I know many of you were dumped out of PCTs, had no choice, or say and ended up working for private providers in the community.
Success has been patchy. Circle lost £5m and paid a further two, to get out of The Hinchingbrooke deal. Serco bailed out, as did BUPA. Virgin seems to be clinging on.
As someone who has run businesses for most of their adult life and straddled local authorities and the NHS for two thirds of it, I can see the story from both ends.
The private sector can be nimble, innovative and quick to adapt. The NHS is solid, reliable and cautious.
However, they have something in common. They both need money to run properly. Yes, the private sector has to make a profit. Without a profit there can be no reinvestment, no development and repayments to the bank or shareholders.
So, if I were to tell you a major provider to health and social care looks very flaky, would you care? You should.
The company is Four Seasons. The majority of the residents in their homes have their fees paid by social services. We all know what has happened to social care budgets. In consequence some local authorities are paying around £385 a week... barely enough to keep the lights on.
In addition the company is faced with the introduction of the living wage. A good thing too, I can hear you say. Quite right. But, in an
organisation
, employing over 30,000 staff, with no way of adjusting prices to pay for the extra and no operating surplus... it's a disaster.
With some justification you might argue the company is a victim of its decisions. It has a debt of £510m. The owners borrowed heavily to raise the money to buy the business. They have to find about £1m a week to service the debts.
The credit-rating agency, Moody's, has cut the company rating to junk status; accounts show FS's earnings have about halved. If it goes broke, 450 care homes and their residents are at risk.
Let's hope they are too big to fail, or there is a Plan B on a shelf somewhere?
We're the company reckless? I doubt the lenders would have given them the money if their biz-plan didn't stack up. Who would have foreseen the collapse in local government funding?
I'm pretty sure the scrape Four Seasons are in, is not unique. The CQC are now responsible for the financial viability of care homes... as useful as a red light in Grand Theft Auto.
According to the CQC, half the care homes in the South of England need to improve. The fruitless folly of inspection, as a way of improving standards, was never so well illustrated than by this forlorn quote from the CQC;
Asked how many homes needed to improve... 'Too many' was the answer.
Are all care home providers money grabbing idiots that couldn't run a reunion in a gin factory? I don't think so. I think most of them are like the South of England, facing the same problem; providing a first class seat for a cut price ticket.
There is not enough money in the system for the authorities to pay a decent rate for care. That is why private families pay £1,250 a week, some cases, £2,500. They are subsidising social services. Bet you thought it was supposed to be the other way around!
There will be a collapse in the care home market. Company Watch data, covering 20,000 homes, shows a funding black hole of half a billion pounds. The signs are all there but no one is doing anything.
The pressures of elder care are well beyond an austerity driven government to resolve.
Beyond the 2% LA precept-surcharge to provide a resolution.
The slums that some of our most vulnerable citizens are forced to live in, beyond the CQC to revive.
Age is an issue of mind over matter. If we don't mind, they don't matter..
