We get the kind of older people's services we deserve

Following the high profile demise of Southern Cross, reports suggest that more than 250 of its care homes are to transfer to other operators.  With some 31,000 beds, Southern Cross was the largest care home provider in the country for older people – and its ongoing problems hit the financial, political and social affairs headlines at various stages this year.  The University of Birmingham was directly involved in this process, producing national guidance on how to support older people if care homes close. However, looking back at events, what can we learn – and could this happen again? 

First is the issue of transparency.  Public service providers have historically been subject to a range of rules and regulations that mean it’s always possible to scutinise and, if necessary, challenge what they’re doing.  Councils, for example, have clear codes of conduct in terms of standards required for those in public life and they advertise their meetings, send out their papers in advance and often make their decisions in public.  With independent sector providers, it can be harder to know and understand what’s going on behind the scenes.  With Southern Cross, it seems to have taken a number of very dedicated journalists and commentators to understand the sheer scale and complexity of what was unfolding before anyone even realised there was a problem.  Independent sector colleagues often say there should be more of a level playing field when deciding who should provide a given service – but this extends both ways and perhaps anyone delivering public services should be subject to exactly the same requirements in terms of openness, transparency and ongoing monitoring.

Second, local Councils wanting to buy beds from a large provider can make a judgement about the cost and quality of local services – but probably can’t judge the overall business model.  In health care, a regulator called Monitor looks at the books of all Foundation Hospitals and makes judgements about their financial health.  Perhaps a similar approach is needed for all companies wishing to provide public services?  While Southern Cross now looks like an accident waiting to happen, the truth is that not enough people realised what was happening till too late.

But above all, the story of Southern Cross reveals that we get the older people’s services we deserve as a society.  For too long we’ve been happy to select providers on the basis of price rather than quality – and the result is an inevitable rush to the lowest common denominator where large companies that can cut costs most ruthlessly will win out.  This isn’t the fault of the care homes industry or of the Directors of Social Services who commission them – it’s a product of a wider problem.  Ultimately, if we really cared enough as a society about having good quality older people’s services for all who need them, then we could achieve it tomorrow.  But the sad reality is we don’t.  While many people were shocked by what emerged during the Southern Cross saga, this situation has been gradually developing for 20 years and nobody took enough of a stand until it was too late.  Perhaps now we have a chance for more of a public debate about how much we value older people in our society, what kind of life we want to have together and how we’re going to pay for the services we want and need.

Jon Glasby, Professor of Health and Social Care

Director, Health Services Management Centre