Care for elderly and disabled ‘in crisis’ as providers increasingly pull out of contracts
Companies that provide care to the elderly and disabled are increasingly handing back contracts to local authorities because they are not being paid enough, the leader of the health regulator in England has said.
The problem arises mostly with smaller providers, said David Behan, chief executive of the Care Quality Commission (CQC).
Following the collapse of care home operator Southern Cross, the CQC was given market oversight of large providers to ensure that residents would continue to be looked after if such an event happened again.
But Mr Behan (pictured) expressed concern over the numbers of smaller operators which have stopped providing services but are not covered by the regulator.
Meanwhile, companies that provide care to people in their own homes are also handing back contracts because they cannot deliver quality care for the price they are offered by local authorities, Mr Behan told the Health Select Committee.
Almost two-thirds (62%) of councils in England said they have had residential and nursing home closures and 57% have had care providers hand back contracts in the past six months, according to the latest figures from the Association of Directors of Adult Social Services (ADASS).
ADASS estimates that the closure of services and handing back of contracts has affected an estimated 10,820 people using council-funded care with some of them having to move to a new home.
Mr Behan told MPs: “I think the issue that we have got now is that smaller providers handing contracts back, not the larger ones.
“I think the issue about risk in the market is not the same one that existed in 2010/11 when Southern Cross got into difficulties.
“The buying and selling of companies isn’t the issue, it is companies that are leaving the market and replacement care not coming in.”
“Effectively, post-Southern Cross we have been asked to have an oversight of that market to ensure that there will be continuity of care for people receiving that care.
“We don’t do that for the smaller providers. Local authorities were given the market oversight responsibilities for the smaller providers.
“What has changed since these powers were shaped and formulated post-Southern Cross, is that the greater risk to continuity of care is from the small or medium-sized providers. And we don’t have oversight of those.
“The vast majority of contracts handed back in our experience have been domiciliary care contracts where providers are saying: ‘We can’t deliver the quality of care and the volumes of care at the price being offered.'”
The CQC’s State of Care report, which was released in October, raised concerns about providers handing back contracts to councils because they believed them to be “uneconomic and undeliverable”.
A spokesman for the charity Independent Age said: “Providers handing back contracts is a serious problem for two reasons.
“Firstly, it inevitably means disruption to the continuity of care that it important to older people.
“But secondly, it’s because it is a symptom of a system in crisis. Providers give up contracts because they can’t provide good quality care at the price on offer and it is very unlikely that an alternative provider can either.
“That means if another company is found the care is likely to be worse or that none will be found at all and people in need will languish in hospitals, or at home without support, until it is.”
Meanwhile, Mr Behan warned that some of the big care providers were approaching the level where CQC would have to issue an alert to a local authority when “continuity of care” for residents was at risk.
Following the publication of the CQC’s State of Care report, the regulator said that the social care sector needed an injection of funding.
Mr Behan told the committee: “Our view is that we would not have done our job unless we made the comment that we did.
“Social care is helping fewer people at a time when demand is going up.
“If social care continues to help fewer people, and the unmet need goes up, that will mean there are more people not getting help.”
Caroline Abrahams, charity director at Age UK, said: “It’s worrying to hear that some care providers are giving up trying to make existing contracts work as their costs rise but funding fails to keep pace, and if these organisations are losing confidence in the sustainability of the care sector, how on earth are older people and their families supposed to put their trust in it?
“No care provider would ever walk away unless they felt they had no choice and the fact some are now doing so says a lot about the parlous state of the market at present.”
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