We only have sound bites at present in respect of how those in Government will seek to alleviate the pressures across social care and there are indeed a great number of pressures that need to be addressed. The suggestion that the Government will pay social care providers to accept discharges from hospital who may not otherwise have been able to do so is one particular suggestion which may release some pressure. However the number and scale of challenges the sector faces in recruitment, rising costs and the widening gap between what providers are paid versus the true cost of providing that care has not yet been addressed.
Steps have been taken and are being taken in the current cost of care exercises which are intended to enable local authorities to properly gauge what the cost of care is by engaging with providers in their area. A great deal of autonomy has been given to local authorities in conducting these exercises and there clearly is an understanding that one size will not fit all. What the sector needs are guarantees that the cost of care exercises, that are presently being undertaken by local authorities with provider input, will be treated in such a manner as to ensure that the actual costs of care for each individual provider are reflected in the rates that councils pay towards meeting the cost. Meeting the actual costs of providers is the only way that social care providers would be likely to be reassured as to the sustainability of the sector as a whole. Incremental change isn’t needed to bring fees paid by local authorities closer to what private payers pay. The change must be significant. Much is spoken of the parity of esteem upon which the NHS and social care should both reside and a correction should be made to make this so. There is a more fundamental question regarding the fair cost of care- fair to whom? Who assesses what is fair? Is it fair to recover the full cost of providing care plus an element of profit in order to enable the business to be sustainable?
In October 2023 self-funders will be allowed access to the same rates that local authorities pay, which at present rates would result in a 40% deficit in what is paid versus the cost to providers. The white paper released in December 2021 speaks of a move by local authorities to meet the costs incurred by providers with a view to eliminating this gap. The exercises that are ongoing may seek to apply flat rates based on the median figures provided to local authorities which may result in an uplift in fees across the board but this may still result in certain providers not being compensated properly.
We have been party to several challenges to fees paid by local authorities and the mechanisms upon which providers are typically able to challenge the rates set by local authorities are woefully imbalanced in favour of the local authority placing with providers. There is a malaise in the sector insofar as the local authority pays its fees and outside of the larger and more specialist providers the sector as a whole are forced to accept the fees that the benevolent local authority gives them. In these cost of care exercises there appears to be a focus on the efficient implementation of revised cost of care calculations. This efficiency is at the cost of engaging in a meaningful way with individual providers to ensure that they are being paid the proper amounts they need to meet their specific costs on a case-by-case basis; rather than on the basis of a standardised contract with rates being paid based on an average provider who may (or may not) have any relation to the specific costs incurred by individual providers.
Much is made of the blank cheque approach to Government that which has been borne out of the response to the pandemic and, more recently, to the cost of living crisis. The blank cheque approach is referred to slightly tongue-in-cheek as a responsible government set out how those increases in expenditure were to be paid for. But the principle is the same, the Government have been able to source funding where it deemed it to be unconscionable not to find funding to meet those crises. An expert in economics I am not but the overriding feeling is that where there is a will (or significant political pressure) there is a way. Councils clearly have a vested interest in maintaining the status quo since they have been tasked with assessing how much will be paid for care for so long and their budgets are not limitless. Parity here is in respect of the respective power of each side of the argument- the public purse versus independent providers providing the care. Throwing money at this issue is unlikely to lead to a satisfactory resolution in isolation. What is needed is an acceptance of the importance of independent providers and their needs. Being able to realise profits at an acceptable level to encourage reinvestment and sustainability is critical to meeting the fair cost for all involved.
There also needs to be a recasting of the wages paid to staff within the care sector. Without such a recasting the retention and recruitment of staff will continue to impact upon the ability of providers to provide outstanding care. It also has to be a profession that people look to enter aspirationally and it is undeniable that the amount that staff are paid would likely impact those prospective entrants into the sector both at school age and upwards. The importance of the work performed cannot be overstated. But it does feel as though some social care roles are overlooked in terms of their importance when considering how much those staff members are worth. The argument is however cyclical since providers can only pay what they can pay when set against the market for such staff, operating costs and the income they receive.
Governments are by their nature short-term in thinking- at most in four yearly cycles. They are also limited in their focus and approach insofar as there has to be sufficient political will in order to effect change. Much has been said about a need to look at the issues with social care with non-party political longer-term lenses in place and there is merit to this line of thinking. Everyone, irrespective of their party allegiances or lack thereof, wants to see the social care sector thrive.
The effectiveness of the cost of care exercises will be determined by providers alone and their ability to attract a reasonable profit on the provision of care. Some may see the word profit as a negative concept but it must be remembered that in the absence of independent provision of care it is likely that the local authorities would have to step in. Their costs are likely to be higher than any that independent providers would be seeking to offer. It would only be fair also to enable a mechanism to be in place which does not simply pay lip service to the ability to challenge rates awarded by the local authority but which is effective in allowing challenge.
The issue that remains is how does the New Government move swiftly towards a shared understanding as to what is best for providers and by extension all stakeholders at large in reforming how the social care sector operates. Making serious strides to make the social care sector a place where investment is encouraged because of its solid financial base would be a good place to start.
