David Craig, on April 17th, 2020(Friday blog)
Quite rightly, most of us have been impressed at how many front-line NHS workers are risking their lives working with Covid-19 Chinese plague victims, often in difficult conditions and often with insufficient personal protective equipment (PPE). And at least 20 NHS workers have lost their lives to the Chinese plague which accidentally leaked from a virus research laboratory in Wuhan.
Jumping on the ‘angels and heroes’ bandwagon?
But I’m beginning to become a little bit queasy at how the Social Care sector seems to be trying to jump on the healthcare NHS ‘angels and heroes’ bandwagon.
Daily in the media we see care home bosses bleating about not having sufficient PPE for their staff and not having support from the Government.
To be sure, caring for people with learning difficulties or with dementia is a pretty miserable and exhausting profession. I know because a member of my family works in care homes and in palliative care. The shifts are long, changing adult nappies or trying to calm down loads of crazy grannies or being asked to wank off horny but impotent grandads isn’t most people’s idea of a fun working environment. And few care homes pay a penny more than the minimum wage they can get away with.
Moreover, while some care homes provide two or three days training for their staff, others (especially care staff agencies) provide no training at all. Instead they just tell new recruits to watch a few training videos from companies like Social Care TV.
So, I’ve no doubt that front-line care home staff are doing an admirable job in difficult circumstances for pathetically small rewards.
Money, money, money?
But care homes aren’t NHS hospitals. They are mostly privately-owned and privately-run and are in business to make a profit. As one report on the sector warned “Many care home operators are structured as private businesses, with complex ownerships, including individual or institutional investors, hidden from view”.
Average care home costs for a patient with dementia can very from £30,000 a year for an absolute dump to £60,000 a year for a more top-of-the-range service:
Let’s just take one company I know a little about – we’ll call it the LCG.
The LCG specialises in dementia care and owns four care homes – A****** (45 beds), B********* (72 beds), R********* (69 beds) and S****** (48 beds). That’s 234 beds in total. At the last series of Care Quality Commission inspections, 208 of these 234 beds were occupied – an occupation rate of 88%.
The LCG positions itself as providing top-of-the-range living conditions. So let’s assume that the LCG charges near top-of-the-range rates of say £55,000 a year. Then with 208 residents, the LCG is taking in £11.4m a year in fees. Specialist consultants in the care home business have calculated that the average care home profitability is around 8%, though industry sources suspect that profit margins are actually much higher due to a whole lot of mysterious extra charges.
But even if we stick with the 8% profitability, this would mean that the LCG is making profits of at least £900,000 a year for its owners. And there are many care home groups larger than the LCG
One might have thought that companies making this kind of money could afford to buy PPE for their own minimum-wage staff instead of bleating endlessly about how the Government is supposedly letting them down.
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Very well said David. A few facts at last about so-called “Care Homes”. The very best are, as you rightly say, excellent. They offer a high standard of care at an equally high cost – around £5,000 per month in the South East where I live. That gives residents – obviously – a bed in a moderate sized room, private bathroom facilities, heating and lighting, food and laundry. They also get assistance with personal care and visits to the loo if necessary. Then come the “extras” for which additional charges are made – hairdresser (particularly important for ladies who are still compos mentis and take pride in their appearance), chiropody (medically essential for residents with diabetes and highly desirable for those whose stiff joints prevent them reaching their feet), a bit of booze or a newspaper to relieve monotony and brighten the day. In short, for anything other than basic bed and board additional charges are levied.
How can this level of care home charges be justified? I live alone and my level of income disqualifies me from any additional support such as Pension Credit, yet I am expected to pay all the normal domestic bills on my small bungalow, feed and clothe myself, run a car, and finance any holidays or leisure activities on a net income equivalent to two months’ care home charges.
Much of this excessive cost for care must be laid at the door of the Labour Government, which insisted that every “client” in a care or nursing home have their own personal bathroom facilities. I was working in health care at the time and almost overnight dozens of modest residential homes, catering for working or lower-middle class ladies and gentlemen whose requirements were for care in a friendly, unpretentious environment similar to that which frailty had forced them to give up, had to close almost overnight. Their architecture just did not lend itself to installation of a number of separate bathrooms, never mind the prohibitive cost. I could point out today the locations of several such erstwhile care homes in my home town. This insistence on individual bathroom facilities is pointless anyway, since many residents require assistance to shower, wash or toilet themselves and it doesn’t matter in the least whether the bathroom is in which this all takes place is subsequently used by another resident.
