Beaumont Healthcare was a home care agency that had been in operation since 1997, providing care mainly to adults with disabilities and complex health conditions in the Cambridgeshire area. In December 2023 Beaumont went into voluntary liquidation, having already handed back its care contracts to local authorities and care boards.
Unfortunately, Beaumont’s collapse was not an isolated event. It was the fifth care provider in Cambridgeshire to hand back care contracts in 2023 and is the latest in a large number of such business failures that have occurred since the creation of a ‘quasi market’ in social care.
The quasi-marketisation and privatisation of adult social care services in the UK stems from the NHS and Community Care Act 1990. Part of the Thatcherite project to marketise and privatise public services, this Act was designed to create a ‘purchaser/provider split’ with local authorities becoming commissioners rather than providers of social care. Previously, the bulk of adult social care was provided directly by local authority-run social services departments, with a much smaller amount of provision coming from the voluntary and private sectors. The creation of a quasi-market in social care reversed this situation. By 2018 98 per cent of council-funded home care hours in England had been outsourced to independent sector providers.
The trend for private home care providers to either hand back contracts or cease trading is not new but has got worse in recent years. Market conditions have become ever more challenging, for example with rising staff and energy costs. However, because most rely on income from contracted care, they have been hit by a decrease in the number of hours commissioned by local authorities, many of whom still pay below the sustainable rate for home care.
The social care workforce is also in crisis, with high vacancy rates and high levels of staff turnover. The reasons for this include the fact that care work is characterised by low wages, poor working conditions, heavy workload, the use of zero hours contracts and few career development possibilities.
By any measure, the domiciliary care market in the UK is in poor shape. Predictably, commercial decision making has led an increasing number of home care providers to either exit the market completely or terminate their arrangements with the local authority.
Care provision for those who need it is not only an important service but a statutory requirement but, in a quasi-market, local authorities have little or no control over the process, particularly when their budgets continue to be cut.
When providers hand back contracts it causes significant disruption to service users and their carers. When decisions to cease trading are made, they tend to come very suddenly for service users and carers, causing high levels of anxiety – even dread – about how future provision might be arranged. The lack of familiarity and continuity among care staff hits service users with dementia or other cognitive impairments particularly hard, as it can take longer to build trusting relationships.
A consideration of the human costs of market failure must also include care staff. Care staff face anxiety, disruption, poverty and even deportation when home care agencies go out of business as many are employed on special work visas linked to a particular employer.
Given the pressures on services and levels of unmet need there seems to be no doubt that more money, in general, needs to be funnelled to adult social care. However, increasing levels of funding alone will not prevent the problems identified. The quasi-market system, as it is, is unfit for purpose and needs to be reformed, if not scrapped altogether.
Arguments have been put forward for creating a national care service in England. However, the sheer amount of cost and disruption involved in creating a national care service is a concern, particularly as there is no guarantee of achieving favourable outcomes.
A less ambitious and more workable proposal would be to incrementally return home care to local authority control. Although cast very much in a residual role now, local authorities have a proven track record of delivering home care. As contracts expire or are handed back, local authorities could gradually build up their own in-house provision. This would retain local, democratic accountability and would mitigate the kind of uncertainty and disruption that comes with wholesale change. Not only would this policy maintain continuity of service, but it would also provide much better working conditions for the care workforce and, as a consequence, better care for service users. In short, local authorities would have much more control over the supply of adult social care.
Peter Scourfield, Fellow at the Faculty of Health, Social, Care and Education, Anglia Ruskin University, Cambridge.
The hidden, human costs of the UK’s failing ‘market’ for home care by Peter Scourfield is available here on Bristol University Press Digital.
Bristol University Press/Policy Press newsletter subscribers receive a 25% discount on our books – sign up here.
Follow Transforming Society so we can let you know when new articles publish.
The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of the Bristol University Press and/or any/all contributors to this site.
Image credit: Josep Martins on Unsplash