The corporate brokering will seal the fate of the faltering care giant, Southern Cross
Around 30,000 of our frailest citizens have suddenly acquired an anxiety-inducing interest in complex negotiations between executives, landlords and financiers. The corporate brokering will seal the fate of the faltering care giant, Southern Cross – and also determine how many residents of its hundreds of homes will be shunted out. Moving house is rarely easy, and the strain of uprooting is incomparably greater for people who can barely move themselves. Some mix of state action and commercial compromise may yet avert a lethal mass arthritic exodus, but as the crisis unfolds there is an abject lack of guarantees. This sorry tale is, at root, about a failure of responsibility.
The specific ideal of honouring our elders is familiar from Confucius to the commandments, and a more general injunction to protect the weak is also shared by faiths around the world. Alas, such ethical edicts need spelling out precisely because human nature so often falls short. The horrific treatment of people with learning difficulties at a Bristol hospital, brought to light this week by BBC's Panorama, is sadly the latest in a long catalogue of institutional abuses that stretches from the old mental asylums to children's homes. It is not, however, such cruelties which condemn ever-more people to see out their days in residential homes, but rather extended families' reluctance to devote themselves to their elderly as they may once have done. In a world where households rely on both partners working, this reluctance is understandable enough – and all the more so since medical advances stretch conditions of geriatric infirmity which would once have lasted a few months to many years. The real problem is that our collective desire to find someone else to do the caring is not matched by a shared willingness to foot the bill.
The terms of the Dilnot commission, which is due to report in July, make plain cost controls will remain centre stage. Its unarguable but politically poisonous message to baby boomers may well be that those who do not want to care for parents themselves will have to accept big consequences in terms of what they will inherit. The only alternative is a further withering away of quality and coverage. In stark contrast with the health service proper, where commercialisation remains the controversy of the hour, privatisation of elderly care got going in earnest two decades ago and is now all but complete. Few illusions linger about the comprehensiveness of the service, and a Financial Times probe this week suggested poorer care was more widespread in for-profit than charitable institutions. But farming care out has, perhaps, allowed cash-strapped public authorities to imagine the demographic tide of decrepitude as someone else's problem. As Southern Cross teeters, this final delusion is falling away.
Should Southern Cross collapse, councils will have obligations to re-house some but not all of the residents. What they will not have is the power to commandeer assets to meet these duties, assets they mostly sold years ago. When the utilities were privatised, emergency provisions were written into the law to allow the government to seize the reins in the event of corporate failure to make sure, for example, that the lights stayed on. The care of the frail was not deemed worthy of similar protection.
Of course residential institutions are supposed to meet all sorts of standards. But as with restaurant hygiene rules, everything depends upon inspections, which the Bristol debacle have found wanting. While Southern Cross has been free to dabble in sale-and-leaseback property bets that have now gone so wrong, the Care Quality Commission seems oddly constrained: one of its inspectors this week revealed his fears about a "dangerous" situation only on condition of anonymity. That body should start by taking responsibility for speaking frankly about the state care is in. All of us will then have to take responsibilty for fixing it.