Reform of the social care sector will fail if the government’s
long-promised plans focus solely on funding and ignore the
fragile state of the provider market.
Years of delay to reform, costs from the pandemic and a lack of
understanding and priortisation of social care have eroded an
already precarious and fragmented market for organisations
providing social care services. Social care providers have been
left without support for innovation, the structures of some large
providers leave services unstable and the regulator lacks powers
to manage risk or drive improvement, argues the Nuffield Trust.
"Fractured and forgotten? The social care provider market in
England" identifies a number of long-standing deficiencies
besetting the complex social care provider market, made up of
more than 14,000 different organisations in England. The report
finds:
- The response to Covid-19 has highlighted a poor level of
understanding of the provider market and a historic lack of
prioritisation of social care within central government. A lack
of clarity over responsibility for social care, which is split
between local government and several central government
departments also complicated the covid-19 response.
- The risk of collapse of large private equity-backed providers
remains a constant threat to stability and continuity of care.
The CQC does not have the capacity nor the powers to intervene
and prevent financial collapse.
- Data on who receives and provides care is poor, especially
for people who pay themselves, and there is limited accessible
information on the finances of many providers.
- Substantial real-terms cuts to council budgets over a decade
of austerity have led to providers of social care being paid fees
below a sustainable rate leading to a lack of innovation or
investment, uncertainty for care organisations and inconsistent
care for those who require services.
- Individuals struggle to navigate this hugely complex market,
particularly at times of crisis, so the market forces of choice
and competition are weak. In the absence of other strong drivers
of improvement, it is notable that there has been little
improvement in some poor performers over time.
- Severe workforce issues weigh down the sector with a high
vacancies and turnover of staff. Low pay, inadequate
representation and working conditions mean the sector struggles
to find sufficient staff.
Full structural change is now needed to get social care on stable
ground and ensure those most in need of care can access
high-quality services.
But to move to a more sustainable model of care in the long term,
the report clarifies that there needs to be a better
understanding among policy-makers of how the market works and an
acknowledgement that any reform to funding also needs to address
the structural faults.
The report also highlights a series of priorities for reform and
considerations for policy-makers. These include the need for
stronger mechanisms for driving improvement, whether stricter
rules could be imposed on the social care provider market itself
to limit risk exposure, and steps that need to be taken to ensure
sustainable and long-term staffing for the sector.
Nuffield Trust Deputy Director of Policy Natasha Curry said:
“There is political and growing public consensus that the social
care system is in urgent need of reform. We have seen years of
promise with no delivery. Now the Covid-19 pandemic has made our
social care system's fundamental flaws even more clear to see.
“There is now more than ever a need to enact meaningful change.
The prime minister has already promised to 'fix' social care, and
we are expecting the sector to feature in the Queen’s Speech next
month, making a clear commitment for the parliamentary year
ahead.
"But ultimately, unless we move beyond the sticky question and
singular focus on funding and financing, then future reforms are
doomed to fail. Too frequently forgotten in discussions of reform
is the need to address the complexities and the structural
problems of the social care provider market, which money alone
will not fix.
“It was striking that not a single interviewee within our
research felt that the social care market is functional as it is
currently structured. Comprehensive and wide-ranging reform to
the entire system is required to ensure a sustainable footing for
the long term.”
ENDS
Notes to editors:
About this report:
- This report seeks to set out what is not working in the care
provider market(s) in England in order to identify key priorities
for policy-makers as they address this complex issue.
- This analysis will form the basis of a second phase of work
that will focus on potential solutions for provider market
reform, drawing on the experiences of Germany, Japan and the
other nations of the UK.
- This work is based on a rapid literature review, supplemented
by a series of interviews with a range of stakeholders, including
providers of residential and home care, representatives from the
Association of Directors of Adult Social Services, the Care
Quality Commission (CQC), the Local Government Association and
the National Audit Office, a number of academics in the field, a
geriatrician and other commentators on the sector.
