Will history repeat itself, or worse?
Social care is facing one of the biggest challenges since 1962 when local authorities were demanded by Government to draft a 10-year health and welfare plan to “help older and disabled people stay in their homes for as long as possible.”
It was a visionary ideal that would not be out of place today, but its application was poor.
The history of social care in the UK makes harrowing reading, but the 1960s provided a benchmark decade with Parliament recognising it had social responsibility towards those who could no longer care for themselves.
However, what some would refer to as the golden years of provider opportunity, the following decade did very little to foster a real care at home ethos and the residential home marketplace boomed amid poor regulation of quality.
Significantly, politicians agreed NHS funding could be used to finance care that was overseen by movers and shakers in both local government and health.
With ‘joined-up’ monies available, fiscal returns on care were good and realistic fees fuelled investment.
History has an uncanny habit of repeating itself and at the start of this New Year it appears – just like in the early ’60s – everyone theoretically recognises a need to save money by providing reliable at-home care; to fund residential care at a sustainable, realistic level; to sustain excellence in care for our learning disabled and to be person-centred in its delivery.
But now, unlike with the historic lavish indulgences of state-funded support, the latest chapter of social care is seemingly unfolding without the monies to make the radical transformations for survival.
How does the embattled social care sector survive 2018? Answer: with huge geographical anomalies and an ideology that is generously tempered with pragmatism.
As I travel the country, it’s clear that the real world knocks louder on the door in areas with poorer economic/social demographics. There’s a major fault line in the UK wealth distribution and it affects deeply the care sector. The Office for National Statistics found that 19.3 million people had experience with poverty in a three-year period.
The ‘have-not’ care providers are generally reliant on business from local authority referrals, can charge only marginal top-ups, if at all, and are not privileged with the generous business model advantages self-funders can make happen. Their catchment areas for business can be down-trodden with significant pockets of social deprivation.
The clichéd North-South divide really does exist, with weekly private residential charges in the leafy South, commanding a £1,000 – £2,000 figure, while in the industrialised Midlands and North the fee is a comparatively modest £450 – £600.
A favourite expression with economic students assessing market forecasts – other things being equal – cannot apply to the national projections for social care provision.
The best we can hope for is regional supply and demand roadmaps, but with little divulged on the Government’s cross-party proposals for funding social care there’s caution all round.
Doubtless, some of the ‘have-nots’ will go under this year as market forces beyond their control are brought to bear.
Inflation, pegged funding, the Living Wage and the sheer weight of slog to survive will sadly prove too much.
The Midlands, where I’m from, has been recognised as the engine room of ingenuity since the Industrial Revolution and that inborn ability to reinvent and survive has clearly been apparent with its care providers.
I know of one business where the owner/manager has stoically preserved her business, very often working 24/7 covering shifts, so her poorer catchment area could be served without top-ups. Inspection ratings have been good, the home is loved by the Local Authority, residents and relatives and for ten years it has held true to what it believes is its social obligation. But unrealistic local authority fees paid for care have finally taken their toll and the only survival option is for the owner to levy top-ups. The big question: Who could possibly pay and for how long?
The crumbs of comfort for such providers is that there appears to be fewer staffing problems than their more fortunate colleagues in wealthier areas.
Doubtless new Living Wage rate increases will bring relief to thousands of workers squeezed by rising inflation. However, the cost to the care sector is potentially devastating.
With businesses already struggling on unsustainable margins, the wage increase, due from April 1 – £7.50 to £7.83 per hour – returns some scary care home calculations.
Based on a survey carried out by the Association figures reveal that
50 per cent of care providers in the West Midlands are looking to close or sell.
Some 90 per cent of homes have had to increase their charges above the cost of living and 50 per cent of those polled have increased fees more than the cost of the cost of living – the cumulative effective of ever-increasing expenditure.
Also, ten per cent of homes have introduced a top-up for the first time.
A staggering 60 per cent of home care providers have considered handing their packages back to local authorities.
