Reimagining the adult social care sector

As the UK slowly starts to emerge from the lockdown, it seems almost inevitable that there will be some form of inquiry, public or otherwise. The adult health and social care sector will no doubt feature with questions asked about its fitness for purpose and, if found lacking, what model(s) might work better. Whatever the outcome of such inquiries, it is likely to boil down to one thing: money. It always does. So as the country starts to think about a post-pandemic future, it is a good time to imagine a new structure of charging for and funding social care to create a fairer and more sustainable system. In doing this, solutions to other problems and challenges within the system might also be addressed.

As an example, we’ll consider residential social care in England.

Paying for residential adult social care: a three-part funding solution

Instead of considering the costs of residential care as one monolithic block, the various fees and charges could be restructured into three elements:

• Accommodation
• Hospitality
• Care

Accommodation

Accommodation or housing charges would cover just that. It would be charged at the market rate and funded either through existing housing benefit (where eligible) or private means. This would solve the challenges posed by local government funding of care beds and introduce fairness and transparency into the system. Tenancies could also cover regular related costs, such as utilities.

It could also help tackle another issue related to care home residency.

Unlike homeowners and tenants, residents have few legal rights and protections. Terms of residency are subject to changes, for example, in market conditions and to a contractual framework that is far from offering stability and security. Changing to a system whereby accommodation charges are explicit and modelled after traditional rent would bring much needed stability and security to the system, giving legal protection to some of society’s most vulnerable adults and peace of mind to their families.

Hospitality

Hospitality charges would cover meals and access to shared facilities, such as gardens, communal rooms and laundries. These have become a bone of contention as private providers of assisted living schemes have used mandatory communal charges to push up income.

But they needn’t be controversial.

In our new model, services would be offered as a pick-and-mix menu with a set of clearly-defined fixed costs. This would also allow a much bigger element of choice and independence, as tenants could add services as they require them.

Care

Care would still be charged for and paid by individuals or local authorities, depending on means, but at a fixed national rate set by parliament. This would end the postcode lottery and eliminate the unfairness of the current system. This standard national rate would also support providers in long-term planning and investment in staffing, facilities etc.

The advantages of our new system

Splitting accommodation, hospitality and care costs in this way would bring a number of significant benefits – most notably in guaranteeing providers a sufficiently sound funding foundation on which to operate the businesses. Without the financial pressures and inequalities inherent in the current system, standards would be expected to rise. The industry could go back to doing what it has always wanted to do: care.

Providing tenants and their families with a clear and easily-understood structure of fees and charges would also much more effectively open up the market to choice and competition, while bringing those charges and fees into far greater scrutiny. This in itself would likely help raise standards: there is no pressure a business feels more than that which comes from well-informed and engaged customers.

The new system also removes commissioning decisions from local authorities, as well as their oversight responsibilities, ending a situation that has helped bring the sector almost to its knees. Going forward, responsibility for oversight would lie with the Care Quality Commission, which alone would be held accountable for standards.

No room for excuses

There would thus be no muddying of the waters caused by 155 different local authorities, all paddling in different directions. There would be no blaming unstoppable demographic trends or an inability to plan and budget for the long term. Instead, there would be clarity and fairness, not to mention flexibility, to ensure our most vulnerable adults are given the care and support they deserve.

Although unable to carry out face-to-face audits at this time, W&P are working with their customers offering desktop audits, health and social care policies and procedures, and business support.  W&P also supports new providers as they navigate their way through the Care Quality Commission registration process and the various aspects of setting up as a social care provider.