Faced with more elderly people living longer and pressure on local authority budgets, politicians had to decide how they could get more bang for their buck.

‘Councillors have been forced to make very unpopular decisions’

The obvious answer seemed to be make greater use of the private sector. In-house services could not compete, so across the country social service departments closed their own residential care homes and made greater use of the private sector. The same value-for-money argument was used to shift spending on the in-house home help service to private sector providers of home care.

Over the last 3-4 years budgets have been cut by up to 30 per cent, with some local authorities claiming that by the time of the next general election they will have endured a 50 per cent reduction in their budget.

Closures of libraries, swimming pools and day centres; withdrawal of services for vulnerable people; and compulsory redundancies have followed. In this climate, where councillors have been forced to make very unpopular decisions, they have not been inclined to increase the contract price paid to private sector providers.

Frequent complaints

When providers protested that they could not recruit or retain staff without increasing wages and therefore costs, the response was local authority staff have not had a pay rise for three years.

What impact has this had on the service provided? Is it better to have a poor service than no service? To answer this question you need to study the complaints; not just the volume but the detail of the experience of elderly people and their relatives.

‘All too often another complete stranger arrives to carry out personal care tasks’

They have frequently complained that careers don’t turn up at the agreed time, are in such a rush that they don’t complete the agreed tasks or do so only by feeding the elderly person while they are sat on the toilet, giving an client a quick wipe round with a damp flannel or providing a sandwich and cup of tea rather than the hot meal stipulated.

Another frequent complaint is the high turnover of staff, meaning that all too often another complete stranger arrives to carry out personal care tasks. Increasingly there are complaints that the staff are too young and inexperienced. These are not isolated complaints or restricted to a small number of rouge providers; they are routine daily occupancies that contracting and commissioning staff are well aware of but which are a direct result of seeking to keep the contract price as low as possible.

So we have moved from a “take it or leave it” public sector service to a “like it or lump it” private sector service.