Separating assets from activities
We have a particular problem in the UK, which is rising asset prices and particularly land and building prices. This is partly because we are a small crowded island and could do with more houses but it is also because we have an excess of money, and it tends to accumulate in the hands of a minority.
In care, the result is that individuals and even the state find it increasingly hard to acquire care homes and they attract private equity and hedge funds who treat staff as human “resources” and patients as “consumers” of health care services, squeezing the system to extract wealth.
This is, arguably, an extreme way of presenting the situation (after all, even hedge funds have to employ managers, many of whom are very professional and caring). However the fact is that having “owners” who have different drivers and values from the care-givers causes a tension that too often results in quality of care taking second place to “delivery of health services”, which is quite a different thing.
A useful parallel is the struggle many communities have to create affordable housing. An interesting and succesful innovation has been the community land trust, where land is acquired by or on behalf of the community and held in trust over the long term. They make the land available for affordable housing. Separating out the ownership of the land from the occupation of the land allows people who couldn’t otherwise afford to occupy the land to come in and use it, subject to the conditions set down by the trust. We imagine a similar type of structure.
To put it another way, using financial language, owning land has a different time horizon and a different risk profile from owning a business. A care home that separates the two can attract different sorts of capital for the two different needs, and thus more closely match the interests of the investors with the interests of the stakeholders. That’s the theory anyhow.