken when it was owned by a private equity company have brought the care home to its knees, generating real fear amongst residents as to what will happen to them if the business folds.

There is no suggestion that care at Southern Cross is in anyway substandard but its financial concerns yet again leave highly vulnerable people exposed by the machinations of a private company in the pursuit of profit over consistent and reliable care.

I only hope that the public recognises that these simultaneous failures in social care are stark warnings of what could happen to our health care system if private companies are allowed to cherry pick services it wishes to offer, gleaning off profit at the very expense of the people it is meant to be providing a first-rate service to. At the very least, the CQC must not be given any more 'providers' to oversee until it has become apparent how widespread its failure runs, people are held to account, and meaningful reforms are implemented.

1 comment:

  1. I am late - I have only just discovered you!
    Wished to point out that the above story dwarfed another that had just come out then got put out of sight as news of Winterbourne came through!
    Have cut and pasted the bit below, but I think staffing levels wil always be an issue when shareholders are in the equation.

    Guardian blog - May 31st 2011

    "Meanwhile the FT website leads with a fascinating investigation into UK care homes. Behind a paywall Sarah O'Connor and Cynthia O'Murchu write:

    Britain's care homes face a deepening crisis as some private-sector companies that piled into the sector struggle with their financial miscalculations amid fresh evidence that they provide worse quality care than their non-profit rivals.

    They go on:

    The quality of care in one in seven privately run homes in England was rated "poor" or "adequate" by the government regulator. The low ratings indicate potentially serious problems such as a failure adequately to feed or clean residents.

    By contrast, the low ratings applied to one in 11 homes run by non-profit organisations or local authorities, based on April 2010 ratings from the regulator, the Care Quality Commission, which were scrapped in June 2010.