Social care market warning

In a report published today, the trust said government inaction over reform, the cost of the Covid-19 pandemic and a lack of understanding of social care had further affected the balance of an already precarious and fragmented market for social care providers.

The report, Fractured and forgotten? The social care provider market in England, added that Westminster had not supported innovation and the regulator, the Care Quality Commission (CQC), did not have the powers needed to manage risk or drive improvement. The risk that providers backed by private equity would collapse was a constant threat to stability and the continuity of care. However, the CQC did not have the capacity or powers to step in to stop financial collapse.

The market had been further undermined by significant real-terms cuts to council budgets over the last decade, which had led to social care fees that were below a sustainable rate. This curtailed innovation and investment, with councils taking a short-term approach, manifesting in highly transactional relationships between commissioners and providers. It also created uncertainty for providers and inconsistent care for clients. Low pay had led to difficulties with recruitment and retention.

The government has promised to bring forward proposals to reform social care this year, possibly in next month’s Queen’s speech. The report said that long-term change must be underpinned by a better understanding of the market among policy makers, together with an acknowledgement that funding reforms must address the structural weaknesses. It also suggested priorities for reform, including the need for stronger mechanisms to boost improvements; whether risk exposure could be reduced by introducing stricter market rules; and steps that could be taken to ensure sustainable, long-term staffing.

Natasha Curry (pictured), the Nuffield Trust deputy director of policy, there was a growing consensus in favour of reform, particularly now that ‘fundamental flaws’ in the social care system had been exposed by Covid-19.

She added: ‘But 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 in 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.’