The requirement for individual bathrooms forced many Local Authority care homes to close as well – or rather, provided an excellent excuse for Local Authorities to offload onto the private sector what had long been burdensome. The LA homes were excellent for certain ladies and gentlemen, particularly those who had lived on Council estates all their lives, moving from 3-bed houses to small bungalows as their families moved away, then into LA care homes when they’d lost a spouse and could no longer cope. Often on admission to a local LA care home people rediscovered old acquaintances.
I and family members currently working in the NHS have been asking from the start of this plague pandemic why the State is being expected to pay for PPE for care home workers when the owners must be making enormous profits from the fees paid by those in their care. Because those fees most certainly do NOT adequately remunerate their staff, who are mostly on minimum wage and often ill trained for what they are required to do. In the present emotionally over-hyped state of the nation it is all too easy to over simplify the issue of lack of PPE for care staff. It is the absolute requirement and duty of our Government to ensure that all NHS staff, at all skill levels from cleaner to consultant surgeon, have adequate PPE and this they have, so far, signally failed to do. I heard only yesterday from someone “in the know” about the utter chaos currently reigning in distribution of PPE. Yesterday one family member joyfully informed me that at last she has what she needs – scrubs provided personally by a newly formed GoFundMe charity! This morning we hear that Barbour, the wax-coat manufacturer, are urgently tooling up to mass produce protective overalls for medical staff, but it seems that before the garments can be released for wear they have to jump through a series of “safety testing” hoops. Given the usual empire-building procrastination of Gvt. departments, I guess we can expect the garments to appear on the wards some time next year! What idiocy! Better, it seems, to go onto a Plague ward with no PPE than to take the tiniest risk that your cover-all coat might not be totally impermeable to a single virus! If I were a medic I know which I would prefer!
So back to masks and other gear for care home staff. Let us by all means provide them with PPE at the earliest opportunity. They merit it and should have it. But charge the Care Home owners the full cost of this provision and ensure those bills are paid. Furthermore, make it a legal requirement that in future all such homes hold adequate supplies of PPE against future Plague visitations.
Why shouldn’t they ask for government support, every other company does, including the billionaire Richard Branson? Let’s not forget that the government encourages this and nothing demonstrates it more than the bank bail outs. The reason for this is that we do not have true capitalism, we have state controlled capitalism. Market driven competition is essential for capitalism to work, but companies do not like competition and the big companies lobby governments to ensure that regulations benefit them and not the consumers. Governments use the regulations to convince us they are protecting our interests, when they are not. They are looking after their own interests since most senior politicians are on the boards of companies or will be when they leave politics.
State controlled health care is a disaster. It distorts individual decisions and everybody has to accept one size fits all when the useless governments are in control. Margaret Thatcher’s has been misquoted many times about “society”, recently by Boris, who now seems more socialist than Corbyn. Thatcher believed in personal responsibility and not state dependence. When the state provides free but inadequate health care people do not have to bother making provision and so, what is ultimately the most important thing in their life is ignored to spend on luxuries and they wonder why there are waiting lists for NHS treatment.
Those who take responsibility for themselves are penalised by the state, and the irresponsible are rewarded. This is the basis of the care home policy. Those who save have to pay for their care, perhaps in care homes with poor standards, whilst the irresponsible have their care paid for by the state. People using private health care and education have to pay twice. There should be a means to opt out.
I don’t understand the views of Stillreading, why should people get services free of charge just because they are in a care home? Single people are ripped off by council taxes, something that Thatcher tried to address with poll taxes but the masses object to fairness. The government is responsible for heath-care policy and funding. The problems with the NHS are due to the useless management who always blame the government for their failures and they know they will get public support for this. This morning we are told that the director of an NHS trust has asked the BBC for the telephone numbers of Burberry and Barbour, so utterly useless that they cannot find the numbers themselves. Stillreading wants care home owners to pay for PPE, why should they, they are not charities, the people wanting the service should pay. The something for nothing culture needs to end, because ultimately we will all have nothing.
