By Stephen Sloss
It’s time we all faced up to some harsh truths about the state of social care in this country. Yes, the introduction of the ‘living wage’ will significantly increase the cost of delivering it. Yes, government cuts and budget pressures from local authorities make it increasingly difficult to uphold standards. And yes, if nothing changes there soon won’t be many care providers left in business to deliver it.
However, just calling for or relying on the government to provide extra funding isn’t the answer. The prevailing mood doesn’t suggest the government’s purse-strings are about to be substantially loosened. Even if they were, with longer life expectancy and an ageing population we’d just be storing up even bigger problems for later. If we’re to find a solution that works better for care providers, for care users and for the public sector then we have to take a whole new approach.
Reduce dependence on local authorities
To make the business of social care more sustainable we need to reduce our dependence on the revenue we generate from local authorities and derive our income from a wider range of customers.
This is where I think far greater adoption of self-service and assessment – perhaps by making direct payments the default rather than the exception – can make a big difference.
To put the problem into perspective around £14bn of the money spent on adult social care each year in England comes from local government, with a further £10bn contributed by self-funders. That’s an awful lot of revenue to have associated with one single investor, particularly one that is very publicly experiencing financial difficulties. In any other line of business the warning lights would all be flashing that it was time to diversify.
The maintenance of a supplier service directory is expensive for the local authority and leads to procurement processes that become little more than a ‘box-ticking’ exercise. Suppliers end up competing for the services they are asked to tender for largely on price, with little incentive to offer up any form of innovation that could attract a wider target audience.
For example care and nursing homes compete for the limited number of users whose health has deteriorated to the point that they need 24/7 care. In the process they miss out on the much larger customer base that don’t yet require 24/7 care but who might be ready to pay for a more semi-supported lifestyle in a retirement village style environment.
End divide with self-funders
So, how might this work in practice? Well, in my view it requires us to take a more universal approach to social care provision and to stop making such a distinction between those who are state-funded and those who fund it privately. We need to enable every citizen and their family to have a say in who provides their care through greater adoption of online technology for self-service and self-assessment.
In most walks of life we trust people to go off and find their own solutions. For example, we buy and sell houses, book travel and pay for holidays with no intervention from the state. However, when it comes to care the assumption is that things must be done for us. Of course there will always be a small minority that need extra assistance. But this level of dependence should be seen as the exception, not the default setting.
Online ecommerce technology that brings the simplicity of consumer shopping websites to social care provisioning can help. Establishing a curated national platform through which citizens can purchase their own care using their personal budget, or a debit or credit card eliminates the need for complex systems of invoicing and payment in arrears. This will improve suppliers’ cash flow and save local authorities millions of pounds associated with care administration and provisioning.
Positive impact on quality assurance
Some may argue that increased use of self-service and assessment could have knock-on effects for quality assurance. However, implemented correctly I believe it could have a positive impact. The Care Quality Commission is already chronically under-funded in this area and savings made in the administration and finance departments may help to alleviate this.
In addition, allowing users to rate the quality of the care services they receive via an online marketplace can help the CQC to better target its resources. For example, it will enable the regulator to keep a closer eye on those who consistently receive poor feedback and reward the best providers with less frequent visits.
This is exactly what we hope to achieve with www.mycaresupermarket.com, a one-stop shop which brings together buyers and sellers of social care for the mutual benefit of both parties.
An influx of extra funding might plug some holes in our social care system but it can never deliver a sustainable long-term fix. The time has come to give citizens greater choice and suppliers’ access to a wider range of users. It’s time to take care of the market, not to beat it into submission.
Stephen Sloss is chief executive of Salvere, a community interest company that helps people to develop support plans. Salvere has, with e-commerce company cloudBuy, recently launched Mycaresupermarket.com, which enables self-funders and direct payment holders purchase care and support services online. He is a registered social worker and former director of social and adults’ services at Blackburn council.