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For people, not for profit

Professor Vic Rayner OBE, CEO of the NCF

Professor Vic Rayner OBE is Chief Executive Officer (CEO) of the National Care Forum (NCF) – the leading association of not for profit care and support organisations, joining the NCF in 2016.

As CEO she is the co-chair of the government Strategic Advisory Forum on the social care workforce, chair of the National Social Care Advisory Group on social care and technology and sits on a range of government and national specialist groups with a focus on the social care workforce, digital transformation, new models of care and regulation.

Professor Rayner is a regular national and international speaker, and has extensive knowledge and expertise across a wide range of care, support, housing and social policy agendas. Here she shares her thoughts on why social care should be for people, not for profit.

Adult social Care is complicated and raises complex emotions amongst professionals and the general public alike. However, there are some important opportunities on the horizon that can make the pathway for recognition of care integral to all communities. The first is to state really clearly that social care is a public service. The ability to access social care is enshrined in legislation, most recently in the Care Act 2014. Local Authorities are provided with a statutory duty in order to ensure that their community’s care needs are appropriately met, and the state itself pays for large elements of the care that people receive day in day out, 365 days a year. This is an important point to make, as in the context of the current financial strictures, it can be very easy for care and support to be represented as less important to people, and as a consequence less important to fund than other core public services such as health or education.

Reimagine social care

Following the recent budget, it is clear that the reform agenda for social care has taken a back seat, a situation that would not be allowed to happen in other public services. The current pause is unfair on people receiving care and support, those waiting for it, their families and all of those working and delivering care. In the absence of planned government action, there is a need for commissioners and providers of social care to take action to shift the way in which care is delivered now, and to ensure that the care we develop is fit for the future.

There is very important work being done to reimagine social care right now. Firstly, the work carried out by Social Care Future, which is leading with people’s voices, and developing a vision for the future of social care that is relevant to all. In addition, the Reimagining Care Commission is on track to deliver their report on how care needs to change in order to better serve communities across the country.

However, there are also other approaches across the UK that we can learn from in an even shorter timeframe. The narrative around care is often dominated by concerns around profit making organisations who operate within care. The existence of a ‘market’ for the delivery of care is a direct result of government policy to generate a split between purchaser and provider, and at the same time not stipulating that these early spin-offs should explicitly be not for profit.

Eliminate profit from the care system

This all happened over 30 years ago, and many argue that the die has been cast, and we should accept the fact that care offers a mixed economy. However, I have been watching with interest the current consultation by the Welsh government around whether children’s care services should, in the future, only be delivered by not for profit organisations. This consultation is part of a wider manifesto commitment to eliminate profit from the care system, and is borne out of repeated concerns about the high levels of profit that point toward a dysfunctional market. This idea I think has huge resonance in England, where the notion that the ever-stretched public pot should be only held by those who are not for profit in their structure and ethos has increasingly more support.

What difference would only commissioning not for profit care make? Well, investing only in the not for profit care sector ensures that funding from government and private payers alike is reinvested in services both for now and in the future whilst helping services to continue to improve and evolve. There is public reassurance to be gained from a high degree of accountability, and transparency with not for profit care providers accountable to a wide range of regulators including the Care Quality Commission (CQC), Charity Commission and Social Housing Regulator. Finally, for commissioners who actively seek not for profit providers they can be confident that their investment will remain in services and communities; helping to ensure the full economic and social value of social care can be realised.

Not for profit social care should be central to the strategic plans of all Integrated Care Systems, Health and Local Government commissioning and central government reforms. It safeguards public money, it is value driven and people focused. Care should be for people, not for profit.

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