Social Care

Introduction

Social care in England has been substantially privatised. In Wales and Scotland the extent of privatisation is lower, but the same lines of development are clear.

This process means that the most vulnerable sections of society are at the mercy of owners of firms whose only interest is how to turn a good profit; we are talking about the old, children, the sick, and those with physical and mental disabilities.

Scandals sometimes hit the headlines, but behind these is a vast and silent sea of human misery.

The crisis in the provision of social care has an impact on hospitals. Today 1 in 7 beds in NHS hospitals are occupied by those who are medically fit to leave but for whom the follow-up care is not available, either because capacity is limited or poorly adapted to need, perhaps more frequently, because it is unaffordable.

The solution which many are proposing is for the creation of a National Health Service. This could include:

• Nationalise the largest care companies – both those providing residential care and those providing care in the home;
• Restore the approach of the National Assistance Act of 1948 (ie passed the same year that the NHS was set up). This made local authorities directly responsible for the provision of a host of community care and support services. Such services would include:
• residential care
• care in the home,
• children’s care homes,  
• Day care centres for the old and the house-bound; sheltered housing.
• Care of people with learning difficulties, and mental and physical disabilities;
• Youth centres.
• Reversal of the squeeze on local authority finances. Central government grants reduced by 40% in real terms between 2009/10 and 2019/20. They were £46.5 billion in 2009/10 and £28 billion in 2023/24.
• Create a system of training, qualifications and pay for social work of all types, from social workers themselves through to the currently very low-paid work such as home visits to prepare sandwiches or oversee medication.

Privatisation and profit

30 to 40 years ago care in the form of residential homes for the old and children, together with care in the home was substantially organised and provided by local authorities employing the carers and owning the homes. Today nearly 100% of local authority spending on  adult social care is for outsourced provision – either in residential care or in the home; for children about 50% of local authority spending is on outsourced provision, retaining services such as fostering, adoption in-house.

According to a recent government-sponsored report: “For adult social care, public provision has virtually disappeared, with 96% of residential services now outsourced ….. In children’s social care, over 80% of children’s homes are operated by for-profit companies.”

This compares with the situation in 1968 when the private sector provided 10.% of residential care and the public sector provided 66%. The voluntary sector provision has also declined being 23% in 1960 and just 4% today.

Care provided in the home shows a similar process: “by 2018 98 per cent of council-funded home care hours in England had been outsourced to independent sector providers.”

The process has been promoted and legislated for by successive governments. It began with Thatcher’s National Health Service and Community Care Act which introduced into both health and social care ‘the purchaser-provider split’. The local authority’s responsibilities changed from being a provider of social care to being a commissioner and purchase of carer provided increasingly by the private and voluntary sectors.

The Care Act 2014, made local authorities responsible for the promotion of the “efficient and effective operation of a market in services for meeting care and support needs”.

In 2026 there were around 5,500 providers of care homes in the UK operating about 11,300 care homes. The largest 26 providers provide about one third of the beds. Many are owned by private equity firms and sales of such companies are frequent and can boose the overall profitability of the investment.

Profit levels, for instance among providers of children’s care homes are high: according to a government report ,“for the largest firms, which represent a substantial proportion of independent provision, prices and profits are materially higher than we would expect.”

Profits can be gouged from the process is a myriad of ways. Many medium and large care companies run two businesses: one is a care home operating company and the other is a property developer or rental company – building and then  renting out care homes. Overall an average of £3,181 profit per bed per year is made by landlords from the rent paid by all for-profit homes. Where care homes are operated on a leasing basis rent “typically absorbs 20% of revenue for homes subject to leasing”.

The problems created by private ownership

• Poorer standards and outcomes. Inspection ratings are consistently higher in public adult care homes and children’s homes and larger care homes are associated with a worse quality of care.
• Low wages. As the staff are the largest cost for care providers wages, conditions and numbers employed are squeezed. Low wages are endemic, skills training exceptionally limited, and time allowed to spend with people who need real care is curtailed.
• Failure to invest in capacity – profits will rise in conditions of scarcity.
• Development of residential care is geared to the higher end market so that deprived areas have fewer facilities. Local authorities may be forced to send children in their care out of the area.

See also:

The Case for Insourcing Social Care: https://www.apse.org.uk/sites/apse/assets/File/Andy%20Mudd%20PDF.pdf

We Own it Care Belongs in Public Ownership:  https://weownit.org.uk/public-ownership/care-work