Covid-19 has made the struggles of the adult social care sector feel very real for those who need it. Many people have been isolated in care homes, disabled people continue to struggle to maintain their health and wellbeing, and other services that are a lifeline to many have ground to a halt.
There have been years and years of delay to the long-promised reform plans for the sector. We should expect to see that reform feature in the Queen’s Speech next month. Yet, all too often the debate starts and ends with the question of how social care should be funded. But the issues with social care aren’t just limited to its funding.
The organisations which provide this vital care were already on the verge of collapse well before the pandemic. Deep-seated structural issues have created a market of provision that is not delivering for people, and reform must urgently address these if we are to pull social care back from the brink.
A fractured market
The market for care is not easy to navigate for either policy-makers or the public, as our report today illustrates. It is made up of a complex web of over 14,000 diverse organisations, not just care homes, which are intended to support people of all ages to maintain their independence and lead fulfilling lives.
Many users of social care find themselves surprised at time of need to discover that, unlike the NHS, the social care market is neither free at the point of use nor publicly owned. People with over £23,250 to their name need to fund their care themselves, leaving many people facing ‘catastrophic’ costs.
Providers of care are swimming against the tide. A decade of austerity and underfunding has increasingly squeezed council budgets to the last drop. Councils are often driven by low-price transactional contracts with providers rather than a collaborative approach to personalised care. We’ve heard stories of people at home receiving visits that are as short as 15 minutes. How can we expect social care users to feel valued when the support they receive can be delivered in barely enough time to boil a kettle?
This short-term outlook means providers often struggle to pay the bills and many have been forced to hand back contracts or rely on increasingly higher fees from those paying for their care themselves. What has developed is an unfair system, with falling numbers of providers willing to cater for council-funded care users and those paying for their own care footing extremely high bills.
People who need social care are often forced to choose from options that in no way reflect their needs or wants – often at a time of crisis. For those who end up ‘stuck’ with sub-par care, there is little hope that their care will improve. 3% of providers have never been rated better than ‘requires improvement’ by the Care Quality Commission.
Social care users are also let down when heavily debt-financed providers suddenly crash out of the market due to their risky financial behaviour. These large providers make up around 30% of provision and are often owned by hedge funds and private equity funds, attracted to the market due to its potential for refinancing. With limited responsibilities for providers to maintain care delivery in the event of failure, social care users can find themselves displaced and without care from one day to the next.
Hand to mouth
These problems existed long before Covid and inaction over reform for two decades has worsened them. The pandemic has left many users of social care and their families isolated and let down. Piecemeal funding announcements from the government have made providers feel like they are living hand to mouth. The government needs to give the sector and the people using social care the reassurance they deserve that their quality of life will not be chipped away at any further.
But this crisis has also shown that many providers are often willing to go the extra mile for the people they care for. With adequate funding and support, care fundamentally designed around people’s personal needs and ambitions could become the norm rather than the exception, and why would we accept otherwise?
Oung C (2021) “Ongoing woes: the difficulties of the social care provider market”, Nuffield Trust comment.