Why are English care home closures leaving vulnerable people at risk?
In
a recent article in The Guardian, the stark headline read – English Care Home
Closures Are Leaving Vulnerable People at Risk.
And I found myself shouting “seriously”,
not because I doubt this or because I disagree but because it is so obvious and
has been continually reported on for years.
It may not always have been mainstream reporting but from my position
having previously worked in the Management Side, it has been widely reported
and discussed. Yet still nothing has happened, nothing has been achieved and our
elderly are still at risk. What I also
found a struggle to comprehend is how the CQC can state that being judged inadequate is
not all bad for care homes
CQC
warns that sector as a whole is at risk as providers of care for elderly and
disabled people pull out over rising costs and cuts to council budgets
The
quality and safety of social care services received by elderly and disabled
people in England are in danger, as care homes close and providers pull out
because they can no longer make enough money, the care watchdog has warned.
In a
bleak assessment of the future of vital services that support millions of
people, the Care Quality Commission (CQC) voiced alarm that
the care sector as a whole is “at risk”.
Providers
are in trouble because their costs have increased by up to 30% in the past year
while their profit margins have fallen by more than 40%, it warned. It
pinpoints the national living wage (NLW) and the inability of cash-strapped
local councils to pay higher fees for these services as the main causes of a
growing problem.
The
number of care homes overall in England has fallen from 18,068 in September
2010 to 16,614 in July this year, at a time of growing need linked to the
ageing population, according to figures released by the CQC.
The total
number of beds available in care homes also fell between 2010 and 2016 from
255,289 to 235,799 this summer – a fall of 19,490. While the number of nursing
homes increased slightly, from 4,387 to 4,623 in that time, more than one in 10
residential homes – for elderly, often frail, people – have closed. The total
of those available has fallen from 13,681 to 11,991 – a drop of 1,690.
The many
people who rely on care homes and receiving help in their own homes with
washing, dressing and eating could be affected if more and more of the private
companies that dominate the market go out of business, the CQC fears.
Andrea
Sutcliffe, the CQC’s chief inspector of adult social care, was responding to
the leak to the BBC of a recent internal briefing document that spells out how
rises in providers’ costs and the squeeze on local councils’ budgets are
leaving care services in an unsustainable position.
“We know
that the adult social care sector faces many financial pressures which,
worryingly, could undermine the quality and safety of care that people receive
and rely upon every day,” said Sutcliffe.
She
confirmed that information from care providers detailed in the CQC document
“does highlight a concern that the long-term sustainability of high-quality
care within this sector could be at risk. Given the impact this would have on
people’s lives; it is important that we continue to monitor these trends
closely.”
Why being judged inadequate is not all bad
for care homes
The
document emerged less than 48 hours before the CQC, which is the NHS and social
care watchdog for England, is due to present its annual report on performance
and emerging issues, called State of Care, to parliament on Thursday. It is
expected to highlight how worsening problems in social care are having a
serious impact on the NHS, for example, by leading to patients who are fit to
go being trapped in hospital because no package of social care support is
available to allow that.
The
regulator is worried that more and more home closures could leave needy,
vulnerable older and disabled people with nowhere to go.
Its
analysis document says that with care homes the “market position is undoubtedly
hardening – increasing the pace of home closures”.
The CQC’s
anxieties echo those voiced with increasing urgency in recent years by old
people’s charities such as Age UK, the Local Government Association, health
thinktanks and MPs that deep cuts to town hall budgets since 2011 have led to a
major deterioration in social care at the same time as demand for it was
increasing.
The CQC
document, called “adult social care market insight” and based on data received
from 39 major providers, states that: “This is a local authority-funded service
user problem. Notwithstanding recent fee increases, the historic level of
underfunding remains and in some cases has probably increased as a result of
[the] national living wage.”
On the
fees that councils pay providers either to care for individuals in a home or to
help meet their basic needs while they are still living in their own home, it
says: “Fees – At what point will the ongoing focus on fees adversely impact the
quality of service being purchased?”
The CQC
also warns that businesses have been left out of pocket by having to pay staff
more because of the national living wage. It adds: “NLW – Provider sentiment
suggests fee increases have generally not covered the cost of NLW. This
position is unsustainable.”
It is
also worried that the same pressures could push providers of domiciliary care
to the wall. “Provider exit and large-scale contract handbacks demonstrate the
fragility of this market. At what point can the replacement providers only make
the returns work by compromising on the quality of care?” the briefing paper
asks.
Barbara
Keeley, Labour’s shadow minister for social care, said: “These figures are an
alarming reminder of the desperate state of care services in this country.
Despite all the spin from ministers, the Tories have left social care on the
brink of collapse, with thousands of people’s care at risk as a result. It’s
not enough to turn a blind eye to this crisis. We need ministers to step up and
guarantee that they will properly fund care services. Anything less will be a
betrayal to the most vulnerable in our society.”
Norman
Lamb MP, a Liberal Democrat former health minister in the coalition government,
urged ministers to prop up social care before the system collapses. “This
briefing confirms that the care system is teetering on the brink of collapse.
The government has known this for some considerable time yet still they refuse
to act. The whole system is now living on borrowed time as more and more
providers contemplate leaving publicly funded care and face going out of
business because the sums don’t add up,” he told the Guardian.
“The real
scandal is that we are rapidly moving to a position where you will be able to
get great care if you can afford to pay privately – but if you can’t you will
be left with nothing or substandard care. That situation is intolerable and a
stain on our country. It would be grossly negligent and morally wrong for the
government not to act now. There is an urgent need for additional emergency
funding.”
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