Public vs private – a stone we’d rather leave unturned?

Posted on March 2nd, by geoff in CT blog. 5 comments

By Caring Times editor Geoff Hodgson

A friend of mine is an unreconstructed socialist. Whenever we meet for dinner we end up having the old debate about public versus private. With public transport and utilities I find myself in accord with him, but then we move on to the NHS and social care, and sparks begin to fly. We always end up agreeing to disagree and move on to safer topics like the Middle East, but these debates do help me to sharpen my thinking about social care.

More importantly, it makes me realise that there are many people who think as my friend does; that all private care providers put profits before people and pay their staff peanuts in order to reap their ill-gotten gains. I suppose I must dignify this specious perspective with a brief refutation (although I could go on for pages). Briefly then; monopoly stifles change, and poor practice, malpractice and the ascendancy of ‘the system’ can quickly spread and establish itself thoughout the entire structure. Whistleblowing is made that much more difficult (where else could you find a job in social care, were there only the one provider?). That’s enough to be going on with.

My main point is that this public/private polarisation is still with us in spades (and many, like my friend, confuse ‘not-for profit’ providers with public provision). It will take a long time to heal the rift and it has tended to become (forgive me) an ‘elephant in the room’ where politicians, commissioners and yes, providers, attribute problems to anything other than this fundmental attitudinal division.

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5 responses to “Public vs private – a stone we’d rather leave unturned?”

  1. Martin Green says:

    I agree Geoff that there is a lot of dogma in this issue and lots of people go into a view that the public sector is wonderful and the private sector is only interested in profit.

    The evidence says something different. The worst scandals and the most appalling mistreatment has been seen in the public sector, mid staffs being the worst example. There is also a vast and enormous funding disparity between the two sectors, The public sector might not make profit, but with huge amounts of money going to support infrastructure and enhanced staff benefits, they certainly do not put everything into the front line service.

    The truth is scandals and inefficiencies happen in all sectors and we must focus on the outcomes to the people who use services, rather than debating the ideology of ownership.

  2. Bob Ferguson says:

    Geoff, your trawl of the 1980s archive suggests you have struggled to find a topic for this week’s blog! “Public-v-private” died a death as a serious debating item many years ago, roughly, around the time Clause IV was laid to rest.

    And that applies to both sides of the ideological divide – with the exception of your dinner parties, obviously. Even the looney right (in the shape of one N. Farage – once the effects of his last pint have worn off) shrink from proposing privatisation of the NHS. There are many more pressing subjects in the 21st century.

  3. Geoff, I wonder if part of the issue isn’t also that the NHS, when it’s thinking about integration, only thinks of organisations in its own image, and therefore sees local authorities as their equivalents in social care, even when – as with the vast majority of provision – it isn’t the case, and hasn’t been for decades. But it is very convenient for local authorities to present themselves in this light and therefore as having a role in market-shaping, although the market is no longer theirs to shape. And there are many examples of excellent care provided by the independent sector, and of social care providers themselves taking a lead when it comes to integrating with healthcare.

  4. John Burton says:

    The key to this public good / private bad question is the core task. You would think that the clear purpose of public (and charitable) care services would be totally focused on providing good care (the core task). And it seems axiomatic that “private” providers would be in the care business to make money. Admittedly, there are companies that are in it solely to make a profit, but much of the sector is not like that at all.
    Take the example of the couple who set up a care home because they love the work and saw that there was a need to be met, and they found that they could not create the homely care that they aspired to in the NHS or in larger public or charitable organisations. They have to make money in order to invest in the home and to make a living, but many of them are now struggling because public organisations and government (in many forms) have lost their sense of core task and have imposed systems that degrade the core task.
    The same happens to small not-for-profit providers.
    Larger providers (for profit or not) may also be clear about their core task but have found ways to comply with this public interference.
    Many of the problems in social care stem from the failures of the government sponsored organisations to stay focused on social care’s core task. They are working to their own agendas including the protection of government and the perpetuation of their jobs at the expense of other people’s honest livelihoods! So, social care providers find themselves having to work for these bureaucracies rather than for their clients. It is an insidious form of state control. And I write as someone Geoff might describe as an ‘unreconstructed socialist’!

  5. Rekha Elaswarapu says:

    The inter-sector warfare is an ongoing debate. Problems are in every sector and so is good practice. May be it is time to focus on the person at the end of it all – the service user who neither understands or cares whether the service is public or private as long as it meets their needs, is of high quality, keeps them safe and maintains their dignity.

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