Care Act 2014: Councils struggling with ‘market sustainability’ duty

Councils are struggling to implement commissioning reforms introduced under the Care Act, directors have warned.

Ray James, president of the Association of Directors of Adult Social Services, told Community Care the duty placed on councils to ensure a sustainable care market was ‘exercising’ directors due to the tension with existing pressures in the sector.

“The Care Act strengthens the responsibilities of local authorities as commissioners around market sustainability and people are grappling with how do we balance that and do it with reducing resources and the difficulties around sustainability of the sector as a whole,” he said.

‘Sector at risk’

The Care Act requires councils to ensure there are enough high quality providers and services for people to choose from in their local area.

This includes understanding the true costs of care, ensuring providers are paying care staff the national minimum wage and for the time spent travelling between calls, and working with providers to minimise the risk of unexpected failure.

The legislation also requires councils to consider the impact of their own commissioning practices and not take any actions that could threaten the sustainability of the sector.

But James said “wherever we look” there are concerns around financial sustainability and issues such as the quality of services, high turnover of nurses in care homes and the announcement of the ‘national living wage’ policy are all putting pressure on the sector.

“Who doesn’t think that the things we ask frontline care workers to do they deserve to be paid at least £9 an hour for?” he said.

“But until the government give greater certainty about whether they are going to fund councils to be able to meet the cost of it, it’s adding risk in the sector.”

‘Provider instability’

James was speaking to Community Care following the publication of the fourth Care Act stocktake, the first to be carried out since the legislation took effect in April 2015. It was undertaken in May and answered by all 152 local authorities in England.

On market sustainability, the stocktake found more than two thirds of councils (68%) had contingency plans in place to manage the collapse of a major care provider. A further 17% said the plans would be in place by July and 15% said by or later than September 2015.

More than half of councils (58%) reported a ‘robust and comprehensive’ understanding of the fair costs of care in their local area and 70% said they had put in place arrangements to assure themselves that providers were paying staff the national minimum wage.

But 68% of councils also reported ‘the impact on the local provider market’ as one of the main risks they faced in delivering the Care Act reforms.

Care market costs, staffing and provider instability were also listed as concerns alongside inadequate funding and uncertainty around future cuts.

‘Sharper focus’

“The concerns are about how on earth do we ensure a sustainable market in the context of the level of funding reductions councils have had in the last few years,” said James.

“The market sustainability is much more in the place of ‘we need some help to be able to do this [compared with some of the other reforms].”

But the ADASS chief added that the difficulties councils reported around market sustainability and their commissioning responsibilities were a “tension that should be in the system”.

“I think the reforms have brought commissioning practice that is not as good as it should be into sharper focus. Councils shouldn’t be able to ignore it and they should be commissioning responsibly, but the government needs to play their part in funding responsibly too.”