Call for clarity on sustainable provider funding amid reform
The Prime Minister’s vision for a National Care Service has brought greater clarity to the direction of travel for adult social care, but questions remain over how any future entitlement will be funded and delivered, a care provider leader has warned.
Care England chief executive Professor Martin Green said recent comments from Andy Burnham suggesting social care should operate on NHS-style principles and ultimately be free at the point of use marked a “major change in the terms of the debate”.
However, he warned that policymakers must now provide detail on what services would actually be covered under any future settlement and how providers would be funded to deliver them sustainably.
Professor Green’s comments come as Mr Burnham is today expected to outline plans to offer free social care to everyone in England after the next general election, and follows the Prime Minister’s summer commitment to accelerate the timetable for the Casey Commission and its proposed National Care Service reforms.
Professor Green said the “direction is encouraging” and “ambition to give people greater certainty and protection from unpredictable care costs deserves serious engagement.”
However, he warned any new entitlement would need to be matched by reforms to commissioning and provider funding, and highlighted risks with drawing comparisons with other systems across the UK such as Scotland’s free personal care model, as there is a distinction between funding personal care costs and creating a fully universal social care service.
Professor Green pointed to updated Health Foundation modelling estimates that a Scottish-style free personal and nursing care offer for older people in England could require around £6.5 billion of additional public spending in its first full year.
“A much more comprehensive universal model is estimated at around £18.5 billion extra by 2035-36” he said.
“Those figures describe different policy choices, and neither represents the complete cost of improving the existing care system, workforce and provider market.”
Sustainable costs of care
The Care provider leader warned that “another side to this debate which risks receiving considerably less attention” is that “making care free for the person does not make care free to provide”.
Care England is preparing to publish a series of reports examining local authority fee rates, commissioning practices and the financial health of more than 2,000 small and medium-sized care home operators.
Professor Green said the findings will show that many councils continue to pay below the sustainable cost of care and how underfunding of publicly commissioned care is built into the way it is priced and commissioned, making the shortfall a feature of the system rather than the failure of any one council or provider.
“A fairer deal for citizens has to be accompanied by a sustainable deal for the organisations providing their care,” he said.
He also called for social care to play a more prominent role in the Government’s prevention agenda, arguing the sector’s contribution should extend beyond supporting hospital discharge.
He highlighted services including falls prevention, rehabilitation, dementia care, nutrition support and respite care as examples of interventions that can help people maintain independence and avoid crisis admissions.
Professor Green added the challenge now was turning political ambition into a workable system, which he said would fall on the Casey Commission’s review of adult social care.
The Casey Commission is currently seeking public views on eligibility, entitlement and funding arrangements as part of its work looking at how a future National Care Service could be funded, delivered and structured to improve prevention and public confidence.
“The task now is to turn political intent into a social care system that people can rely on and that those providing care can actually deliver,” said Professor Green.
