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The UK's social care system is 'broken', the Prime Minister must fix it

Credit: Alamy

Dr Sanjeev Kanoria, Founder & Chairman | Advinia Health Care

4 min read Partner content

With the onset of Winter, pressures on the NHS are, once again, a point of major political debate. There is no quick fix, but Rishi Sunak must recognise he cannot ease the burden on health care without fixing our broken social care system too.

The new Prime Minister must pay particular attention to the health of the nation and should ensure previous pledges are honoured to increase funding of social care and also to ensure that independent social care providers receive the right fee for care.  This is a sector that is crying out for intervention.  
Over the past 30 years, hospital bed capacity in England has more than halved, from around 300,000 in 1988 to 140,000 in 2022, while the number of patients treated has increased significantly leaving the NHS with one of the lowest rates of hospital beds per person among OECD countries.  An estimated 117,000 patients died last year waiting for medical care on the NHS and the number of patients waiting for non-emergency NHS care is at record levels — about 6.5 million.  

Many of them, are people in employment who have taken sick leave reducing growth and productivity. The vicious cycle of bed blocking by older people who no longer need hospital care needs to be broken for people in employment to be treated rapidly in hospitals, so there is no productivity loss.  This simple equation needs to be appreciated.
 A properly funded social care system ensuring additional funds going to local authorities is ring-fenced for independent social care providers is urgently needed.  Over 300,000 vulnerable older people, receive funding through local authorities and CCG, and have their safety compromised because the fees are currently 40 per cent lower than the true cost of care.  

The most cost-effective way to ease the burden on the NHS is to increase support to care homes 

It is the statutory duty of local authorities and the CCG to pay the right cost for care, however their significant market influence means that if a care provider insists on the right fees, they simply stop placing residents. Thus many vulnerable older people end up getting low quality care, with daily news on some safeguarding issue at a care home.  They blame the government for not funding them, but we increasingly see that the money they receive is used to fill their own financial black holes and are not reaching independent providers. 
The most cost-effective way to ease the burden on the NHS is to increase support to care homes so that elderly patients are not blocking hospital beds at great cost because care homes are closing down or are refusing to take them for low fees.  If the working age population do not get timely medical treatment due to hospital bed blocking, sicknesses, absences will continue to increase and productivity will reduce creating a vicious cycle of low growth. 
Unless social care providers are paid a minimum of £1100 per resident per week (i.e. circa £160 per day) which is then adjusted based on nursing needs and dependency with reassessments done regularly, the vicious cycle of older people blocking the 140,000 hospital beds for the circa 65 million population of UK ( a dismal 0.2%) will not be broken. 

With rising staff, energy costs, and now interest costs and with inappropriately low fees by LA/CCG, social care beds will continue to be lost.  £160 per day which includes 4 hours of personal/nurse care, lodging, food, laundry, electricity etc will go a long way to keep social care viable and hospital beds available for patients with health needs.

Providers are helplessly caught between the two pincer arms of the CQC.  One arm wants them to continuously invest in staff training and physical environment whereas the other arm the CQC Market oversight team, want independent social care providers to have enough surplus cash to ensure viability.  The CQC MO “likely probability of failure” and issuance of warning notices is a significant threat to the independent care sector caught helplessly between the two pincer arms of the CQC and crushed by the LA/CCG with low fees, where is the surplus cash to preserve, where is the surplus cash to invest in staff training and in physical environment.  
This problem is further augmented by independent social care providers unable to claim back VAT, limiting their ability to fund capital expenditure to maintain properties to regulatory standards. We have been forced to close 1000 operating beds in the last one year and plan to close another 200 in the next few months for we cannot operate with low fee paying LA and CCGs and meet the regulatory cost of care. 

A broken social care will lead to a pressurised health service which will impact the health and well being of the working age population, and economic growth will be affected.  We hope that this simple equation is understood by key decision makers in Government. 

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