I agree that we need to end the “something for nothing” culture. But people in care homes are not having anything for nothing. Most are people just like me – people who have worked hard all their lives, deprived themselves of a lot of indulgences when they were servicing mortgages at around 16%, people who at probably took comfort, as did I, from the thought that they would leave something to their children. Now they are too old to manage alone at home every penny of their accrued means – savings, investments, the value of their home – bar, I think, £16,000 – has to be handed over to fill the ever grasping claws of care home owners. Who not infrequently are, particularly in the case of the “chains”, wealthy foreign investors. In other words, the Nation’s elderly are just another bit of the family silver to be sold off to the highest bidder, alongside ports, water and sewage services, electricity, steel and all the rest. As for those who have squandered their all and look to the State for support at the end of their lives, well, there have always been such and doubtless always will be. It’s a basic of the human condition for some, to be feckless and think nothing of the morrow. In the days before the Welfare State such folk begged on the streets or (along with the genuinely unfortunate) went into the workhouse or latched on to merciful better off relatives. I’m not saying I like handing out State support to all, regardless of how profligate they have been, but what is the alternative? To see men and women in their 80s starving and hunched in doorways until they die on the streets? There should be a middle way – State provision of reasonable quality care provision, no frills but offering dignity and compassion, for about the same total cost to the individual as running a modest home, but with the alternative of high cost care for those able and willing to pay. And yes – to some it does seem unjust that parents who pay thousands per annum to educate their children privately should also be contributing, through taxes, to the education of others’ children, but that has pertained since the 1880s when education for all up to a certain age was made compulsory. Let’s be thankful we still HAVE wonderful fee-paying schools for parents who care sufficiently to cough up, but let’s also be thankful that we do have State health care, even if the Managers seem to have a limitless talent for incompetence, rather than be like the USA with its essentially “if you can’t pay hundreds of thousands of dollars, you die” philosophy. The States system always seems to me to constitute the ultimate argument in favour of a National Health Service, available to all and free at the point of service, funded through taxation.
Spot on A Thorpe. We might have nothing sooner than we think!
The magical middle way,Stillreading.I am afraid socialism doesn’t do it,it is a utopian illusion which keeps taking until we run out of money.Oh but now apparently we can just keep printing it and everyting will be OK.Weĺl we are soon going to see where this leads us.Totalitarian dictatorship or war are the usual outcomes.Judging by recent events the former seems likely.Do not imagine this cannot happen under a pseudo conservative government.
Stillreading, I agree with your point about people who “do the right thing”, but it is another aspect of true capitalism. It is not just about trade it is about wealth creation and everybody participating in the accumulation of capital, not just “the rich”. The capital is then passed down the generations but we cannot do it because the thieving governments will take every penny they can get their hands on. They do not want a wealthy, self-sufficient population, they want a population that depends on them for support. Governments have no money to support anybody except by taking from the responsible.
You rightly point out that you want to pass your wealth to your children. My parents were the same. They rented a two-up, two-down terraced house in south Yorkshire with no hot water and a shared outside toilet. It was owned by a local farmer and when the government introduced modernisation he could not afford to carry it out and so he sold the houses at a low price and my parents managed to buy it and got a grant to modernise it. They were lucky to be in that position and it was because they recognised, through poverty, that they needed savings. Eventually, the house had to be sold to pay for care. I felt sorry for my mother who was the one alive at this time after a life of saving and going without. Others in the care home were state funded, but my view is that it cannot be right for the state to pay when people have assets. If the state pays for care when there are assets, it is also equivalent to taxpayers handing money to the children of people in care. Neither situation is acceptable and it is because of state dependency, that is how socialism fails everybody.
The other important aspect of the care crisis is that children used to care for parents at home. My mother did this for her parents. All five of us living in the house. Both her parents died at home without much support from the NHS. It wasn’t needed because I suspect they were much healthier than people today and they had not been kept alive by pills which only results in many elderly living with conditions which are impossible to care for at home. This is another failure of state health care. The state will not make the difficult decisions that we would make if it was our responsibility. When there is limited money it does not make sense to keep people alive in conditions that nobody I know wants. Euthanasia should be a choice for those who want it, so that wealth is passed to younger generations and not wasted on extending life with no quality of life. It should be our choice on what we do, based on our assets, and nothing to do with the government.
