‘Commissioners are asking us to deliver a Harrods service for an Aldi price’

Community care services for adults with complex needs are being eroded because of underfunding. The ones who will suffer are the service users, warns Robin Bush

A Wirral Autistic Society service user with two support workers

By Robin Bush

Stephen Bubb’s report, Winterbourne View – Time for Change, is welcome, but less for its content and more because it allows the sector to reflect on the issues it faces.

As chief executive of a grassroots organisation working hard to give vulnerable people the quality of life they deserve, I find it hard to believe that a mere three years after the appalling events at Winterbourne View were uncovered, we have had to fight tooth and nail to maintain sufficient funding to allow our supported living service to continue.

There’s a mismatch between the market rate the NHS, local authorities and central government think they should be paying – and the commercially viable rate required by specialised service providers to deliver excellent care. Put simply, we are being asked to provide (and are trying to provide) a Harrods service for an Aldi price. The figures just don’t stack up.

Community care services for individuals with complex and challenging behaviour require highly specialised intervention from committed staff, backed by organisations with a real breadth of in-house expertise. In our organisation, our dedicated autism practice department ensures that every new recruit embarks on a six-month induction programme made up of 25 autism-specific training courses, incorporating the very latest learning. Thereafter, staff training is a continuous process, with internal conferences, development days and bespoke sessions used to enhance on-the-job experience.

This level of commitment delivers life-changing outcomes for our service users. For example, before coming to us, no-one knew how to cope with Nigel and he spent 12 years living in a secure hospital.  Now he lives in one of our supported living houses and is a changed man. His confidence has grown beyond measure.  He’s happy in his home, supported by staff he trusts – he’s even able to venture out on his own and has joined a local snooker team.

Another client, Paul, had been slowly destroying his home. His carpets were soaked with urine, he could barely speak and he ate with his hands. Thanks to our work he now lives in an adapted property with toughened furniture. We’ve helped him expand his vocabulary and we’ve taken him on his first holiday.  He’s happy and settled and we’ve never had a serious incident with him.

‘Race to the bottom’ on price

To develop and maintain these excellent outcomes there needs to be a recognition from local authorities that such specialist services require adequate financial resources to support them. Yet, across the country and locally there has been a “race to the bottom” in terms of price for community services with well-respected organisations with a proven track record of supporting complex individuals having their hourly rates cut, because adult social care commissioners are unable to pay a fair rate for this type of service.

The truth is that funding for specialist adult social care is non-existent on the social care landscape.  And social care is the poor relation of the NHS.  At present, vital services such as ours are being eroded at grassroots level because they are unable to sustain the high level of training required to enable staff to meet service user needs.  Even if they could afford to support staff through training, social care providers struggle to attract and retain staff because they can’t afford to pay the wages worthy of such a challenging job.

The Bubb report suggests the development of a social investment fund in order to build capacity for community care. Most social care providers don’t want to be given money to develop services, we just want to know that we will be given a fair price for the care we already provide.  I’d far rather see the Libor fines [from banks for rigging interest rates], suggested as seed capital for the social investment fund, going into direct service provision – and a portion of the £2bn earmarked by health secretary Jeremy Hunt for the NHS in 2015-16 coming to social care via the Better Care Fund, with a commitment that it is ringfenced for specialist services for people with complex and challenging behaviours.

We need to fix this funding issue.  If we don’t, the dreadful reality is that community-based social care providers will fail to provide the right level of support and vulnerable people will end up in the very institutional care we are trying to avoid.  And there they’ll stay, with the discharge pathway blocked, because the funding is not available for the specialist support to help them return to life in the community.

Robin Bush is the chief executive of the Wirral Autistic Society

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4 Responses to ‘Commissioners are asking us to deliver a Harrods service for an Aldi price’

  1. David Bussue December 5, 2014 at 11:45 am #

    I’ve seldom read an article that has been clearer and given such an accurate description of the funding challenges in the third sector.

    As a senior manager in such an organisation, Robin’s insights exactly mirror our experience
    Having worked in a local authority previously and still with friends who do, I am confident that the LA staff no more agree with the current position than those of us in the voluntary sector

    The so-called recovery has yet to make it to social care in my view

  2. R Patel December 5, 2014 at 12:10 pm #

    We are well aware of the kind of fees Winterbourne commanded, I trust that the local authorities do not apply a different criteria when assessing the same individuals for residential placements or in transition units to enable those not suitable for the community yet to gain the appropriate skills.

  3. chris December 6, 2014 at 10:23 am #

    As a service user trying to get support, money seems to be the list thing l receive. It annoys me that despite the millions being spent the ones who should be really benefiting from the care system are simply not.(it’s an issue which politicians can forget about all too easily) i do not enjoy being stuck at home.

  4. Mark December 8, 2014 at 12:04 pm #

    IAlthough I agree with the general principles and realities in this article I can’t say that u have seen this as a reality for “post Winterbourne type projects” funding for these has from my experience not been an issue. The issue is that the rest of thos individuals who require community services (with different types of need) don’t get the same level of funding. There is a risk that high cost post Winterbourne packages (well the NHS paid that much) isn’t a rationale response. When you also ask is the NHS both national and local passing the full value of the money with the individual, I would suggest not. Therefore leaving already desperate LAs to try and do there best without further pulling money from the 95% of the rest of those adults with learning disability and needs.