Written evidence submitted by David Button [ASC 028]

Submission to the inquiry on long term funding of adult social care.

• How has Covid-19 changed the landscape for long-term funding reform of the adult social care sector?

Covid 19 has drawn attention to and magnified problems which already exited pre-covid. These include:

• fragmentation of services with a variety of business models,
• variable resources and access to private funding,
• a range of more or less appropriate properties,
• different staffing arrangements varying in numbers and competence,
• local and remote variable quality of management and authority,
• variable communication favilities,
• deep-seated problems with recruitment, retention, training and churn,

CQC reports clearly evidence these issues.

• How should additional funds for the adult social care sector be raised?

Sir Andrew Dilnot et al have examined this issue over many years highlighting the political and economic difficulties. There has been an inappropriate focus on residential care given that we know that the vast majority of people prefer to remain in their own homes. The emphasis should move to domiciliary care supported by an improved community care and health system. The entirety of the cost of this integrated model of care for those professionally assessed to have needs above and beyond the ability of family and friends to cope should be met from general taxation. The advantages would be universal access to support at the point of need,  a better quality of life for many older and vulnerable adults with potential savings from delay or avoidance of expensive residential or hospital care. There are obvious implications for improving housing stock, communications and transport...

• How can the adult social care market be stabilised?

The market must be dismantled. The instability of the market is acknowledged in the question and Covid 19 has shown that cooperation works faster and more effectively than competition. When the market fails, it is those in need of care and their families who are the prime victims. Commissioning in adult care has failed leaving commissioners, providers and regulators free from any real accountability. The solution has to be to return social care to the statutory services so that quality standards of access and availability, management, staff development [including a career structure]and accountability can be upheld across the piece. Economies of scale will help control the costs

• How can the adult social care market be incentivised to compete on quality and/or innovation?

Knowledge, experience and skills are currently widely dispersed among a kaleidoscope of different organisations, loosely divided between purchasers, providers and regulators. These three elements should be brought together to give adults in need of care and their unpaid carers. Competition has failed to provide incentives. How could it succeed when employers are unable to release staff from the workplace for training, even when that training is free? It goes without saying that staff in the care sector, as in health services, need to be rewarded fairly for their work..

The profit motive has been demonstrated as completely inappropriate as an incentive, largely resulting in a race to the bottom. In residential services, this motivation is complicated by the property market, potentially more profitable than the provision of good quality care.

It cannot be any part of a quality service when Covid deaths in private care homes were kept secret by the CQC because that information might undermine commercial interests.

The Supplementary Benefits Regulations change in 1980 were a disaster in opening the “market” to unassessed access to residential care, growing that sector at the expense of the state to the dtrriment of developing good quality community services.

The purchaser/provider split created by the 1990 NHS and Community Care Act has failed to create a system which protects the safety, dignity and wellbeing of vulnerable people and their carers. And that, too needs to be dismantled in a new funding arrangement.

These two pieces of legislation may be historical but they have created the current landscape.

Any new funding arrangement needs to keep up with costs. The present crisis has been deepened by the reduction of funds to this sector for decades.

Finally any new funding arrangement must make care universally available and be funded to a level that supports services BEFORE unpaid carers are driven to distress.

April 2021