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PRIVATISATION AND OUTSOURCING IN SOCIAL CAREJO MORIARTY, JILL MANTHORPE, SHEREEN HUSSEIN, MICHELLE CORNES, MARTIN STEVENS, JESS HARRIS

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PRIVATISATION AND OUTSOURCING IN SOCIAL CARE: COMPETITION, HYBRIDISATION AND ‘MARKET SHAPING’OUTLINE OF PRESENTATION AND BACKGROUND

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OUTLINE

Drawing on two studies: Social Care Practice with Carers

Longitudinal Care Work Study (LoCS)

Arguing social care helps us understand where we are in terms of wider developments in social policy

Placing discussion in context of Care Act 2014

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‘If the National Health Service “is the closest thing the English have to a religion”, then ‘the social care system is probably the least understood part of Britain’swelfare state’

Independent Commission on the Future of Health and Social Care in England (2014)

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PROVIDERSWHO PROVIDES WHAT AND HOW MUCH IS IT WORTH?

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WHO PROVIDES SOCIAL CARE SUPPORT?

1993 20130

10

20

30

40

50

60

70

80

90

100

Home care services

Local councils Independent sector

1979 20120

10

20

30

40

50

60

70

80

90

100

Care home places

Local councils & NHS Independent sector

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THE CARE HOME MARKET

488,000 care home places across the UK

Estimated market value of £24.1 billion (Grant Thornton, 2014)

EBITDARM in 2012 £7,935 per annum per nursing

bed

£7,696 per annum per residential bed (Knight Frank, 2014)

Carlton Court in Barnet

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THE HOME CARE MARKET

Harder to capture 517,000 adults received local

authority funded home care in 2011-12 (Francis, 2013)

169,000 adults paid for own home care (Institute of Public Care, 2011)

Home care market worth £652 million in 2010 (Institute of Public Care, 2011)

Image from Care to be Different website

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VOLUNTARY SECTOR

Active voluntary organisations 98,000 in 1991

153,000 in 2001

164,000 in 2010 (Dayson et al., 2013)

Voluntary sector income from central & local government £7 billion in 2010 (Bhati and Heywood, 2013)

Not broken down by type so not all for social care

Picture from The Guardian http://www.theguardian.com/news/datablog/2011/aug/02/voluntary-sector-cuts-fair-economy

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PERSONAL BUDGETS

Meant to give people greater choice and control Can be taken in different ways

Managed personal budgets

Individual Service Funds

Direct payment

Combination

2012-2013 figures: 611,000 personal budgets in

148,000 of these direct payment (Health & Social Care Information Centre, 2013)

People with ‘complex needs’ to have merged health/social care budgets14 July 2014

From Cornwall Council website

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INCREASED DEMAND

Number of people with dementia set to double in next 40 years (Alzheimer’s Society, 2014)

Number of people with three or more long term conditions expected to rise from 1.9 million to 2.9 million by 2018 (Campbell, 2014)

http://www.alzheimers.org.uk/infographic

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ANOTHER VIEW

Concerns about quality of care BBC Panorama programme

‘Elderly Care Exposed’

8% respondents to Adult Social Care Survey (2013) felt they were not treated in dignified way

Continuing risks to quality of care and continuity of services (Public Accounts Committee 2014) Reproduced with

permission – Thank you @MartinShovel 14 July 2014

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BALANCING PROFIT AND BEING PERSON CENTRED?

@kateswaffer, https://twitter.com/KateSwaffer/status/482765833651773441, 28 June 2014

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EXPECTATIONS AND REALITY?

Simon Duffy in The Guardian, 30 January 2014

Concerns that positive pictures based on minority who have direct payments (Beresford, 2014)

Additional workload for carers of people who cannot manage own budgets (Mitchell et al, 2013)

Cuts to allocations mean people may only be able to buy personal care (Lipman, 2014)

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INDIVIDUALS AND GOVERNMENTS IN THE MARKETPLACE

‘Weaknesses in consumer knowledge and behaviour’

Governments find ‘long-embedded structural designs and divisions’ hard to change’ (Select Committee on Public Service & Demographic Change, 2013)

Paying for care an increasingly important concern

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METHODSBRIEF OUTLINE OF STUDY METHODS USED IN TWO STUDIES PRESENTED HERE

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SOCIAL CARE PRACTICE WITH CARERS

• Analysis of Carers Workers in NMDS-SC (Hussein & Manthorpe, 2012)

• Care plans• Leaflets and

brochures• Websites

• National survey of councils with social services responsibilities

• Carers' workers • Voluntary

organisations• Commissioners• Family carers Intervie

wsSurvey

National workforce

data

Documents

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LOCS METHODS

• 4 areas in England• Care homes and home care

• 120 interviews (T1 & T2)

