Public Sector Accountability and Private Sector Failure: the business of care homes for older people in England

In Britain, statutory responsibility for the welfare of older people and private sector involvement in the provision of services has a long history. The contemporary turn towards consolidation and take-over of care homes by international corporations and private equity companies has introduced a significant difference in relationships between the State and the private sector. Across a broad spectrum of policy makers, the regulatory function of the State is assumed to be best performed as a ‘light touch’, involving the minimum necessary accountability mechanisms and inspections. The broader responsibility of the State is to ensure a business environment that is conducive to profit-making as well as to ensure that there is a safety net in times of business failure.

At the same time, the State has responsibility to guarantee security and quality services for service users. Statutory responsibility also extends to vetting and barring functions to prevent the entry of undesirable individuals to care work. At times of business failure or care home scandals, the poor standard of statutory regulation is frequently a major focus of press and public reaction, as is the behaviour of individual care workers.

Recent scandals in care homes in Britain and elsewhere have highlighted alarm over the role of private equity companies and the lengths to which some care home owners will go in order to maximise a financial return. However, nowhere is the faith of policy makers in the superiority of the private sector shaken by the failure of this sector to guarantee security for older people. The tensions between the demands for light-touch and firm-handed regulation are played out in the current crisis in long term care.