Who could be against choice? It would be like being against freedom or against justice. So I am not against choice. But I am against the idea that choice is always good, always beneficial, that it carries with it no disadvantages and therefore needs no safeguards. I am against the promotion of choice as a way of creating competition which is then assumed to ensure both efficiency and quality because this fly’s in the face of experience.
T.V.in the USA tells you a lot about life in America and if things keep going in the current direction what life will be like here. The USA is the land of choice where paradoxically there is very little variety. There may be 500 channels on cable tv but you will be hard pressed to find something to watch. So if tv doesn’t get better the more choice you have do other more important things like schools and hospitals?
The Public Sector doesn’t traditionally offer much in the way of choice so will the care of older people be better if there is a choice of Older Persons Homes and Home Help services? Wasn’t the real issue flexibility rather than choice? Local Authority Home Help services in the past were run to meet the convenience of staff rather than the needs of frail elderly customers. Home Helps were not available on evenings, weekends or bank holidays. But we’re talking 20 years ago, the job market was very different and most services were offered only during office hours. The take it or leave approach has long since gone as has the professional always knows best.
The biggest area of complains in the average social service department is about home care providers. The in house home care service has been replaced by dozens of small to medium sized private sector providers and the customers are often unhappy. Staff turnover is higher, staff supervision is lower and staff training is not a priority. Service users biggest complaint is that their home help frequently changes this means their personal care, toileting, washing, feeding is undertaken by a succession of strangers. Minimum wage, anti social hours and the nature of the task means agencies find it hard to hang on to staff and are therefore reluctant to invest in their training. Service uses frequently claim that staff are too young, too inexperienced and too unreliable. The second biggest complaint is that staff don’t turn up at the agreed time and then they are in a rush to complete tasks. Imagine being rushed to eat your meal so you can be “toileted”, washed and put to bed. Having a choice of providers hasn’t improved the quality of care.
In the past the argument has always been about the balance with in a mixed economy, some state, some private. Now the argument seems to be do we really need any state services as long as we have a choice of private services?
But does this mean you won’t have a choice of going Public? Does it mean your local authority Social Service Department won’t run any Old People’s Homes or a Home Help service or Day Centres? And all hospitals will be private but take state funded patients. If that’s what the politicians mean by choice I am against it.
Blair McPherson author of Equipping Managers for an Uncertain Future published by www.russellhouse.co.uk