• Older people, mental health, learning disability

Managers

• Same 4 areas• Recruited via establishments where managers interviewed or elsewhere

• 93 (aiming for 120) T1 and T2

Staff

• Same 4 areas • Recruited via participating establishments or elsewhere

• 51 interviews (one point in time)

Service users and carers

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MARKET SHAPINGTHE ROLE OF LOCAL COUNCILS

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MARKET SHAPING

Care Act 2014 gives new role for local councils in market shaping

Variation in extent to which commissioners see their roles in this Market shapers

Light touch consumerism

‘Moral arbiters’14 July 2014

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Quite often residential care is cheaper, particularly in [this city] … What we are trying to do is to develop the extra care strategy so that people can actually stay at home but with the same level of support, because that’s infinitely better for them. And we are … in the process of procuring … extra care placements which we are hoping is going to affect the local market as a way of erm, helping people to see alternatives

Nancy, Commissioner01

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What does the social care marketplace need? We are moving so far away from us being the main commissioner of stuff anyway. This is going to be driven by people having their own budgets and exercising their own choice. I think the organisations who are providing specialist workers need to think about their business offer and what the market is going to need of them

Delia, Commissioner06

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We have lots of rows about it. … They gave their child up at 13, they went to these special therapeutic communities, isn't it wonderful? … You have to ask yourself, 'Yes, and is that a meaningful life for the next 60 years?' In terms of human dignity and ownership and identity, isn't the whole thing about belonging where you live? Why do we deny a certain group of people in our cohort the lack of identity? No, we're not going to hide them away. They will live here in the community with their friends and neighbours and become a part of this community

Thomas, Commissioner04

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COMPETITIONDISTINCTIONS BETWEEN ‘PRIVATE’ AND VOLUNTARY PROVIDERS IN CONTRACTING PROCESS BLURRED

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COMPETITION

Expectation that voluntary sector would bid for contracts in the same way as the private sector

Extent to which voluntary organisations saw themselves in competition with each other differed

‘Capital’ of voluntary sector different At risk of a different sort of market failure?

Implications for campaigning work of organisations – often built on collaboration

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I think the competition side of things [will be a challenge]. I think we’ll probably see a lot more other organisations creeping out of the woodwork who will say … we can provide the same, a similar sort of service, or even better, for less money which is more of an impact on us personally, job-wise. But I think yes, I think probably the money side of it is going to be the biggest issue because although people say, less money doesn’t mean less quality, it restricts you a huge amount in what you can do and what you can provide

Drew, Worker19

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There is more competition out there now, because obviously you have the private sector in terms of respite services and you also have other voluntary sector organisations that are having to diversify and possibly decide that they want to provide support services for carers … I think the way we are looking at it is, rather than thinking well there is a competitive environment out there which we appreciate there is, is looking to develop partnerships with organisations and when services can complement each other … It’s looking for those marriages if you like that … where there is no competition or stepping on each other’s toes. By working together you actually create a stronger opportunity.

Kent, VOL14

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And then you find out that [the other organisation] charge for petrol, or they try to match your petrol, and then charge the … [service user]

WILLA, Worker37

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HYBRIDISATIONBLURRING BETWEEN PRIVATE AND VOLUNTARY PROVIDERS

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HYBRIDISATION

Organisations with their roots in one sector take on characteristics of another (Billis, 2010) Billis most concerned with how this happened to third sector

organisations

Distinctions between private and voluntary sector often seemed to be more about size and values than structure

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‘THEY’VE GOT THE LIFE OF RILEY’

‘It started with me, yeah… Just me. I had four children, four residents and me’

At Time 2, 3 residents, 10, 8, 1 year

Residents chose newest resident

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As I always say, it’s not a five star hotel. It’s not one of these fantastically purpose built homes that are now being built, but the care is second to none and if I had to choose a care home for … one of my loved ones, that’s what I’d ask for before all the chintzy curtains and nice things

Area2, T2, manager

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DISCUSSION

Examples of market failure Good quality care often down to commitment of individuals rather than

system

Care Act 2014 promises major changes Will they make a difference?

People funded by local councils still form majority of service users Shift away from ‘consumerism’ on grounds of cost?

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DISCLAIMER

This presentation includes independent research funded by the NIHR School for Social Care Research and the Department of Health Policy Research Programme. The views expressed in this presentation are those of the authors and not necessarily those of the NIHR School for Social Care Research nor the NIHR SSCR/Department of Health

14 July 2014