Introduction

Chapter 2 charted the emergence and consolidation of the privatisation of provision of adult social care in England. This has resulted in significant investment by private businesses, especially in residential and nursing care. The precise amounts are difficult to estimate but some within the sector put it at around £30 billion and rising (LaingBuisson, 2014). This is a significant amount and if the money saved by the Treasury had gone into other ways of boosting adult social care, there would be no talk of it being ‘in crisis’. In considering some of the problems thrown up by the privatisation of provision, it is therefore important not to undervalue the scale of this investment. Those hoping for a rapid and substantial ‘renationalisation’ of the sector would certainly have to make a calculation of the sums expended and the costs of compensation that would be required. Chapter 5 examines this issue further.

Nevertheless, this situation has also created problems that would probably have been less likely to occur with a state-run model. Four such concerns will be examined in this chapter: availability; fragility; exploitation and profiteering; and workforce issues.

Availability

Chapter 3 questioned whether the services and support commissioned are well suited to meeting individual needs and preferences, and examined the declining resource base available for the purchase of provision. However, since private businesses will only operate where the financial rewards are deemed acceptable, there are liable to be problems relating to the availability of any form of care in some places. Evidence suggests that care home places are disappearing from areas that already have a shortfall of beds, while new high-quality facilities are opening for those who can pay their own way – a distinct two-tier system in every respect (CSI Market Intelligence, 2020). Indeed, a CSI Market Intelligence (2020) report notes that of the 20 local authorities that gained most beds, ten were already oversupplied, and at the other end of the scale, 12 out of the 20 local authorities that lost the most beds were already undersupplied.