1. SOCIAL CARE POLICIES, NATIONAL GOVERNMENT AND PRIVATE INTERESTS JANE LETHBRIDGE PUBLIC SERVICES INTERNATIONAL RESEARCH UNIT, UNIVERSITY OF GREENWICH, UK

2. Objectives Changes in national social care policies How private interests have become more involved in social care Impact of these changes on users of services and workers Implications for regulation

3. NATIONAL TRENDS Funding Taxation Long term care insurance Co-payments/user fees Benefits / payments for people to purchase their own social care services Carers’ allowances

4. NATIONAL TRENDS Provision Changing role of government Municipal authorities – commissioning and regulation Introduction of business principles to public sector Internal market Commodification of care

5. NATIONAL TRENDS Move from public sector to private/ NGO sector even if funded by public sector Decline in care homes/ increase in home care ‘Assisted living’ – accommodation and care Individual purchasing of care

6. CENTRAL/EASTERN EUROPE Financing Financing still from state budgets Little long term care insurance Some co-payments/ user fees

7. CENTRAL / EASTERN EUROPE Provision Institutional care Long waiting lists for nursing home Social model of care – new Development of decentralised care Local networks of care providers Involvement of private sector/NGOs

8. EUROPEAN UNION No specific legislation care of older people but ‘Green Book on European Social Policy’ –role of partnership Influence of internal market and competition legislation Will social services be defined as a Service of General Interest or Service of General Economic Interest?

9. NATIONAL CARE MARKETS Majority small private providers Some consolidation taking place Increase in regional consolidation Small numbers of multinational companies Increased involvement in private equity financing

10. UK PRIVATE INTERESTS BUPA Care Services Non-profit17,631 beds£357 million turnover Four Seasons Healthcare group (2004) Alchemy venture capital group sold to Allianz Capital Partners (part of Allianz insurance group) 15,315 beds£105 million turnover Southern Cross Healthcare Ltd 2004) Blackstone Group 7,741 beds£105 million turnover

11. UK PRIVATE INTERESTS Craegmoor Group Ltd (2001) Legal & General Ventures – syndicated % interest to group of private equity investors 5,828 beds£125million Westminster Health Care group PLC until 1999, since owned by financial institutions 2004 sold by 3i to Barchester Healthcare Group 5,547 beds£142million

12. FRENCH PRIVATE INTERESTS ORPEADr.Marian 33% Other founders 25% Investors 10% 6,541 beds€192 million Medica FranceBridgepoint Capital 70% Executives 30% 6,332 beds€210 million MEDIDEPORPEA 29% Other shareholders 71% 4,918 beds€250 million DOMUS VIYves Journel 68% Barclay Capital 24% 4,499 beds€150 million

13. NORDIC REGION ATTENDOBridgepoint Capital (2005) SEK 1,444 million CAPIOSold to Attendo August 2004 CAREMAOrkla, Ovriga, Jarla Investeringar AB, and the Saven family SEK 2,356 million ISS CarePartner 49% ISS /Mgt buy out Feb 2005 Joint venture ISS EQT III fund (part of Wallenberg family)

14. BROADER INVESTMENTS ‘Assisted living’ concept – property investment and social care provision Alliances public/private/non-profit Companies providing range of services – social care, security systems, care monitoring, accomodation

15. USERS OF SERVICES Care of older people Services started as poverty relief and welfare assistance Attitudes towards older people

16. USERS OF SERVICES Increased targeting of services to people with high dependency needs People with low dependency needs receive fewer or no services Higher income groups - pay for services Lower income groups – informal care from family – often women

17. USERS OF SERVICES Varying levels of quality - nursing homes and home care services Quality of private providers questioned Systems of regulation still developing

18. CARE WORKERS % of workforce Denmark 10% Netherlands 7% UK 5% Hungary and Spain 3% Majority workers women Increasing ageing of workforce Increasing use of migrant labour

19. CARE WORKERS Changes in organisation and status of care workers Individuals purchasing care – leading in some countries to care as profession Privatisation of care homes – workers often have less control over work

20. CARE WORKERS Low pay – variations between countries Nordic region – higher pay in public sector UK - many jobs part time, temporary, limited benefits Recruitment of migrant labour – often exploits skilled labour Cash for care work – results in use of undocumented, unskilled labour

21. CARE WORKERS Difficulties in organising home care workers as isolated workforce Unionisation often more difficult after privatisation Public sector care workers – more likely be organised

22. IMPLICATIONS FOR REGULATION How to protect the older person and assess whether care provided in appropriate and timely way How to protect care workers from poor working conditions e.g. domestic settings How can governments regulate the ownership of care homes – concept of “responsive regulation” –need better understanding of private companies