If anything has become apparent during the Coronavirus crisis, it is that the current social care system has got some serious structural problems. The roll-out of PPE, testing and now infection control funding is just not getting through fast enough and on the scale needed. And who are providers blaming? Why local authorities of course.
In the nine years I have been writing about social care, the public-facing half of the sector has been severely underfunded with councils citing budget cuts as the reason. When challenging DHSC on this, it points to all the cash it has handed over to local authorities for social care services. Devolving the problem through the social care precept appears to have limited success. So is it time to stop this never-ending blame game between councils and Whitehall and just cut out the middle man?
There is a strong case for doing so. With providers and service users forced to deal with individual local authorities, each with a diverse range of political ambitions and priorities, a postcode lottery has been created at a cost to vulnerable people. Furthermore, as the vast majority of care providers have only one site, a change in council policy could wipe out their business.
With one single commissioning body, practices could be standardised and operators with more than one site would not have to tender for up to 152 contracts, each with their own idiosyncrasies. Imagine how much time and money could be saved? By standardising the process social care providers would be able to plan properly for the future and the system would be far easier for service users and their families to understand. It would also help create an accurate, up-to-date, national picture of the performance of social care services in England and the factors impacting on the sector.
After all, there is only one regulator so why not just a single commissioner?
“A-ha” local authorities will point out “We are best placed to know the needs of of our vulnerable residents”. And they would be right as the requirements of people in Sunderland are very different to those in Surrey. But while social care is councils’ largest financial cost, they have many other priorities. When it comes to deciding between creating a new shiny leisure centre and sustaining a meals on wheels service, it is often towards the vote-winning former that the money flows. Local authorities have been, by their own admission, struggling to provide social care services thoroughout the age of austerity. Maybe it is time for another body to have a try?
However, a “one size fits all” approach for everyone in England would not work on the ground and there would be a real danger of block contracts squeezing out the smaller providers that are the lifeblood of the sector. Instead could an arms-length commissioning collective made of social care experts from each local authority area, accountable to central Government, provide an alternative? This body would focus solely on the commissioning of social care services and offer a single point of contact for everyone who uses them. And if there is another pandemic, as scientists say is inevitable, it would be just one body co-ordinating a strategic response for the sector.
It would be a significant structural change, causing upheaval across the board. But the current system cannot continue to struggle and offer the protection service users need. With social care now sitting at the top of the political agenda, is now the time to push for reform and cut councils out of the equation?