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For many years now, as austerity has siphoned billions from social care, the highly specialized UK social care system for adults with complex physical disabilities, learning disabilities and autism has been quietly held together by the benevolence of charities.
Charities and not-for-profit companies have poured millions of pounds in reserves to boost taxpayer-funded services provided under contract to councils and the NHS. Those subsidies seemed sustainable when inflation was low and subsidizing underfunded public services did not threaten the charity’s own existence.
This year, as the cost of living crisis exploded, wages and energy prices soared and the social care workforce crisis worsened, many of those charities – at risk of becoming unviable themselves – realized they could no longer afford to run at a loss. As Mancap argues, the system is “broken” and it’s unclear when and how it will be fixed.
Leonard Cheshire is evicting some of its residents, playing what one observer calls a “game of chicken” with council funders over who pays for rising costs. An increasing number of providers are “giving back” contracts to deliver care packages that are not viable at current funding levels. The staffing crisis is so acute — a record 165,000 vacancies — that some are drawing on their reserves to raise pay to attract or keep employees.
It would be wrong to see this as a case of “bad provider syndrome”, says one social care insider; Rather it is a lesson in the consequences of underinvestment in the state. “If you don’t fund the system properly it collapses, and that’s what we’re seeing now,” they said.
One provider said recruiting staff is difficult because council contracts effectively limit the amount they can pay in market rate wages currently offered by rivals such as Aldi and Tesco. Another said she was ashamed she couldn’t pay more because some of her care staff had to use food banks.
According to a recent provider-commissioned report, this “market dysfunction” has worsened over the years to such an extent that it is “now largely accepted that some services will operate at a loss because they are insufficiently funded”.
Private providers will look to such unsustainable financial options, yet charities in the sector say they remain in the market to protect the people they serve: highly vulnerable individuals in stable relationships with skilled, trusted, experienced carers. Thrive who know people who care about them. Inside out.
Cuts to care funding with bare minimum service after charities and their subsidies disappear, disrupts those relationships and leaves a bleak prospect for service users. “It would be a case of: washed, fed, clothed, people glued to the TV. Is that a quality of life anyone wants?,” said Jackie O’Sullivan of Mancap.
Last week’s autumn settlement promised an extra £3bn a year for local authorities in England over the next two years, a large part of it to ease the discharge of elderly patients from NHS beds. But the climate is unlikely to change for this under-reported, under-funded sector of social care and the people it cares for.
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