Is low-cost, budget airline-style social care workable?

Airlines and supermarkets show that cheap services can be provided without compromising too much on quality. Social care could take note, writes Brian Munday

The architects of the UK’s welfare state never imagined that fee-paying customers would purchase social care in the same way that people buy airline tickets or supermarket food, with trade-offs between price and quality. Why is this happening?

First, there is personalisation, which turns council-funded service users into purchasers through personal budgets.

Second, there are the cuts councils are making to adult social care. Contracted external providers are under pressure to make do with no increase in fees or even reductions. “Value” for commissioners now means the lowest price at an acceptable, but not necessarily high-quality, level.

Third is the growing market of self-funding care users, many of whom fit into Labour leader Ed Miliband’s category of the “squeezed middle”: those who are not well-off but are ineligible for state-funded residential care because they have assets of more than £23,000.

This all amounts to one inescapable conclusion – purchasers of social care will make choices based on what they decide is the price and quality level they can afford.

Care providers may have a lot to learn from the likes of Sainsbury’s and the budget airlines.

In both cases, cheaper options at lower but acceptable quality have been introduced in response to demand. Sainsbury’s Taste the Difference range is great if you can afford it. If not, its Basics produce is cheaper and acceptable.

Scope for alternatives

An airline ticket including a meal and drinks is fine at a price; otherwise dispense with the extras and just buy the seat. The pilot is qualified. So what scope is there for cheaper alternatives of acceptable quality in social care?

The trend in residential care has been upwards in quality and price, with a growing gap between the fees paid by self-funders and by councils, as the former compensate for the relatively low fees paid by the latter.

In this scenario the pressure on providers to develop the equivalent of Sainsbury’s Basics range will grow. It is the larger providers that will have to develop a wider range of products to include cheaper care. For example, in care homes we could see: smaller rooms; shared bathrooms instead of individual en-suites; rooms in less attractive parts of the building.

This may seem mean and too much like the budget airlines, but if it reduces the weekly cost to the private fee payer by at least £50 a week it could be very attractive.

The pressure towards more affordable domiciliary care services is as great for two reasons. Higher eligibility levels for domiciliary care leaves more people paying for services.

Also, hourly rates paid to personal budget holders for care can be up to 50% lower than the rate councils pay agencies through block contracts.

Under these pressures, personal budget holders can reduce their costs by contracting care agencies for fewer visits with shorter durations. They can also save money by using relatives or personal assistants, rather than agencies.

The budget airline approach suggests that a cheaper but safe service can be offered by stripping down the service to the basic minimum, with perhaps guaranteed call times for care a chargeable extra, for example.

Then there is the issue of regulation. In Italy there is a strong cultural resistance to residential care which, in any case, is scarce and expensive.

Many older people are cared for in their own homes 24/7 by illegal immigrant carers, mostly from eastern Europe.

This arrangement suits the older person not wanting to go into residential care; their families for cost and convenience reasons; the care workers who have a job; and the public authorities that do not have to provide care.

There is much to criticise about this form of care but it has become embedded in the Italian welfare system. There are schemes for live-in carers in the UK that may not always be part of the regulated system. People find their own forms of affordable care, which may be satisfactory to them but raise wider concerns.

In an article last year, Community Care quoted the case of a couple who spent £670,000 on care bills. As an increasing proportion of people needing social care pay for their services, they will inevitably become as discerning and cost-conscious as the customers of the budget airlines and the supermarkets.

Providers of social care need to adapt quickly to this new reality that is a far cry from what the founders of the welfare state intended.

Brian Munday is honorary senior research fellow in international social care at Kent University

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