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Still wating to grasp the nettle of social care

Blog post 31 July 2017

Writing for Driven by Health with Care, Debbie Le Quesne review the social care landscape and offers some timely advice to struggling care providers

The political landscape is a complex one where uncertainty reigns. Theresa May did not emerge as the force to be reckoned with as many had predicted and the snap election has left social care – and many other things  – in limbo.

Any hung parliament is one founded on compromises and with the recent analytics pointing to May’s radical social care proposals as key to her downfall, the proverbial nettle is still to be grasped.

Clearly the British public is reluctant to pay the price of care for an ageing population, leaving our politicians between a rock and hard place as they assemble their wisdom for the long-awaited Green Paper on a sustainable way forward.

Clues from the Queen’s Speech are few, but we do know May shredded the Conservative manifesto, abandoning pledges on social care reform – gone is ‘those that can pay, must pay’ along with energy price caps; and a new generation of grammar schools.

All we are guaranteed is a cross-party consultation – if you please, the life raft of the social care Titanic.

Reflecting on the General Election rhetoric, would it be so unrealistic to expect the public to pay for its care?

I am always surprised that no-one talks about the actual amount of funding that is already provided by the Government in benefits and state pensions . . . perhaps this could be used to offset some of the costs?

A friend of mine was worried when his ailing mum had to move into a residential home. He sold her house believing the capital wouldn’t last very long. However, he was surprised when he calculated he would have to use only a small amount of the sum each week.

Equally I was shocked when someone else explained the home care his father was receiving came at a price and was presented invoices from the local authority.

The care provider believed the local authority was footing the bill, but this man’s family were in fact paying their council for the service the artificially reduced rate for his care that has had major consequences on sustainable care in some regions.

In an ideal world (other things being equal) the natural development of economics dictating price and business success or failure, has been scuppered by this engineered lower rate. Its effect is two-fold: Providers whose core business is with local authority referrals are struggling to survive, while the already dented consumer market is at further risk of diminishing.

Local authorities

Worryingly, the Department of Health seems to believe it is genuinely helping social care. Ed Moses, deputy director at the Department of Health has confirmed that two thirds of the £2bn set aside for social care will go on fees, systems and assessments, and relieving late payment issues that have dogged the sector.

One third in his opinion will help relieve hospital bed-blocking pressures, particularly over winter. Really?

I suspect there are very few councils that will be brave enough to use the monies as part of an overall initiative to increase their fees for social care and pass on the increments to those from whom they buy beds.

The money is welcome, but it’s far from a solution without further forward funding, especially when it is appears to be aimed at ‘prevention, not cure’.

Recent guidelines show it must be used to keep people out of hospital, but I’m not sure how that remit is being worked out with local authorities, or CCGs.

Want to solve the hospital winter bed chaos? Invest heavily in paying realistic social care fees, thus allowing the care marketplace to function properly now and develop future growth.

Interesting, isn’t it, that my home care members and those with residential homes take more people from hospital than my nursing home members, but nationally there seems to be a CCG focus that only nursing is suitable for hospital discharge. With properly-funded care demands on doctor call-outs, district nurses and ambulance crews plummet, but CCGs desperately need to be part of this solution.

Forward-thinking with CCGs

Whatever happens, we need to work together but CCGs in some regions cannot understand why. It baffles me that the only time the private care sector is properly engaged is when there’s a need for project support – stopping falls or Infection prevention.

But there are some strident advances in our attempts to work together. Dudley is forward thinking and on board with a project to support residential and nursing providers night and day. It’s early days and not without IT issues with some care staff, but I’m hopeful this could be a national model.

No support for Home Care

Sadly, home care – essential for any plan to keep people out of hospital – remains the Cinderella of the sector. I have home care members dropping out every week as they are so stressed and they don’t earn a minimum wage rate themselves out of the £13 per hour paid by local authorities.

