It's time to reflect, and work together with those purchasing and providing services to develop policies and deliver change
With all residents from Southern Cross care homes now receiving care from new providers, it is a good time to reflect on the social care market – where it has come from and where it is going.
Unlike other public services, a market has operated for many years in social care. This has been driven by a range of factors – both from government and from individuals and carers. In residential care, we saw a large expansion in private care home provision in the 1980s, and then the community care reforms of the early 1990s acted as a major stimulus to the development of the residential and nursing care market.
This was followed by the best value regime which acted as a catalyst for the development of a market in domiciliary care. The work on best value, following the 1999 Local Government Act, sparked the growth of independent domiciliary care provision. In parallel, individuals have fought for choice and control over their care. The disability rights movement helped secure the introduction of direct payments from 1997. And more recently, we have seen the drive to mainstream personal budgets, with the government committing to a personal budget being available for everyone eligible for ongoing social care by 2013.
This has all led to the diverse market that we have today. Almost 90% of the 8,300 residential care providers operate only one or two homes – with the largest 10 providers accounting for 10% of the market (by homes). At the other end of the spectrum, there are large organisations spanning the country, backed by private equity and corporate investors. The way this market has developed has also led to the large, and growing, numbers of alternative provider models. Social enterprises, voluntary bodies, mutuals, co-operatives, microenterprises and personal assistants, all offer people a wide range of options.
So what have we learned from having a market for many years? What are the challenges that we face; and what can other public services learn from our experience?
The responsibility for the day-to-day delivery and commissioning of social care has sat with local authorities, and their colleagues in primary care trusts, for many years. In the past, this has largely meant arranging care for those they fund. This is changing. As more and more people fund their own care (private payers now account for around 40% of the overall social care market and this is set to grow in the coming years), and as we roll out personal budgets and direct payments, local authorities are having to adjust to a new role – how to facilitate vibrant and diverse local markets.
Local authorities need to ensure care services are available to meet demand and that there is sustainable provision in the longer term. This involves developing new collaborative relationships with providers, going beyond straight contracting and procurement. It means developing new skills and seeking new intelligence. And, it requires better information and advice for those looking to purchase services.
We also need to consider how to support continuous improvement in provision, within a market mechanism, where government – national or local – does not hold all the levers. How can we encourage innovation in the sector, and drive up the quality of provision? How can we create a system that is supportive of new ways of doing things? How can we ensure standards are met, yet offer more differentiated services?
Finally, Southern Cross demonstrated that there are now some providers with vastly complex financial structures; and with disparate and intricate webs of stakeholders, from all across the world. As government, we need to understand these structures better, so we can determine the impact that they could have on the delivery and quality of care. We need a greater comprehension of what is happening in the financial markets, and how the interests of investors can affect care provision.
To address this, the Department of Health published a discussion paper on oversight of the social care market, as part of the wider Caring for Our Future engagement exercise. We posed a number of questions regarding how to oversee the social care market in the future, to make sure that those reliant on care services are not left without the care they need should a provider fall into financial distress. These are not easy questions. We are now looking at the different options, and will set out more about this issue in the forthcoming care and support white paper.
In social care, we understand how important it is to work together to develop policies and deliver change. In the future, this means working more closely with both those purchasing and those providing services. Policymakers and commissioners will need to understand better how the market works locally and regionally, but also nationally and internationally. This is a challenge, but one which by working together I believe we can meet.
David Behan is director general of social care, local government and health partnerships at the Department of Health. He will be taking part in a panel debate at the Institute for Government seminar on Lessons from History: Social Care Markets on Thursday 15 March.
This article is published by Guardian Professional. Join the social care network to receive regular emails and exclusive offers.
Read the complete post at http://www.guardian.co.uk/social-care-network/2012/mar/14/social-care-provision-david-behan
Mar 14 2012, 05:00 AM
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