I think it was back in 2008 that Ivan Lewis, as Care Secretary, said, in response to a Parliamentary question that care providers should at least expect a raise in fees in line with inflation following a round of announcements from Local Authorities giving less than this for the second year running. Since then of course the raises in fees have been even less or in many cases this year non-existent.

            Yet, in that time, there has been terrific inflationary pressure on care providers, particularly caused by the increases in fuel and food costs.

            Now the Local Authorities are faced with a 10% cut in their budgets and, undoubtedly, this will mean another year of 0% increases in fee payments.

            The unanswered question in all this how are care providers expected to provide decent levels of care in the face of ever decreasing margins and what will be the areas that care providers have to cut out in order to make ends meet.  Most providers are private companies and there has to be an element of profitability to ensure that the business continues to survive, the danger in the current situation is that many smaller providers, who care about providing a decent service, will feel that they are not able to do this under the current monetary constraints. Other, less scrupulous providers will feel happy to continue to cut quality in order to maintain profit margins and the only people who lose out are those receiving the care service.

            Of course the larger providers will be able to survive through economies of scale and bulk purchasing but this then creates another potential issue. Do we want a ‘supermarket’ system of care where the only cost effective choice is the big providers using purpose built complexes? Or should those who need care services be able to make choices about the type of provider they want and the way in which they wish to spend their lives.

            Where providers do make cuts, these are, inevitably, in relation to staffing, which is always the biggest cost for providers. Cost cutting is most likely to hit training first, then, almost certainly the overall level of staffing, putting more pressure on existing staff to take on more domestic duties than spend quality time with individuals.

            Very often Local Authorities only see their role in care provision without taking into account how their financial decisions impact on those who actually provide the care and on the impact of choice and quality on those who receive care services. Social Care needs to be raised to the top of the agenda both locally and nationally and we need a debate, not just on the best option for the elderly to pay for their care but on the fundamentals of care provision and how we expect providers to supply the quality the nation expects with less and less money to do that.

            This is an issue that needs tackling NOW. After years of cutbacks already any more will put the lives of the vulnerable in our society at risk and are we really prepared to do that?