The care and support market is diverse. Providers range in size from stand-alone personal assistants to national organisations – some privately-owned, some charitable or other not for profit organisations and some individuals working as self-employed or as unpaid carers. Within the private sector, organisations range from small owner-operated businesses to large entities where there is a separation between ownership and operations. Some services are delivery directly by Local Authorities.
Our view is that most providers are ethical people working in Social Care for positive and altruistic reasons. We also recognise that all organisations, whether private or not-for-profit, need to make a surplus which enables them to be viable, reinvest and prosper in the long term.
Current Issues & Problems
A sector not taken seriously
Social Care is not treated seriously by government as a business industry, but as a burden – even though it employs 1.5 million workers, contributes £50.6bn directly plus a further £7.6bn indirectly to the economy and is set for substantial growth in demand in the next 20 years.
The care and support market is not managed. Even though it is one of the largest business sectors, in receipt of substantial government funds and whose failures impact on significant numbers of elderly and disabled people, is not a market that is managed or even well understood either at central or local government levels.
Local Authorities are asked to publish Market Position Statements, but these are neither visible nor robust nor consistent. Neither do we systematically understand what people want from social care and what different forms of care they should like from their lived experience.
Sector trade representation and relationships are fragmented and weak. There are too many separate bodies with sometimes conflicting positions. The Care and Support Alliance, which brings the myriad of representative bodies together, does not appear to collate a clear and unified ‘ask’ or have a robust influencing strategy. For most providers, their work is invisible.
Market consolidation and risk
The care and support market is relatively immature, but there have been several examples where companies have grown quickly and failed. Today several companies remain over-leveraged. To date there has been limited regulatory oversight of large provider viability and profitability and no open shared learning on this (although CQC now does have a duty in the area).
There are areas where the public purse does not get good value for money which are increasingly being taken over by private equity venture capitalists (such as large parts of the adult specialist market).
There is evidence from CQC that (on average) the best quality care and support is provided by smaller organisations with ‘skin in the game,’ rather than larger private organisations where there is a separation of ownership and operations. Given market immaturity and ongoing financial pressures, however, we are likely to see increasing consolidation which might mitigate against quality.
Taxation and contracting
Tax and contractual treatments are nonstrategic, messy and inconsistent (eg VAT application and offsetting, capital investment reliefs, no standard local government contracts, and conditions, etc). This does not drive practice that is fair and focused on quality outcomes.
We see several ways in which the Social Care market can be improved.
A key business sector
The Department of Business Energy and Industrial Strategy should be encouraged to see Social Care as a key business sector which adds significantly to the economy, employs significant numbers of people, requires fair investment and support.
If the Social Care sector had been viewed seriously as an important sector then if might have been permitted to continue recruiting its vital workforce from overseas.
A strong market
Opinions vary as to what constitutes a strong care market. In particular, people have differing views on the role of private providers. We see virtue in a mixed market which provides a wide range of service options from which people can choose. The most important element, regardless of ownership structure, is that organisations operate ethically and transparently to deliver high-quality services, backed by ethical and transparent procurement arrangements focused on delivering outcomes that people want.
Promotion of the best ownership models
CQC gives some insight into which ownership models give the best quality care and support. We would wish this work to be extended, and for market shaping activity to promote best-practice models.
Meaningful detailed market information and strategies should be co-produced at central and local levels – to enable forward planning by all stakeholders, and to also consider integrated markets in social care and health, but most importantly to understand the care that people want.
The Social Care sector needs to take itself more seriously and invest more significantly in inclusive, joined-up impactful representation
Greater transparency is required on ownership, profitability, and viability across all market segments so that we can prevent market anomies, risk, or failure
Unity of standards
Support the sector through unity of standards such measuring outcomes and value, fair and standard contractual terms, employment terms, and business tax treatment.
Commentary on ‘People At The Heart Of Care’: The Adult Social Care Reform White Paper (published 01/12/21)
Best Practice Share
Our Key Takeaways