As the BBC is giving blanket coverage of the structural problems in Health and Social Care; we look at some of the responses to the Competition and Markets Authority study into the Care Market.

The study was launched in December 2016, with a brief to examine consumer protection issues, i.e. contract terms, fees, services offered or withdrawn, contract protection;  explicitly NOT the quality of care.

The Competition and Markets Authority’s (CMA) study will assess how people find the experience of choosing a care home, explore whether the current regulation and complaints system gives residents adequate protection, and examine how well care homes are complying with their obligations under consumer law.

 As part of this, the CMA will look very closely at reports of potentially unfair practices and contract terms being used by some care homes to assess how widespread these concerns are, how they are affecting residents, and whether they are likely to breach consumer law.” Andrea Coscelli: CMA Acting Chief Executive

Seventeen responses from interested organisations were uploaded in January; we looked at those from Age UK, Care England (CE) and the National Care Association,(NCA)  looking for the key themes and commonality.

This statement from the CMA press release has an implicit assumption that the Care Market can be described in traditional market terms of the relationship of supply and demand, purchasers and sellers, where relative quality and price be set by the market. The statement does not recognise the role of LAs as described by the Care Act.

The first and major theme that emerges from the responses we looked at is a sense of power differentials and a skewed market. The responses all implicitly underline the relative powerlessness of clients; their vulnerability and their need for stability and person centred care. They all cite under-funding as a major hamper to creating a healthy sustainable market, both in limiting service and also in limiting ability to attract a committed workforce

The second theme is poor commissioning practice and behaviours and the third theme is poor and inadequate information available to clients; none of which is directly within the power of providers to influence.

In terms of ‘Market Shaping, NCA point to the dominance of local authorities, and in comparison the relative powerlessness of providers. NCA further suggest that there is a massive conflict of interest because the LA has responsibility for market shaping and also has budget responsibilities. The underlying crisis is of course where LA fees paid for services do not meet the cost of providing that service.

Age UK also highlight LA responsibilities for market shaping under the Care Act, but focus on differentials. They point out the differentials between LA funded and self-funded clients, citing a 43% average premium paid by self-funders; they also highlight the inequalities of provision geographically where poorer areas are more vulnerable to LA funding because there are not the number of self-funders to boost incomes and quality.

Care England, of course highlight inadequate funding from local authorities and claim that the number of smaller care homes exiting the market is damaging for the long term sustainability of the market

A second theme is poor commissioning practice. NCA say that person centred care needs person centred commissioning and differential pricing accordingly. They and CE say that this doesn’t happen; that commissioners don’t have the knowledge or the skills to engage like this; CE bewailing the growth of Commissioning Support Units as a practice which leaves commissioners even more out of touch. They also claim that the Market Position Statements of many LAs to reduce the use of care homes is not based on evidence and does not reflect local need.

A third area where the responses  show similar concerns is in the amount, quality, accessibility and timeliness of information being made available to consumers at the point at which they are asked to make decisions. Whilst a number of local authorities have directories, these responses claim that the majority are incomplete, do not have the relevant information about providers and the scope of services available and are not generally adequate particularly with regard to fees and top up information. Age Uk are particularly concerned at the lack of attention paid to understanding what happens if the client need changes or if the client simply runs out of money, when the reality may mean traumatic upheavals. They also cite the issue of a provider losing their financial viability having potentially catastrophic impact on clients.

All responses indicate the vulnerability of people having to make decisions, possibly in a hurry, often sick or with learning problems, elderly or with dementia, concerned and anxious about relatives. Whilst the study wants to look at transparency and quality of information given by Care Providers, the market is complex and it’s unrealistic to expect individual providers to provide more than their own terms and conditions.  While LA provision is inadequate, CE highlights the role of the 3rd or charitable sector in filling the information gap. 

Interestingly, both CE and Age Uk comment on the value of a complaints process. Providers are required by CQC to have a complaints process but transparency and openness are crucial if a provider wants it to be effective. The propensity to complain will fall if the process is seen to be flawed. Age UK claim that complaints and feedback, used effectively can drive systemic improvement.