In an attempt to keep the service viable, WMCA is running a conference that that will zone in on business survival. Working together, pooling resources and ideas will help secure a future, but we desperately need to make it clear that those tendering for contracts at less than £13 per hour are going to struggle.

Last year we warned providers that taking a tender for three years with these figures would return a first year with a small profit, the second small loss, and the third year a big loss. Bizarrely, there is still a rush to tender.

Care quality and funded places

The quality of care is always paramount, but it’s at risk like no time before. However we dress it up: Money buys quality. There are ever-hungry council commissioners seeking beds at a knock-down price. The reality check is simple – pay more, have fewer places; pay the same and receive poorer quality.

I am concerned that in talks with West Midlands Care Association, officers apologise profusely that rates cannot be raised yet still demand increased quality, more administration and a greater reservoir of provision. It’s an impossible ask.

Surviving the challenges

In the absence of a Government lead, I believe it is we as the care collective body that must take it. That means securing a future for both supply and demand in the sector. If you run your care business as a business and not a charity that helps shore shore up local authorities there is hope, but some big lessoned need to be learned.

Be realistic with CQC rating targets

One of the things I hate advising my members in the West Midlands to do is NOT to aim for an outstanding CQC rating. Intentions are good, but business reality can be cruel and there is no local authority extra payment to recognise such achievements.

Unless there is a generous percentage of self-funders on the books, ‘outstanding’ goals can quickly diminish already meagre resources.

It is, in my opinion, far better to aim at being consistently good – no mean feat in itself. If you look at CQC’s ratings and map them with what the authorities pay, you’ll find the more authorities/self funders pay, the greater the number of good providers.

We have very few outstanding home care providers and the ones that have achieved this have additional running cost to support staff and their clients. Remember too that ‘outstanding’ does not necessarily mean your care is below standard.

Understand your area

Understanding the demography of your area and where you best service user potential is found are essential. Assessing potential clients’ ability to sustain realistic rates for care is also key. Geographically, some areas will support top-ups, while others not so.

Market your business

Don’t ignore your marketing and public relations. Get some good images – it’s worth the investment when you see what some businesses load into their websites. And ensure that everyone knows what you are trying to achieve with your care. The internet is the biggest shop window you could ever imagine and it’s seen by potential clients, social workers, commissioners and potential staff.

Have a look at the good, the bad and truly awful sites out there and learn lessons.

Work with your local care association

Ensure that you are part of a providers’ voice of reason. Help assemble data that is a true reflection of outgoings that can be part of an essential toolkit for those speaking for you.

Most regional associations will know what is happening. Several of the areas I work with are carrying out cost of care exercises. Experience tells us that the best way to secure upward shifts in fees is with credible, independent financial data on the costs of care.

Conclusion

We have always had the LA funded/private funded divide in the care sector, but I believe as the market shrinks because of the enduring austerity measures it will become more clearly defined.

What will remain will often be determined by geographical location alone . . . a catchment area that can support private payers should convert into a healthy business model. But it’s the businesses that are wholly reliant on council-funded placements I fear for most. I am regularly being told by local authorities that they believe there should be more outstanding providers, but are not prepared to pay the price for it with raised bed fees.

For those businesses that geographically straggle both the ‘have’ and have-not’ areas, it’s essential to secure a proper balance of council funded and self-funded service users. It’s common sense, but hospital discharge officers and commissions badgering for urgent beds can easily upset finely balanced margins.

Long term I foresee a smaller, leaner social care sector emerging as beds currently filled at unrealistic rates are lost with closures.

Perhaps all the answers to this long-running saga of our embattled care industry will be found in the Green Paper, but I’m not holding my breath.

The old saying ‘you get what you pay for’ is true, but educating the public that this must apply to a commodity that whom for many will not be ready to purchase for decades, is a steep curve to climb. Odd, isn’t it, many elderly needing home care will shun the service because of cost, yet have paid for a cleaner and gardener for years . . .

Debbie Le Quesne

Co Chair of Care Association Alliance and CEO of West Midlands Care Association