Care for the UK’s most vulnerable faces ‘collapses’ as providers factor in costs

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For several years, as austerity sucked billions out of social care, the UK’s highly specialized social care system for adults with complex physical disabilities, learning disabilities and autism was quietly held together by the goodwill of charities.

Charities and non-profit companies have poured in millions of pounds of reserves to support the alleged taxpayer-funded services they provide under contract to councils and the NHS. That subsidy seemed tenable when inflation was low and subsidizing underfunded public services didn’t jeopardize the very survival of the charity.

This year, as the cost-of-living crisis has exploded, wages and energy prices have soared and the welfare workforce crisis has worsened, many of these charities – at risk of becoming unprofitable themselves – have realized that they can no longer afford to run at a loss. The system, as Mencap claims, is “broken” and it’s unclear when or how it will be fixed.

Leonard Cheshire is evicting some of its residents, playing what one observer called ‘a game of chicken’ with council funders over who pays for the increased costs. A growing number of providers are “giving back” contracts to deliver care packages that are not feasible at current funding levels. A personnel crisis so acute – a record 165,000 vacancies – that some are drawing on their own reserves to fund pay rises to attract or retain staff.

It would be wrong, says a welfare insider, to see this as a case of “bad provider syndrome”; rather it is a lesson in the consequences of state underinvestment. “If you don’t fund the system properly, it collapses, and that’s what we’re seeing now,” they said.

One supplier said it was difficult to recruit staff because council contracts effectively limited the amount they could pay in wages at a much lower market rate than rivals such as Aldi and Tesco are currently offering. Another said she was ashamed she couldn’t pay more because some of her care staff had to use food banks.

This “market dysfunctionality” has become so ingrained over the years, according to a recent vendor-commissioned report, that “until now it has been widely accepted that some services will always operate at a loss because they are inadequately funded.”

Private providers would balk at such unpromising financial returns, but industry charities say they remain in business to protect the people they serve: highly vulnerable individuals who thrive on stable relationships with skilled, trusted and experts, who know the people they care about inside and out.

The cut in funding for care, coupled with the bare minimum service that results once charities and their grants are gone, sever those relationships and offer a grim prospect for service users. “It would be about: washing, feeding, dressing, sticking people in front of the TV. Is this the quality of life that anyone would want?” said Jackie O’Sullivan of Mencap.

Last week’s autumn deal promised an extra £3bn a year for local authorities in England over the next two years, much of it aimed at making it easier for older patients to get off the NHS. But the weather is unlikely to change for this under-reported and under-funded sector of social care and the people it cares for.

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