Transfer of social work to ‘lead providers’ mooted as solution to care market failures

The transfer of local authority social work functions to a ‘lead provider’ could be the answer to care market failures, according to market analysts Laing Buisson.

In a white paper published yesterday, the market analysis firm proposed a new commissioning model for the care of older people, which would see a lead provider take control of functions currently administered in-house by councils.

The ‘Social Care Maintenance Organisation’ (SCMO) would contract with NHS trusts, clinical commissioning groups and councils with adult social services responsibilities (CASSRs), in order to provide a comprehensive range of social services for older people.

This could include taking on social work functions, such as assessment, care management and the administration of personal budgets.

William Laing, chief executive of Laing and Buisson, said: “The paper is a means by which to open up debate on an issue which dogs providers of care services working for publicly funded clientele. In particular, the mismatch between public sector commissioners’ need to contain costs in an extended period of austerity, and providers’ need to earn an adequate return in order to sustain existing services and develop new ones.”

The paper, which analyses the state of the UK care services market, describes the SCMO as a possible solution to the difficulties faced by local authorities trying to make savings and independent providers looking for realistic return on their investments in the sector.

It highlights the widespread adoption of the ‘task and time’ model, which has seen home care visits reduced to just 15 minutes in a bid to cut costs, and councils’ exploitation of buying power to negotiate lower prices, as “endemic” market failures.

In a bid to tackle these issues, the SCMO would commission long term, outcomes-based contracts – an approach where providers are rewarded for helping service users to achieve agreed goals. The contracts would ideally last for a period of three to five years, but would be terminated if providers failed to perform.

The SCMO would either be a for-profit, not-for-profit or statutory body and the paper sets out three levels of development for the organisation:

• A basic model that operates in defined geographic areas and could be implemented immediately for publicly-funded service users, with no need for legislative change.
• A SCMO plus model that operates on a national basis and allows service users to choose their SCMO.
• A SCMO-double plus model that extends the role of the plus system to allow private funders of care services to use the new organisations.

According to Laing and Buisson, the commissioning role of a council could be almost fully transferred to the SCMO, but the CASSR would need to retain some commissioning responsibilities for itself to “avoid conflicts of interest”.

A mixed response

The white paper was unveiled to a group of social care leaders, providers and commissioners at an event last week, which was conducted under the Chatham House rule to allow participants to speak more freely.

The event saw a panel of six social care experts present proposals for the future of long-term care for older people, before debating the topic with the audience. The guests were then invited to vote on which proposal they thought should be added to the paper.

Laing Buisson’s vision for an SCMO divided the audience, with 10 members in favour, 7 against it and 27 voting ‘no comment’.

The clear winner of the vote was the proposal for ‘information, choice, personal budgets, competition and leadership’, which scored 34 out of 44 votes in favour.

The speaker had called for more action on health and social care integration and said that it was time to allow individuals to “own the system” through an increase in commissioning using personal budgets. “We need to trust that individuals can make the right choice in their best interests,” said the participant.

A joined-up system

The integration of health and social care services was a key theme of the debate, which generated agreement among panel and audience members.

Proposals from the experts included the commissioning of multi-agency, outcomes-based contracts, and one speaker argued that a single ring-fenced pooled budget for the two systems was the “only way forward”.

But while there was a resounding ‘yes’ in favour of more joined-up working between the two services, one audience member asked the question: “How can we integrate these services when there is not a level playing field between the two systems?”

This sentiment was echoed by another participant, who called for more money to be spent on cultural change in social care, in order to see the same level of support and status attributed to the sector as is already seen in health services. “The NHS spends £100,000 a minute on training so it would be useful if some of that money could be used across social care,” said the audience member.

The split between the two funding systems was also highlighted, with one participant adding: “Let’s not forget the issue between free at the point of delivery and means-tested.”

Taking the lead

The development of an intermediate care sector in the UK was highlighted as an area where social care could be integrating with health services, in order to prevent delayed discharges from hospital. “At any one time there is a 10% vacancy rate in care homes so why aren’t we using that space to get people out of hospital,” asked one participant.

Another audience member added that there needed to be more focus on what reablement services care homes could offer. “There is a lack of understanding about what care homes can deliver and what they already do deliver,” said the participant. “We need to look at what is possible in the sector and help people to understand more about residential care.”

Sector reaction

Speaking at the end of the session, William Laing, said: “My main take on the day was that extended personal health and social care budgets could be the game changer. People being able to use their own money and subscribe to services would be part of Laing Buisson’s Social Care Maintenance Organisation model.”

Des Kelly, chief executive of the National Care Forum and a guest at the event, added: “I thought there was remarkable consistency and a fair bit of consensus around the main issues that were being discussed, from both providers and commissioners.

“However, I thought the overall tone of the discussion was far too pessimistic. If you look back at a period of 25 years, the sector has transformed and much of that change was due to legislation introduced in the early 90s. Why can’t we think that the legislation we are putting in place now, such as the Care Act, has the same power to transform services in the next 20 odd years?”