美国投资者正在大量收购英国养老院——监管机构表示正在“密切关注”这一局势，以防其威胁到建立国家护理服务的计划。
US investors are buying up UK care homes - a situation regulators say they are "watching carefully" in case it threatens plans for a National Care Service.
作者：尼克·特里格尔 监管机构表示，私营公司收购英格兰的老年人养老院可能会削弱政府建立全民护理服务的雄心。
By Nick Triggle Private companies buying up care homes for older people in England could undermine the government's ambition to create a universal care service, the regulator says.
护理质量委员会（CQC）的年度报告指出，大型企业拥有的养老院市场份额不断增加——前五大企业在过去两年中的市场份额增加了26%，这主要得益于美国房地产投资者的兴趣。它们合计拥有约七分之一的养老院。
The Care Quality Commission's annual report highlights how an increasing share of the care home market is owned by large firms - the five biggest have increased their share of the market by 26% in the last two years, driven by interest from US property investors. Between them they own around one in seven homes.
虽然这可能带来好处，但人们担心这一趋势会导致价格上涨和护理质量下降——CQC表示这需要加以监控。
While there could be benefits, there are concerns the trend can lead to higher prices and a reduction in the quality of care - something the CQC says needs to be monitored.
与此同时，居家护理（为人们在自己家中洗澡、穿衣提供支持）变得更加碎片化，小型服务提供商数量增多。
Meanwhile, home care, providing support to help people wash and dress in their own home, has become more fragmented, with a greater number of smaller providers.
CQC表示，这可能造成效率低下——近三分之一的此类服务仅为四人或更少的人提供护理。
The CQC says this could create inefficiencies - nearly a third of these services are providing care to four or fewer people.
相比之下，被认为对于提供专业和个性化护理至关重要的小型养老院却很少。
In contrast, there are few smaller care homes judged important for providing specialist and personalised care.
小型养老院一直只占养老院市场极小的比例，但在过去14年里，其数量大幅下降，特别是那些将护理与护理支持相结合的养老院，数量减少了四分之一。
Small care homes have always represented a tiny proportion of the care home market, but over the last 14 years the numbers have fallen significantly, particularly those that combine care with nursing support, which are down by a quarter.
需要更清晰的愿景 CQC表示，资金体系依然脆弱——使用护理服务的人要么自费，要么由国家为最贫困者承担费用。
Clearer vision needed The CQC says the funding system remains fragile – people using care services either self-fund or, for the poorest, the state helps to pay for their costs.
在一些地区，服务提供商越来越多地转向自费者，这使得地方政府更难为依靠国家资助的人购买所需的护理服务。
And in some areas, providers are increasingly turning to self-funders, making it more difficult for councils to buy the care they need for those relying on state help.
英国护理质量委员会（CQC）成人社会护理首席检查官克里斯·巴杰表示，市场的重塑“主要是偶然发生，而非有意为之”，这是由经济压力以及一些地方政府在为依赖国家资助护理的人购买服务时遇到的困难共同驱动的。
CQC chief inspector of adult social care, Chris Badger, said the reshaping of the market was happening "largely by accident rather than design", driven by a combination of economic pressure and the problems some councils were having in buying services for those relying on state-funded care.
他说，政府重新将重点放在社会护理上——安迪·伯纳姆在成为首相后将其列为关键优先事项之一——这是受欢迎的。
He said this government's renewed focus on social care – Andy Burnham made it one of his key priorities when he became prime minister – was welcome.
但他表示，重要的是市场要“围绕对人们最有利的方向进行塑造”。他补充道：“需要一个更清晰的愿景。”
But he said it was important the market was "shaped around what's best for people". "A clearer vision is needed," he added.
健康基金会智库的休·奥尔德威克表示，CQC的报告“赤裸裸地揭示了”政府面临的巨大挑战。
Hugh Alderwick, of the Health Foundation think-tank, said the report by the CQC "lays bare the massive challenges" facing the government.
“首相致力于改革该领域，这提供了一个从根本上重新规划国家社会护理承诺的机会。“但现在需要变革，以巩固体系的基本面。
"The prime minister's commitment to reforming the sector provides an opportunity to fundamentally redraw the state's offer on social care. "But change is needed now to strengthen the fundamentals of the system.
“地方政府需要足够的资金、正确的技能和强有力的领导，以围绕人们的需求来塑造服务。”
"Councils need enough funding, the right skills and strong leadership to shape services around people's needs."
代表护理服务提供者的“英格兰护理”组织的马丁·格林教授表示：“如果政府和监管机构对护理行业的整合感到担忧，他们需要采取一些明确且切实的行动来支持较小的护理院提供者。”他说，雇主国民保险缴费的变化、通货膨胀以及能源成本上涨，正使较小的护理院难以维持。
Prof Martin Green, of Care England, which represents care providers, said: "If the government and regulators are concerned by consolidation in the care sector, they need to take some clear and tangible action to support smaller care home providers." He said changes to employer national insurance contributions, inflation and the rising cost of energy was making smaller homes unviable.
“除非我们在资金安排上取得实质性进展，否则较小护理院关闭的趋势将会持续下去。”卫生和社会护理部表示，该报告凸显了“这届政府继承的挑战规模”，但表示致力于彻底改革社会护理。
"Unless we get some real progress in a funding settlement, the trend of smaller homes closing will be a trend that will continue." The Department of Health and Social Care said the report demonstrated the "scale of the challenge this government inherited", but said it was committed to overhauling social care.