For years, the social care sector has been waiting for a Green Paper which has shown so few signs of life that we are all starting to get a bit concerned for its welfare.
We all know that there is a clear need for systemic reform of the social care system, including baseline funding which has created a challenging environment for many providers’ business models. By my estimate, around two thirds of all media commentary around social care relates to baseline funding for people using services who are reliant on the Government to pay for their care.
This focus is something that must continue; a leading industrialised economy such as the UK must be better at providing for its most vulnerable.
However, an area that receives less attention is the supply-side revolution which is already underway outside of those providers we traditionally associate with social care.
In my view, the Government has been insufficiently focused on market shaping and ensuring appropriate frameworks for investment in health and social care outside the realm of public sector commissioning. However, these new models of provision can play a significant part in expanding the supply of social care, and in meeting increasing demands.
The housing with care market is currently seeing very significant interest. It is seeing large-scale investment both from private companies and from traditional care home providers.
It has major potential benefits, however, only 0.5% of over-65s live in specialist housing with care communities in the UK, while in other countries this figure stands at 5% or more.
The reason for this? Curiously, this is not a failure of commissioning or funding – it is the lack of a joined-up market shaping approach, which has led to our planning and regulatory systems being unable to categorise, comprehend and process this type of housing appropriately.
Nevertheless, our sector’s ambition is to expand provision by 230% by 2030, providing housing with care for an additional 175,000 older people in the UK. This will require an investment of £40bn, but will save the NHS and social care services more than £5bn over the next 12 years. It will also free up more than 525,000 bedrooms in the UK, helping to solve the housing crisis.
And this isn’t untested. Consider a country like New Zealand, which has long had a well-regulated retirement community sector. Five of the 15 largest housebuilders there are retirement community operators – who operate largely without subsidy and are investing £1.5bn in the New Zealand health and social care infrastructure over the coming years. These services were not commissioned – instead, a sensible regulatory and legislative approach created a framework for investment to be channelled into areas which meet customers’ needs and aspirations.
Extrapolate the New Zealand figures to the UK and this would mean an investment of £20bn. The benefits would be felt by society at large.
Importantly, this is not an ‘invest to save’ proposition for the Government – it is more a question of letting us invest so they can save. But for this to happen, our thinking about health and social care needs to go beyond the commissioning mindset. We must look at introducing more clarity into the planning and regulatory systems as well as more co-operation between those authorities responsible for planning and those responsible for social care provision.
We know that the Secretary of State understands this and has put prevention at the heart of his agenda. The NHS Long Term Plan talks extensively of how to improve provision outside acute and primary care services – with housing with care being a prime example of how this can be achieved in the community.
However, this also requires a joined-up approach with other Government departments. To put together an appropriate legal and regulatory framework on planning and consumer protection, the Department of Health and Social Care will need to work with officials in the Ministry of Justice, the Ministry of Housing, Communities and Local Government and others.
There are also other areas in which a more joined-up approach is required. For example, advances in big data, artificial intelligence and robotics will require a co-ordinated approach to issues such as health and safety and CQC regulation – and a sensitive and sensible approach to personal privacy – to come to fruition.
What these projects have in common is that they sit outside the “mainstream” discussion on social care, as they are beyond the realm of funding, commissioning and traditional service delivery. I sincerely hope that, while we await the Green Paper and any following change, a grown-up debate about how regulatory and legislative reform and market shaping can change the care sector can be added to the general debate about social care in the UK.
Michael Voges is Chief Executive Officer at Associated Retirement Community Operators. Email: firstname.lastname@example.org Twitter: @ARCOTweets