Voscur responds to House of Lords social care consultation
Voscur has contributed to a recent call for evidence on the future of social care from the House of Lords. You can read our response below. To find out more about the call for evidence, visit: www.parliament.uk/business/committees/committees-a-z/lords-select/economic-affairs-committee/news-parliament-2017/social-care-call-for-evidence
What are the funding challenges for social care in England, and how can they be overcome?
1. There are insufficient funds to commission interventions that can control or limit rises in demand for intensive and costly solutions. This has been true for around 10 years. Funding is increasingly being focused on crisis management, meaning that those lower down the ‘need scale’ are more likely to slip into crisis due to a lack of support – this is a false economy that perpetuates the issue and does not deliver value or sustainable change. A variety of preventative services have been deployed, e.g. social prescribing, integrated care delivery, community-led falls prevention. However, they have been undermined by ever-tightening budgets.
2. Breaking this cycle requires managing current demand at the same time as increasing investment in preventative measures for people with moderate need. To do this without massively increasing immediate funding entails deferring the cost of prevention through social investment (bonds), for example, in order to expand current care contracts and grants. This could create the opportunity for a long-term shift from crisis management to prevention.
Why have successive governments been reluctant to address challenges in the delivery of social care?
3. Government is reluctant to paint a long term vision and then make bold long term funding commitments to deliver that vision. This appears to be due to short term associated political risk (the government’s reliance on older voters, the economy’s reliance on housing) and because of a reluctance to make difficult choices that could reduce funding to other causes or require investment.
How can a sustainable funding model for social care supported by a diverse and stable market be created?
4. Planning for social care funding starts with the meaningful co-creation of the future society we want: a vision of how we want our futures to be, of how we want later life to be lived and how we want need and vulnerability to be supported.
5. We also need to be clear about what we mean by ‘sustainable’ – the question here suggests a more commercial approach. Some of our members do not think that this would be a stable way to deliver services as commercial markets will introduce uncertainty and risk and exclude people without the resources to buy care from the market.
6. A suggestion to make service delivery genuinely sustainable is to build the cost of future social care into the National Insurance system.
7. However, a number of our members see benefits in introducing some commercial aspects to their organisation, i.e. charging service users (those that are able to pay), as a way of sustaining their service level. Voscur itself is taking this approach and we are encouraging our members to consider it.
8. In order to support this approach, the state must make long term commitments around funding and policy that would allow value-based, socially minded, entrepreneurial providers to generate new and additional funding – e.g. from trading, social investment and fundraising. This would be used to support the delivery of locally co-created and proven preventative interventions.
9. There is an opportunity for commissioners and voluntary sector organisations that generate income to work together to bid for and attract either social investment or grant funding. Commissioners could also help boost charity trading efforts.
10. A more commercial approach to social care requires ending the paternalistic relationship between contractors and providers. Until local authority funders stop treating their providers as tools to deliver outdated, narrow and poorly specified services the true value of voluntary, community and social enterprise providers will not be realised.
11. Social value also has an important role to play. We would like to see a social value minimum of 10 percent of tender scores in every contract, as well as specific and differentiated targets for micro, small and equalities organisations.
12. The culture of risk aversion in commissioning also needs to be examined in order to support bids from smaller providers.
13. The inclusion of micro/small/local organisations/businesses should be a requirement in bids – for Voscur, it follows that, if contracts are too big for smaller organisations to bid for and the only real likelihood of delivering public services is through sub-contracting/collaborations, it would be helpful for commissioners to state that as a requirement of the market.
How can the cost of the provision of social care be fairly distributed?
14. Our members pointed to what is being researched and reported at a national level and did not have much to add beyond this. However, one suggested that a fairer tax system and breaking up monopolies in the social care sector would help.
What lessons can be learnt from elsewhere in the United Kingdom, or other countries, in how they approach social care?
15. Voscur member WE Care and Repair has received £1m/year of local authority funding under a contract in Bristol and Bath. The contract is designed to incentivise the organisation to trade and seek other funding. WE Care and Repair leverages that funding to pay for roles that generate an additional £500,000 of income and the resulting £1,500,000 is used to deliver proven preventative interventions. This effectively allows the organisation to deliver 33 percent more than it could based on public funding alone. The lesson here is clear: select reliable, commercially minded, socially responsible providers and give them the freedom to do what is best for local vulnerable people.
16. Bristol City Council has set a target that social value should represent 25 percent of the value in all contracts. This proportion could be applied to overall spending, rather than each contract, ensuring that 25 percent goes to local businesses, with micro and small businesses, voluntary groups, social enterprises and community groups considered a priority. This target is often exceeded by a considerable margin, helping to sustain care at a community level.