Thankfully, working together with providers, councils and health is gathering pace as all parties recognise it is central Government that holds a solution – or at least a means of help.
Of course, local authorities are aware of the industry dilemma. Recently the Local Government Association warned that by 2020 a whopping 60 per cent of council tax will be spent on social care. Consumer group Which? warned that “urgent action” is needed because of a rising population of older people.
England has 407,000 care home beds but would need another 50,000 by 2022 to meet demand, according to its figures.
In recent times I’ve witnessed a desperation within local authorities as they try to do the ‘right thing’.
In one area there’s the case of a resident who just ran out of money to pay for her residential care. She was then reassessed, and a place was found in an extra care facility. Staff could not meet her needs within the extra care remit and she was returned to the original care home. The case is still unresolved as social workers frantically searches for a cheaper home. However, the market opportunities for social services placements are shrinking as more and more providers walk away from council contracts because they are no longer financially tenable.
Person-centred care with stretched resources . . . an impossible ask?
The pivotal point for social care this year will be what happens with funding. Ahead of negotiations, Knight Frank have done some research about the cost compare to the CQC rating.
It shows that companies pay more for staff if they are rated ‘inadequate’, compared to those with ‘good’ ratings.
So-called ‘inadequate’ homes pay considerably more for agency staff and significantly, according to the CCQ, it is nursing homes which struggle with this most and on average across the county score lower ratings than residential homes.
The Knight Frank report also shows that ‘inadequate’ homes have the least self-funders and those with ‘outstanding’ ratings have the most.
The outlook for domiciliary care is again bleak – nothing changes. Unlike care home businesses, providers do not know which of their clients are self-funders as contracts are generally though the local authority and payments are made directly to it.
Offsetting losses between self-funders and funded placements is therefore not an option.
Of all the social care businesses, it is those working in community that I fear will return the worst casualties of 2018. Successive years of austerity and no increments in council payments are shrinking the resources pool of home care providers at an alarming rate. Sadly, it is not necessarily the best that will survive; it will be those who are prepared to run on the edge with limited staff and management to serve – with reduced quality – as many clients as possible.
I find it ironic and frustrating that in the last Budget, Chancellor Philip Hammond acknowledged health needed a financial lift and gave £2 billion to help.
However, he let slip an opportunity of helping the NHS by allowing these funds to be swallowed up on a variety of projects, none which serve the social care goals.
Already we’ve had the scaremongering of winter flu prompting concern over the wellbeing of elderly and, critically, the issues of increases in hospital bed blocking.
Despite Theresa May’s spin that the NHS is ‘better prepared’ for winter than ever before, thousands of operations have been cancelled and patients will be put on mixed wards.
A well-served and properly funded home care and care home market would dramatically ease the discharge issues facing ward managers. Surely, this is the where financial traction needs to happed as it would drastically ease the ward overloads.
Age Concern suggested that 1.2 million people in England were living with unfulfilled social care needs (such as not receiving assistance with bathing and dressing), a rise from 800,000 in 2010.
Despite the need at this primary level of caring, between 2010-11 and 2015-16, overall funding from central government to councils fell by 37 per cent in real terms, according to a Parliamentary report.
Last year, there were 1.8 million requests for social care support – almost a third of which resulted in none being provided.
Successive Governments have failed to grasp the nettle of social care funding. but ultimately market forces will have sway over the fees paid – especially by local authorities to the private sector.
Already we are seeing in some parts of the UK, councils having to pay the going rate for packages as shifts in provision have seen decreases in supply and a wholesale unwillingness of providers to enter into contracts that are financially unsustainable.
The Reformed Poor Law of 1834 acknowledged the destitute, disabled and elderly would actually cost the state money.
The response then in real terms was at best poor; at worst cruel.
I wonder what history will write about this latest unfolding chapter of social care and what lessons, if any, will be learnt from it?
To date, our track record has been woefully ineffective.