NHS staff like police and prison staff etc volunteered to do jobs with potentially dangerous risks either all the time like a prison officer or occasionally like the other two. Valued and appreciated yes but my heroes that I will virtue signal for are the supermarket check out staff on minimum wage who didnt but find themselves right in it.
I agree totally Thorpe with your comments about keeping people alive well past their due date. I know I don’t want it for myself. Following an accident less than 3 months ago I had to have a GA lasting about 4 hours and I insisted that a DNACPR be put in place before I went to Theatre, as I had no desire to die under anaesthetic, be revived and then wake up to find myself physically or mentally incompetent for the remainder of my life. I knew – still know – that death would have been preferable. I certainly want euthanasia when what I regard as normal life is no longer possible. I certainly do NOT intend to go into a care home if I can possibly avoid it. My great fear is that I may have some kind of cerebral accident, be regarded as incompetent, and find myself in one anyway. Many, many people feel as I do, yet no Gvt. will grasp the euthanasia nettle and wring out its sting! Without doubt a large proportion of the covid-19 deaths have occurred in people who, not so many decades ago, would have previously succumbed to other morbidities. Of course there is truth in much else you say about the Welfare State and taxation, but what are you or indeed anyone, able to propose as realistic and acceptable alternative?
As for what is to happen in future, Hardcastle, I am very fearful. The Police have been given powers to control and interfere with the daily, private life of citizens which may be desirable in this present crisis but which they will be very reluctant to relinquish. Set this and the current incarceration alongside the (undoubtedly correct) assertion that city air is cleaner because there are no cars and the ongoing “climate change” issue, alongside our Government’s declared intention to reduce carbon emissions, and we are well and truly set up for ongoing controls on where and when we can drive, where we can go, inquisitions into why we need to go there, etc. etc. and the requirement to apply and pay for some sort of “long distance driving permit”. I can see oldies like me being told that since we have free bus passes, we no longer need to drive, so we won’t be permitted to. Aided and abetted by Government we are sleep-walking into a Police State and it terrifies me. The unresolved question so far is just how much will the UK population, generally noted for its law-abiding nature, be prepared to take before breaking out?
Stillreading, I agree with your last post, and I usually do agree with everything you say. I obviously saw something different in you first post of today.
You put your finger on the problem – what can I or anybody do to propose a realistic alternative. I feel have proposed an alternative, which is classic liberalism or capitalism, but it is not my idea. I started to think about the problems and then found a ready made solution. It has been around for years. Many think we have a capitalist system, but it is what I prefer to call state controlled capitalism, which is effectively no different to socialism from my point of view. Capitalism is just an idea, it is the details of how to get from here to there that need to be worked out. I have come to the conclusion that it is impossible. I think we will go down the socialist path until we end up in complete poverty and then we might find a way back. Capitalism was proposed at a very different time to now. I wonder if modern life is too complex and made more difficult by the huge population growth and globalisation, because a change must be worldwide.
My vision of an alternative would be making political parties illegal and all politicians would be independent. They would not be allowed to hold any position in business during or after their political career. Businesses would not be allowed to lobby governments, only consumers. Politicians would then have to co-operate to get things done and with the electorate and consumers in control. Their number would be drastically reduced, doing only what we cannot do for ourselves. The present concept of an equal outturn for all would be illegal. Humanity has been successful because we do not have equality of outcome and this is what encourages entrepreneurs with benefits to all. We have to accept that we are different and that is the incentive to do better. Socialism destroys that. Education is vital to everybody participating in our success and the belief that we can control the climate sums up how useless our education system has become.
I hope we can both enjoy our remaining years, because the standard of living we have worked to achieve was quickly disappearing before the recent closure of the economy. I hate to think what the rest of this year will bring, but I know where the blame lies – Boris doing a Corbyn – the evil twins of the 21st Century.
There shouldn’t be a steep price for care, when there’s a lack of it. Elderly have done their bit for the country so it’s about giving back. They shouldn’t have to sell their home for their care it’s not fair. And in some places they need to hire people with a good giving nature. Enough said