Let’s make a new contract with the country over social care

We are living through the worst crisis in social care provision since the foundation of the NHS in 1948. Yet, with the general election, we are also witnessing the greatest opportunity for the social care system since the 2011 Dilnot Report on the future of the sector.

In recent weeks the evidence has been stacking up of just how parlous the state of our national social care system really is. The Communities and Local Government Committee of MPs in March identified “serious threats to social care provision” and called for an “urgent review” of social care funding.

“With less funding it is inevitable that higher needs services are prioritised.”

Meanwhile, the respected Institute for Fiscal Studies (IFS) found between 2009/10 to 2015/16, spending by English local authorities on social care fell 11% in real terms. The IFS also found a large variation in council spending on social care from £325 per adult in a tenth of local authority areas to £445 per adult in a tenth of local authority areas – a difference of more than a third.

Commissioners and care providers have worked hard by innovating to mitigate the impact of these funding pressures – and the additional £2bn pledged by the Theresa May administration has definitely helped.

Yet the overall picture still sees fewer people receiving state-funded social care support and more people with complex needs in mental health or other areas presenting themselves at A&E departments in crisis.

As a not-for-profit support and care provider, we work with commissioners to best meet their needs.

We recognise and understand the pressures they are under. However, with less funding it is inevitable that higher needs services are prioritised and services for those with lower to medium needs are often no longer commissioned.

Even then there remains considerable pressure to deliver services for less. In some circumstances this may be possible, yet in many it is not.

We give careful consideration to exactly what we can afford to deliver as a business.

In doing so two considerations are critical.

First, ensuring the ability to deliver high-quality, safe services for our customers. Second, that any contracts are sustainable. This means allowing us to continue to pay our staff at least the Living Wage and London Living Wage and ensuring a potential contract doesn’t make us a loss.

If we assess that we will struggle to deliver on these aims under the terms of a potential contract we will politely reject it. We do this with a heavy heart, but it is the right thing to do. We cannot and will not compromise on the quality of our services and support we provide to people in real need.

“We give careful consideration to exactly what we can afford to deliver as a business.”

As I mentioned, the general election – and the subsequent expected Green Paper or systemic review – presents the best opportunity in recent years to address this at-times depressing state of affairs.

Politicians and their advisors have identified the potential for votes to be won in addressing the problems of the NHS and the crucial role played by social care. This is our opportunity to secure support for policies that will set the social care system on a much firmer footing.

First, we must revisit how social care is funded to allow commissioners and providers to deliver effective and sustainable care. This may mean dusting off Dilnot’s findings, or it may mean exploring how to fund social care through general taxation – it is a discussion and debate that we must have at a national level.

Leading politicians across the spectrum have pledged to tackle the social care crisis and we will study their manifestos with real hope of a commitment to find a cross-party approach after 8 June.

Second, while care, support and supported housing providers must continue to be prudent in the contracts they bid for, there is an important and exciting role for innovation and new solutions in delivering better services and outcomes.

There are numerous examples of how providers are doing this across the sector. One of which we are particularly proud is our new Recovery Houses, delivered in partnership with Barnet, Enfield and Haringey Mental Health NHS Trust.

There are three Recovery Houses providing short-term, therapeutic accommodation of up to 14 days for people experiencing a mental health crisis, as a community-based alternative to hospital admission. 

The houses offer a range of interventions and treatment to support recovery, in an appropriate and modern environment. The support focuses on maintaining and improving customers’ quality of life as well as promoting independence and enablement.

Ultimately this is why we and the hundreds of other support providers in the UK do what we do – to deliver better outcomes for the individuals we support.

The current framework within which we provide this support is unsustainable. The opportunity exists to address this and we stand ready to help politicians and policymakers make the most of it. We want to bid for contracts with enthusiasm, not trepidation.

Chris Hampson, chief executive, Look Ahead