26th June 2019

2019 Social Care Fees Briefing paper

Social Care amnesia... but at what cost?

It is five years since the Care Act received Royal Assent and we felt that we were on the brink of a sustained focus on creating a robust and sustainable social care sector which would meet the needs of a growing, demand led, sector – a sector which has evolved considerably over the past three decades bringing with it concern for those who use, commission and provide it.
During this period expectations have been raised to a degree outweighing any sustainable investment from local and central government. Providers are expected to deliver a service which would sit within the proposed integrated model of health care, without any vision of how this should be funded. Regrettably, the integration agenda which was to be a panacea for a joint up health and social care model has failed dismally in most cases.
Social Care providers are responding to the increased expectations of the public based on the shift in government policy at both local and national levels. The result being that Local Authorities feel comfortable commissioning complex care at unrealistically low prices – a patient in an NHS facility with assessed care needs costs the state over £2000 p/w but on discharge the commissioner will expect to purchase the same care in more homely surrounding for about £600 per week. Clearly, there is a disconnect between what we pay for care!
Having chosen to defer the thorny question of the funding models more hopes were raised when in 2017 the government promised the publication of a Green Paper which would look at funding options and create solutions. There was an anticipation that we would be able to see a sustainable framework which would recognise the role of social care within the health care agenda and create pathways towards raising the status of care workers in the field.
Two years later, we have no sight of any paper! We have had promise after promise broken and the sector continues to deliver despite the continued under investment, but at what cost to vulnerable people ..? As we look at the political agenda today, despite the will of ministers who have worked on this, it is unlikely that the Green Paper will see the light of day and if it does the impact may be nominal.
It is widely reported that between 2017 and 2018 we have seen about 230 care services close across the country, which equates to a loss of just under 7000 care beds. The reasons cited for these are often varied but the common factor is that the providers can no longer continue to subsidise the state. The business models that providers have had no alternative other than to adopted are not sustainable – expectations rise on delivery standards (quite rightly) but state funding is not negotiable!

Additionally, we are told that:

Providers cannot improve the service to get them out of a required improvements rating as they do not have the funds to do so,
The impact of the National Living Wage increases tips the balance of outgoings against income,
The challenge of recruiting staff in a sustainable way to meet the needs of the people they are caring for – this has been further hampered by the procrastinations over Brexit with no recognition of the social care workforce.

We have had two decades of attempts by successive governments to formulate a tangible strategy to create a response to the challenges faced by the nation and we have had no clear pathway or long term plan! This is one of the greatest failings in modern times for politicians as they continue to neglect the social care sector which remains the bedrock of communities where our frail and vulnerable citizens struggle to maintain health and wellbeing.
There is little or no confidence amongst the general public of a resolution to the funding of social care. The Just Group published a report this month (June 2019) in which it highlighted that adults (over 45’s) do not believe that any government would prioritise social care in the coming years. (Care Report 2019, Just Group Plc).