An inspector calls on privatised care

Any day now, the Government is due to bring out a White Paper on the social services and we will no doubt hear Health Secretary Stephen Dorrell complaining again about "politically correct" social workers. But the real reason the Government is acting is straightforward: it is giving in to lobbying by small firms who see a rich seam of gold in the growing numbers of old people needing care.

The private care industry, aided and abetted by the Department of Trade and Industry, is after two things. One is the privatisation of remaining council homes, and the other is less regulation by councils of the quality of care private homes have to provide the growing numbers of frail old people.

The "care industry" is mostly made up of small firms; and their interest group, the Federation of Small Businesses, has been bending ministers' ears with, it seems, some success. Their pitch is couched in terms of saving public money: by closing council homes, the state could save pounds 750m on cheaper places in private homes.

The federation attacks the whole policy of community care, which tries to keep old people in their own homes as long as possible, because it has left many home-owners with too many empty beds. They have been telling ministers that community care wastes money and it would be cheaper to shovel the old more quickly into the spare beds in private homes. In the document they have just published, it is surprising to see how nakedly they promote business needs ahead of choice for old people. While there is nothing wrong in principle with private provision, it is the quality of care that matters, and that depends on rigorous inspection.

But now the inspection system itself is also under attack and the White Paper is likely to undermine it further. The Department of Health, under Stephen Dorrell, looks set to take up the home-owners' view that officious local authorities are being far too strict in their inspections. The White Paper will reinforce a circular that was sent round to all local authorities over a year ago, telling them to regulate private care homes with a "lighter touch". But what exactly does that mean?

Take the London Borough of Croydon as a case study of the battle between the Government-backed home-owners and the local authorities trying to make sure their old people are decently looked after. It is a big borough with a fairly large population of old people. Already there are 100 private care homes and eight local authority homes, so it is hardly a case of public sector provision squeezing out private. Croydon says the council needs a few homes of its own for the severely demented whom the private sector does not cater for.

Yes, the council's homes do cost more. But that is because the staff are recruited and trained to higher standards than in much of the private sector. Croydon council staff are paid a living wage (hardly princessly - it's about pounds 5.50 an hour). Private sector conditions are generally lower. Nationally, there are some half-a-million women working in care homes at exploitation wages, some as low as pounds 2 an hour. (Incidentally, a minimum wage would not lose them their jobs: these homes are staffed at minimum levels anyway, so their wages would rise and private home costs would be closer to local authority home costs.)

Last week, the Croydon official responsible for purchasing social care for the elderly wrote an alarming letter to the leader of the (Labour- controlled) council. She lists various examples of poor practice in private residential homes which include: "Serious concerns [over] inappropriate medication being given to residents. Convictions for fraud. Residents' personal finances mishandled and mis- appropriated. Poor record-keeping. As a result of concerns, three homes were compulsorily closed down in the private sector during 1995/6. One home-owner was prosecuted for running an unregistered home."

Croydon council has been coming under strong pressure from local home- owners, especially those belonging to the South London and Surrey Care Homes Association. Croydon, they say, is running an inspection unit that is far too rigorous. Naturally, there is going to be tension between the inspectors and the inspected. But what the council did not expect was intervention from the Department of Health; the junior minister, Simon Burns, has weighed in on the care home owners' side. In a letter sent in January, he said he was "struck by the apparent breakdown in relations between a section of the independent sector providers and the inspection unit. This seems to have been caused in the first place by the sort of regulatory practice which we had hoped to avoid". He refers them to that circular calling for the "lighter touch" in inspections.

Christine Ferrier, leader of the local home-owners' group, protests that Croydon and other local authorities have not been implementing the "lighter touch". She told me: "Of course there is a need for inspections, but we want to be treated as businesses and not as social services. Of course there should be basic standards, but each home should be allowed to evolve in its own way. There has been oppressive interference." She wants inspection units taken out of the specialist social services departments and given to trading standards officers "who understand business".

What exactly are these inspectors' "oppressive" demands? She gives an example: "Eighty per cent of residents say they want their own room, and 20 per cent want to share double rooms, so the inspectors say that we should offer that ratio." One of the Croydon home- owners complaining to the minister protests that inspectors spent two days on their annual inspection of the home, and this was too much. For its part, Croydon says it takes that long to observe what goes on and to examine all the books and records.

Many hard-pressed areas cannot even inspect to that standard, according to Marian Whitton, chair of the National Heads of Inspection, who runs Barnet's inspectors. How "oppressive" can inspectors be when they are spread as thinly as her department? Three inspectors cover 110 residential homes, one covers 33 nursing homes, six cover 650 child- minders, and two cover 100 children's nurseries, day-care and after-school schemes. (Astonishingly, small children's homes with fewer than four children don't need to be registered or inspected at all.) She says her inspectors are spread so thinly that they are very reluctant to take anyone to court, as it ties them up for too long.

Does that sound like over-regulation or over-protection of a group of people who are vulnerable, and dangerously hidden from public view? All the scandals, all the evidence of recent years point in one direction - closed institutions need frequent and effective monitoring. But the way this White Paper is shaping up, the interests of the frail old come a clear second. It is business that comes first.