Reforms could make local care markets ‘unsustainable’, warns report

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Government reforms will not improve access for people ineligible for services and could destabilise care markets and providers, a report has warned.

The State of Care in County and Rural Areas, released by the County Councils Network (CCN) and the Rural Services Network (RSN), backs the government’s cap on care, means-test threshold, and its intention to publish a white paper.

However, their study concludes reforms will not address the existing problems within the social care system, while making local care markets potentially unsustainable by allowing private fee payers access to council arranged care and the fee levels they pay providers.

County leaders have warned ‘things could get worse before they get better’ and are concerned the majority funding from the health and social care levy will stay with the NHS once its backlog is cleared, rather than switching to social care.

Analysis of data for 40 of the largest county and unitary authorities’ areas in England found last year, 58% – 545,000 – of people who made a request were told they were ineligible for care. This figure has remained stagnant since 2017.

While supporting a cap on care as they will ensure more people do not pay catastrophic care costs, councils argue proposals will not improve eligibility for those below the criteria to access services.

The government’s commitment to allow self funders to access council contacts and ensure greater fairness in care costs paid between private and state fees will lead to a significant increase in demand for council arranged support, the document said. The bodies argue this could destabilise county care markets by making some providers economically unviable or result in unaffordable additional costs for authorities.

Self-funders pay 40% on average more than councils for the same standard of care, therefore cross subsidising the market.

It is estimated there is a fee gap of £761m in county and rural areas. Councils are concerned the government has underestimated the costs of bringing these fees more equal, and it is uncertain whether the £5.4bn committed for all the reforms and to move towards paying ‘a fairer price for care’ will be enough.

Between 2018 to 2021, 227 care homes closed in county and rural areas, the report revealed.

The new levy could raise £12bn a year, but outside of 20% set aside for social care reform, there is no commitment on how these resources will be distributed between the two systems. CCN and RSN the want government to enshrine in law that beyond 2025, most of this income is earmarked for social care.

Cllr Martin Tett, CCN adult social care spokesperson, said: ‘Unlike successive governments, this administration has grasped the nettle and set out the first attempts at reforming the adult social care system in a generation.

‘However, these reforms, and the sums committed, fall short of truly addressing all the issues within the social care system and could have unintended consequences, including destabilising county care markets. They will not address existing challenges, not least in improving eligibility for the hundreds of thousands unable to access to services.

‘Because no short-term funding is available for current pressures, things are likely to get worse before they get better.’

Graham Biggs, Socia chief executive, said: ‘Already rural communities contribute some 7% more than their urban counterparts towards the costs of social care in their areas. The government cannot keep pushing costs onto council tax without reform to the present system which sees urban areas this year receiving some 61% more in government settlement funding assessment grant.’