There are now only two days to go until local council elections in England, and for many people, these elections come after sharp increases in Council Tax to pay for the increased costs of adult social care. The reaction to this should be at the forefront of anybody looking to stand or be re-elected as a councillor. Both local and central government need to be aware of the growing discontentment about the way in which adult social care services are commissioned, funded, and accessed, particularly considering an apparent absence of central government action on reform.
This is reflected in the media. Over the past number of months, an increasing number of headlines have addressed the complex issues surrounding safeguarding and quality for both those receiving care and support and the care workforce – such as here, here and here. Each of these headlines has drawn specific attention to concerns related to the role of profit within either children or adult (in many cases both) social care provision.
This is not new, and the narrative around care is often dominated by a narrative around profit making organisations who operate within care. It is important, of course, to remember that 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. 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, there is another way.
We have been watching with interest the actions of the Welsh government laying out a programme to eliminate ‘for profit’ provision from children’s services. We believe this idea could have resonance in England, where the general public is increasingly unhappy to see the ever-stretched public pot being used to fund for-profit services – particularly where they are backed by investment hedge funds looking for a return. The Welsh government focus is borne out of repeated concerns about the high levels of profit that point toward a dysfunctional market. In direct consultation with the children using these services, it is reported that the message coming back loud and clear has been that children ‘do not wish to be looked after by privately owned organisations that make a profit from their time in care’.
In 2020 when NCF carried out public polling, we discovered that 75% of those surveyed would like their care delivered by charitable or publicly run services. However, more recently, Ipsos carried out a poll which had a surprising result that fewer people had confidence in care accessed directly from a not-for-profit provider than directly access from a private provider, but more confidence in a care provider commissioned by the LA or NHS. We think this result is down to the way the question was asked and the options given which were more about whether you accessed care provision directly or via a commissioner. People had more confidence when services were commissioned on their behalf by the state but the survey didn’t split out the difference between state commissioned not-for-profit and state commissioned for-profit. Nevertheless, this indicates that there is more work to do to understand the views of the general public. We remain confident that the case for care to only be provided by those who are not-for-profit in their structure and ethos is increasingly gathering support – particularly among those actually accessing services.
The case for not-for-profit care
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 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.
If we want this to change, then we need an explicit plan from both national and local government to commit to expand the market share of not-for-profit provision, with the end goal where not-for-profit provision of care and support is once more the norm. Commissioners should be looking to not-for-profit provision as their preferred choice. We need a clear transitional period and a transformation deadline that makes clear that publicly funded social care of the future will be underpinned by organisations that safeguard public money, are value driven and people focused.
A number of reports have made the case for the expansion of not-for-profit care in the past. The most recent of these was published by ADASS last week. Their roadmap for the reform of care and support in England, calls for an overhaul of procurement processes, capital and social investment to enable to expansion of the number of not-for-profit providers. Similarly, the Church of England’s Reimagining Care report stated that they wanted to see the not-for profit sector grow, so that the system has a more relational, values-based approach to care.
Care should be for people, not for profit.