The gulf between what either commissioners or the public feel is a fair price to pay for adult social care and what providers say it actually costs, whether in a care home or an individual’s home environment, was starkly highlighted for me this week via two separate developments.
The first was comments from Baroness Louise Casey as her Independent Commission on Adult Social Care published a widely covered report looking at governance in the sector.
I happened to tune into Channel 4 News last night as presenter Ciaran Jenkins spoke to the Baroness after presenting a package on the report, and my ears pricked up as he flagged that the “debilitating and extortionate” cost of care homes specifically had been left out of the high profile announcements and promises on adult social care reform since Andy Burnham became Prime Minister.
Baroness Casey talke about how people pay rent and mortgages for their own homes and shouldn't expect to therefore not pay towards bed and board in a care facility. However when the presenter flagged that people wouldn’t pay “thousands a week” for a mortgage I’m sure many care operators would have wanted to shout at the telly that care home fees are for SO MUCH MORE than paying for a roof.
For many homes, the fee pays for a level of service that’s akin to full board at a luxury hotel, with all the catering and service that entails, plus a full daily programme of wellbeing and fun activities provided. And that’s before you layer in round-the-clock care, either provided by carers or nurses depending on level of need.
If people were given a break down of what they would be expected to pay per week for full board with nursing care in a hospital setting they would probably use the same adjectives as Ciaran did about care home fees.
There is of course a debate to be had about fee levels and the levers government can use to influence the market (as discussed in this week’s Casey report), and it’s understandable that the Independent Commission chair did not want to be drawn into giving an opinion on granular funding policy ahead of her report, but I’m sure provider leaders are finding it frustrating that the opportunities provided by the current political attention on care reform to make clear that care home fees are not just for rent are not being realised.
Home care
If the debate about care home fees illustrates the gulf between public perception and provider reality, developments in home care this week suggest a similar disconnect exists between commissioning ambitions and the funding available to deliver them.
The government has said this week it is set to ‘publish new guidance and toolkits’ in the spring aimed at ‘encouraging’ councils to commission home care from ‘1-2 providers’ covering ‘smaller geographical areas’, as part of neighbourhood health plans.
The move is designed to make sure carers can spend more time with people as they won’t be covering large geographical areas, according to the announcement, which social care and mental health minister Alison McGovern said is part of its wider plans to save the NHS from becoming “overburdened” by an ageing population.
Provider and commissioner leaders welcomed the announcement but, inevitably, they warned that rearranging boundaries or rewriting guidance is meaningless without more funding (to paraphrase).
Coincidentally, the situation of ever-tightening home care funding was flagged to me this week regarding a situation in which a commissioner had reportedly asked a provider to cut individual visit times by half to ensure they could stay within budget.
Both developments this week ultimately come back to the same questions: who pays for care, and how much are we prepared to spend? And we can’t answer those until we are prepared to be honest about the true cost of care provision.
