The NHS’s willingness to pay higher care costs could have damaging consequences
"This has to be a joint and shared endeavour, not least because NHS interventions into this market can actually be quite destabilising as often they can pay over the odds compared to adult social care.” Paul Burstow, chair, Social Care Institute for Excellence
By paying “over the odds” for care, the NHS is destabilising the care market, former care minister Paul Burstow has said.
Burstow, a Liberal Democrat care minister from 2010 to 2012, and now chair of the Social Care Institute for Excellence, said that social care needs to be a “genuine partner” in the new integrated care systems (ICSs) that come into force in July.
Speaking at a King’s Fund event, Burstow said that the “renewed emphasis on market shaping” in the government’s social care reforms is “in some ways helpful”. He added: “But market shaping simply led by local authorities in looking into adult social care services won’t be sufficient. This has to be a joint and shared endeavour, not least because NHS interventions into this market can actually be quite destabilising as often they can pay over the odds compared to adult social care.”
Burstow said it was necessary to have a “grown up conversation about the positive and negative effects that NHS interventions can have into the labour markets that are essential to supporting social care”.
There is also concern in the sector about the better care fund, a programme that requires clinical commissioning groups (CCGs) and local authorities to enter into pooled budget arrangements. The NHS is expected to pay for the first six weeks of care through the fund. Researchers from the Institute of Government interviewed local government representatives who said that this might “permanently increase costs, as NHS commissioners paid more for care placements than local authorities did”.
Interviewees were reported as saying, however, that this was “probably inevitable, given evidence that councils were paying less than the cost of care-home care prior to the pandemic, and NHS England and NHS Improvement discharge guidance encouraged commissioners to cover the full cost of care placements”.
A senior councillor told the Local Government Chronicle that this was a “major worry” that is compounding the crisis in social care.
The problem of staff shortages was also raised at the King’s Fund event, with Vic Rayner, chief executive of the National Care Forum, saying that her members were reporting 18% vacancy rates, “with a 14% absence rate laid on top of that”.
Fears about staff shortage are supported by an Association of Directors of Adult Social Services survey that found that one in eight authorities are moving to “life and limb care only” some of the time. Ms Rayner described this as an “appalling situation”, adding: “It’s seeming to be responded to by the government repeating how much money is put into social care during the Covid crisis.”