If it's broken, papering over the cracks won't fix it | adam HTT

There can be no doubt that the Social Care system is broken. Too many sector leaders, commentators, and politicians are saying “we’re in a care crisis”, for it to not be true.

However, we would argue the crisis that we see is different from the one that many refer to, specifically one based almost entirely on lack of funds. Crisis point, edge of a cliff or falling off the ‘precipice’. These headlines have been around for so long now that surely it goes to prove that this can’t just be about funding as many will have you believe.

In our opinion the hyperbole that is generated often detracts from the message and drags down the debate into a very binary one… “we need more money” … which isn’t the case. The fundamentals of the system are actually incorrect and by simply throwing more money into the pit will continue to only paper over the cracks of a much deeper hole.

So what do we mean by that?
As with many previously state run industries the care sector has gone through a fundamental shift from being wholly centrally managed and delivered, to being largely delivered by the private sector whilst management has stayed central with the Local Authorities. This change has happened gradually though, as many services were released to the private sector bit-by-bit over years. The patchwork of approaches, in speed and design, across the entire council landscape goes some way to show how the system has broken.

A private market has emerged to support the demand, but it has not been an organic growth, instead rather much like growing a bonsai tree, the provider market has often been restricted and has never fully matured.

The thinking behind this is easy to understand; from the providers’ perspective at one end of the spectrum smaller less commercial providers whose focus is often on delivery and less so on sustainability has led to an immature commercialisation. Whilst at the other end of the spectrum national organisations look to leverage their position of importance to the councils; and from the councils’ perspective the delivery of services is paramount, meaning that different commercial vehicles are put in place to ensure capacity, to satisfy both the immature and more commercially astute providers.

What this has led to is a dysfunctional market where the power often rests with the provider, and the ‘buyer’ is reluctant to risk making changes for fear of the repercussions?

Clearly from a dispassionate viewpoint the answer is easy. Stop restricting the market. Take the risk. Markets do, and always will, develop to meet demand.
The additional money that is being called for should not be spent on the same services from the same providers, but rather for creating a better system. The fundamentals need to be in place to support this market, namely transparency and fairness aligned with competition and flexibility. These are the foundations to building and evolving an efficient and mutually beneficial process for both buyer and supplier, to ultimately benefit the citizen.

In what kind of system would we expect a provider to charge the same for a service every time, when their cost of delivery fluctuates? In what kind of system would we think that one provider is best placed to deliver all the services, regardless of specific need?

Yes, it makes it easier for councils to manage, but only in the context of the ‘broken’ systems. Yes, it makes it easier for councils to budget, but basically this only works when you spend too much and ensure sufficient margin to mitigate for the downturn. Instead choose the best provider to deliver a specific service and pay the right price. This right price is best set by the market themselves based on the specific service you want. This doesn’t mean you pay too much, as it’s easy enough to have floors and ceiling to manage the exceptional.

Sounds simple doesn’t it? But it is the courage to make such a fundamental change that is the barrier.

Here’s just one alternative approach that has proven sustainable in Domiciliary Care which bucks the Locality Model and Fixed Framework focus.
It certainly goes without saying that such change can be painful, and there are often significant challenges along the way. But short-termism has been the enemy of the care sector for decades now, the sticking plaster instead of surgery has only served to create an even more imbalanced, disjointed system.
Only by looking at the long term can the system be fixed for future generations. A system that can evolve, meet changes in council and citizens’ needs by supporting a market that is no longer restricted but rather guided, managed and engaged with.


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