The Government response on the long term funding of care as proposed by Andrew Dilnot could not be occurring at a more critical time.  The warning signals are already there that the Treasury Department will not loosen the purse strings to release the required £1.7 billion pounds per year to deliver a fair and equitable system for all us in our old age.  Dilnot’s central argument that everyone should be liable for the first £35k on long term care is a good one thereby releasing middle England what became to be called the middle class tax with peoples capital assets being taken down to the last £21k.

Royal Commissions have come and gone as have reports such as the Wanless Report from the Kings Fund skillfully highlighting the time bomb of old age to come.   2012 provides stark evidence of our ageing population.  On average around 150,000 people each year reach the land mark age of 65 well in 2012 750,000 do!  The often quoted baby boomers have reached retirement age – luckily for the Government this is also the generation who never had it so good with a level of affluence, life long job security, and crucially a home owning middle class.  This will ease some of the burden through private funding for care but the tidal wave of social care demand is now upon us in the week local authorities are being criticised for increasing their costs for care.  A bumpy ride awaits.

The primary sticking point for Council’s remains procurement processes which makes the LATC model particularly attractive in both driving through much needed efficiencies as well as enabling former public sector services to operate as a private company in the wider market.  Understanding of the ‘Teckal Exemption’ is key for Councils which enables such externalisations to occur without going to the market as well as the drafting of the business case to prove value for money as the statutory instrument to validate such a transfer.

CHS have now worked successfully with over 12 Councils in scoping and enabling Councils to go down this road.  As such we are happy to offer consultancy advice so please contact us .

Contact us at info@careandhealthsolutions.co.uk if a meeting is required.

Both Ernst and Young and CHS have delivered transformation and new delivery models across several County Councils and Local Authorities.  This is a further opportunity to hear about our experience and gain support and advice in creating new models of service delivery coupled to efficiency savings.

This seminar is aimed at Chief Executives and Senior Managers wishing to consider New Models of Delivery.

For Seminar details please contact Gayatri Persad at gpersad@uk.ey.com or mark@careandhealthsolutions.co.uk

Radicalism and honesty from our politicians is called for in reviewing Pensions, the role of the private sector, and the increased responsibilities of the private individual in the coming decade.  A healthy and honest wake up call is needed by all of us in recognising the levels of saving we all we need to do for our old age.   Lets hope this becomes the leading political debate in the coming years before it is to late.

The Seminar which will be in November will be aimed at CEO’s and Director’s of Councils wishing to learn more about alternative models of service delivery including the LATC, Mutuals, and Social Enterprises.  Building on our direct experiences as leading specialists in this field the Seminar will take delegates through each step of the process in creating and delivering such models.  Direct examples of Wokingham of Essex LATCs will be used.

Further details will be publicised shortly.

These proposals will also see the increased rights of communities and public sector workforces to have the right to run their own services through mutual and co-operative models.   We could therefore be witnessing the beginning of the break up of public services as we know them with a reduction in control from Whitehall.    Whether the mechanisms to enable this radicalism to occur exists remains to be seen.   At the same time a potential land mark day of industrial action by Southampton City Council employees faced with redundancy or accepting revised contract terms will be watched by Councils across the Country.   We therefore  have an interesting and ‘heady cocktail mix’ of agendas coming together in the reshaping of local government and increased power of the individual.

Two key quotes are made, firstly Vince Cable who comments on the ‘fragility of Investor-Owned business’ which is quite a statement given the domination of care companies like Southern Cross but perhaps of greater significance is the call and reminder of the Coalition Government commitment to mutuality by the Cabinet Office Minister Francis Maude who states ‘employee ownership is the way of the future’ with a pledge to see one million public sector staff taking ownership of their services.

In practice the procurement and competition rules on the externalisation of services from the public sector remains an issue if we are to see wholesale transfers of public sector services to the open market with control given to employees and service users.       Plenty of examples are emerging of Local Authority Trading Companies (Wokingham and Northamptonshire) , Social Enterprises (particurarly the new NHS provider arms), Co-operatives, and Mutuals but more needs to be done by our politicians to open the doors to greater opportunity for public sector workers to operate and control their own businesses.

Unlocking the potential and freeing skilled workforces must be a ‘no brainer’ particularly if the outcome is new businesses which are close to the communities they serve, more responsive, quicker in decision making, and freed of red tape.   A radical agenda is urgently needed to be embraced by politicians which moves us away from investor to employee ownership of our local services.

Time is pressing as is being most elequently highlighted by Dilnot in his media coverage on his proposed solutions for bridging the looming funding crisis for old age care.   Long term Care Commissions, the much rated Wanless Report and the radicalism from the likes of Frank Field as long ago as 1997 to ‘think the unthinkable’ on social care have all come and gone.   Ministers must grasp the nettle despite their concerns on any public reaction to increased self funding.   A break up of public sector provider bodies with the mutualisation of employee owned services will be one part of the wider solution in providing more flexible cross effective services to self funders as well as state supported individuals.

For years the growth of the private market in the provision of registered care has been well documented including the practice of land purchase and lease back as portrayed within the Southern Cross model of delivery, incidentally funded by two of our part state owned banks Lloyd’s and RBS.   At the same time the continued use of NHS hospitals to provide support and care and protection to some of the most vulnerable service users with a learning disability highlights a model of service delivery which is outdated and no longer sustainable.    Indeed following the various hospital scandals of the 1970s and 1980s the advent of Community Care in the 1990s was supposed to have seen an end of hospital provision for people with a mental health or learning disability.

The link for the 31,000 residents within Southern Cross Care homes and all the thousands of people still retained within a hospital environment requiring specialist care is an inadequate model of property and building investments.   On the one hand the purchase and lease back model seen in the private residential sector as a business model is now placing at risk the security and safety of some of the most vulnerable older people who live in these homes;  whilst why as a Society have we not invested in greater housing options for people with a learning disability to end the need for hospital provision?

The property and financial investment requirements for the longer term support for vulnerable people especially in need of registered and regulated housing and support models must be one positive outcome promoted from these two unrelated but extremely serious events.   Democraphic trends confirm the rapid increase of both our older and learning disability populations over the next 30 years.   If we are to avoid so called ‘warehousing’ models of care then Government Policy must promote and invest in greater funding for new housing and care models.  One consequence of the credit crunch has been the radical reduction in funding in new build developments by the Housing Association Sector who traditionally have been a major provider of extra care and supported housing schemes.

The 2000 Community Care Act which set well defined building standards for Care Homes has never been fully implemented as the majority of today’s care homes would failure the standards of single en-suite rooms along with ratio’s of floor space and communal space.   Yes, new standards are applied to new build but it highlights the critical under investment in public and private property investment for older people at preciously the point that demand will double and triple over the immediate next few years.

I was fortunate to lead the development of one of the country’s first set of dementia designed neighbourhood resource centres for the London Borough of Greenwich which opened some 10 years ago.   The three buildings replaced the Council’s former older peoples homes and offered state of the art homes for some 160 people.  I remember on day one relatives and residents moving in some in tears because they could not believe how lovely the new builds were.   Yes, it was done under PFI itself a controversial model of finance but at least were investing in the future of older people.  What ever we say about the old institutions built by our Victorian ancestors at least they invested money!

A demand crisis for specialist care now places Social Care at a crossroads – politicians, policy planners, and regulators must come up with a blue print for the provision of secure housing and regulated care which will address the immediate pressures of the ‘baby boom’ generation and confirms the safety of the most vulnerable people in our society. 

 If nothing else we must all take a long hard look at these two unrelated events and consider what type of care system do we want for the future?  Major investment is needed.