Social care in Scotland: People before profit!

Iain Ferguson shows why the case for a publicly-owned and controlled care service is unanswerable.

On 19 April 2021, BBC Scotland published the Covid-19 deaths by care home in Scotland, based on Crown Office figures. They made grim and tragic reading. Of the 10,000+ Covid-related deaths, around a third – at least 3,400 – occurred in care homes. Deaths in care homes in Scotland were, in fact, higher than in any other part of Britain. As Public Health Scotland recently acknowledged one factor contributing to that toll may well have been the decision – based on a mixture of panic and ageism – to discharge almost 5,000 patients to care homes between 1 March and 31 May 2020, the vast majority of them untested. Given that 78 of those who were discharged had tested positive, this seems a distinct possibility. The comment of Richard Horton, editor of medical journal, the Lancet, that ‘one of the lasting legacies of Covid-19 will be the silent human destruction it wreaked on the most unprotected older members of society’ should have a particular resonance in a country which prides itself on being more caring than its southern neighbour.

But what the Crown Office figures also highlight is the extent to which the residential care of older people in Scotland is dominated by care providers whose primary concern in not the care of vulnerable people but rather their profit margins. Thus, in a list of the twelve care providers in whose homes most deaths occurred, ten are owned by large private care companies. Leading the pack both in terms of size and also the number of deaths is HC One with 523 deaths. HC One is the biggest care provider in Britain since the collapse of Southern Cross in 2011 (which it bought over). It came under the spotlight when one of its properties, Home Farm Care Home in Skye, was taken over by the Scottish Government last November, following outrage over ten deaths at the home. Private care home providers often plead poverty. Yet a Financial Times (10 May 2019) report in 2019 found that HC One had paid out more than £48.5m in dividends over the previous two years, despite claiming that local authority funding cuts have brought the sector to the brink of a financial crisis. The report also found that HC One had paid no corporation tax since 2011 (it is registered in Jersey and the Cayman Islands) but instead had received net tax credits of £6.5m since a reorganisation in 2014. Ironically, ‘HC’ stand for health and care and its logo includes the words, ‘The kind care company’.

Other major care providers in the top twelve include Advinia Healthcare (195 deaths), Four Seasons (165 deaths) and Care UK (75 deaths). Like HC One, several of these companies have headquarters in offshore tax havens, are financially highly unstable and are typically anti-union. Care UK, for example, became notorious in 2014 when it was involved in a bitter and protracted strike with 70 employees from Doncaster who had been transferred from the NHS to Care UK, only to find that their wages were being slashed by up to 35%.

It is not unreasonable to expect, then, that the ‘Independent Inquiry into Social Care in Scotland’, set up last November by Nicola Sturgeon under former NHS Scotland CEO, Derek Feeley, would have seen curbing of the power of these sharks and vultures as a priority. The most effective way to do this would be by bringing them back under public control. The profit motive has no place in the NHS. Why should it dominate social care? In fact, Feeley’s report explicitly ruled out that option:

The evidence suggests that nationalisation would not in and of itself improve outcomes for people using care … Evidence from the pandemic indicates a correlation between size of care home and quality of care, with smaller facilities faring better than larger ones, but no evident link between type of ownership (public, private or third sector) and quality. We therefore think that the evidence does not support nationalisation into public ownership on the basis of improving the quality of care.

The Crown Office figures quoted above suggest exactly the opposite. And a key ingredient of good quality care is continuity of care, freedom on the part of residents and their families from the fear of losing their home and of staff of losing their jobs. As the collapse of Southern Cross in 2011 and Four Seasons in 2019 showed, however, continuity of care is one more thing that a market-based system of care cannot guarantee. As recently as March 2021, HC One announced the closure of ten homes in Scotland. There is nothing in Feeley’s proposed Social Covenant on social care that would prevent such closures and the massive distress they cause.

The outgoing SNP administration accepted Feeley’s proposal for the abolition of charges for home care, saying they would implement this ‘as soon as possible’ This is welcome, although it will probably take a campaign along the lines of the Bedroom Tax campaign to make this a reality. But we should go much further. The SNP Election Manifesto stated: ‘We believe social care services, just like health care services, should be provided on a truly universal basis, free at the point of use’. Good.

But that should apply not just to home care but to residential care. We should end the system where older people in NHS care pay nothing (rightly) while those in social care homes often pay eye-watering fees. That would mean a social care system, funded through a wealth tax, with much greater democratic control by workers and service users. A good starting point would be a moratorium on any new private sector involvement in social care. Anything less will mean simply tinkering at the edges of a system which the Covid-19 crisis has shown is broken beyond repair.

Iain Ferguson is co-editor of ‘People Before Profit: The Future of Social Care in Scotland’ available from