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Reform of Social Care “Doomed” Unless Issues of Fragile Provider Market are Addressed

A report from the Nuffield Trust warns that years of delay to social care reform and a fragmented market has left provider services unstable and without support for innovation.

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.”