Social care, the market and the prospects for a National Care Service

John WoolhamJohn Woolham is Senior Research Fellow at the Social Care Workforce Research Unit. (524 words)

Professor Guy Daly, Executive Dean of the Health and Life Sciences Faculty at Coventry University, Bleddyn Davies, Emeritus Professor of Social Policy at the Personal Social Services Research Unit and I spoke at a Research in Specialist and Elderly Care (RESEC) seminar on 10 March at the House of Lords. RESEC is a national charity whose principal aim is to promote research and teaching in social care by identifying priorities for funding and teaching and securing funds to invest in these priorities. It provides finance for agreed projects and ensures findings and outcomes are publically disseminated.

The event was hosted by Baroness Dr Ruth Henig and was chaired by Dr Richard Hawkins, a leading UK publisher of health and care related journals and other publications. The purpose of the event was to review the viability of social and health care provision for older people, and the overarching theme was of reflections on the need for, and shape of, a National Care Service. The three speakers set out the context, referring to:

  • changes to demography, increased life expectancy, but also the rise of multiple long-term conditions/co-morbidities, exacerbated by health inequalities, that affect health, quality of life, and are expensive to treat and manage;
  • the fact that though the NHS is free to those who need its services, social care, though also allocated according to need, has always been means-tested; and,
  • the fact that social care has fared particularly badly over the last decade, with spectacular market failures such as Southern Cross, and striking differences in the use of residential care across the UK, with the residential care sector in London all but collapsing because no one can afford it.

Guy and I argued in response to these issues, that the public sector reform agenda, with its emphasis on choice and the creation of social care markets (along with the promotion of integration and asset based solutions) as the means by which this can be achieved creates significant new problems without solving those for which they were intended, and obscures to some extent the underlying problem of funding. We provided two examples. Guy referred to the Dilnot Review, which argued that market based solutions do not provide an answer to the spiralling costs of residential care, but that there was a need for the government to provide funding to prevent further ‘market failure’.  I referred to findings from recent research on personal budgets and direct payments for older people which provides further evidence that such approaches to service delivery do not produce better outcomes for this group of citizens. We suggested, instead, the need for government to (re-)establish a socially insured social care system.

The event attracted over 30 RESEC trustees and guests from the provider, banking, third sector, NHS and policy sectors and our presentations led to a lively debate, which focused on the needs of home care and domiciliary sectors, and the need for greater integration of health and social care through a more devolved framework. Discussants also drew attention to the need to resolve tensions between regulators and local authority commissioning and the urgent need for enhanced care workforce training.

John Woolham is Senior Research Fellow at the Social Care Workforce Research Unit.

See also:

Woolham, J., Daly, G., Sparks, T., Ritters, K. & Steils, N. (2016) ‘Do direct payments improve outcomes for older people who receive social care? Differences in outcome between people aged 75+ who have a managed personal budget or a direct payment’, Ageing & Society. doi:10.1017/S0144686X15001531