Save the NHS: Deliver a Fair Fee for Care
In the decade before the pandemic, while health care budgets went up every year, social care spend was savaged with multi-billion-pound cuts. As a result, today, care capacity is at rock bottom.
In my three decades in the sector, I’ve never seen a such a desperate situation. And we are all paying the price.
There are 3.2 million people over 80 in the UK, almost 1 million of them live with advanced frailty and dementia and this number is only going up. To support them, there are only 450,000 care home beds. This number, which is 55,000 less than in 2015, could drop by a further 140,000 in a worst case scenario where, without investment, we lose another 6,500 homes in the next five years.
Already, thousands of vulnerable elderly people are being evicted from quality care homes which have been forced to close. The number of private care givers handing back local authority contracts which pay below the cost of care has more than tripled in 22 months.
Those fortunate enough to keep their beds are not receiving the support they need because there aren’t enough carers. Brexit, vaccine mandates and insufficient pay has prompted a mass exodus with over 105,000 job vacancies in the social care sector.
The doctors I worked with when I was an NHS surgeon tell me that the lack of social care beds means that there are significant delays in discharging older patients from hospitals.
A staggering 2.7 million hospital bed days are occupied each year by older patients who do not need to be in hospitals.
This is worsening the backlog with hospital waiting lists and costs spiraling further out-of-control. Critical patients, particularly those with cancer, are unable to receive the treatment they need in a timely fashion.
The cost of an older person occupying a hospital bed is around £3,500 per week. According to the National Audit Office, this cost the government £820 million per year in 2016.
Adjusted for inflation, that figure would be close to £1.2 billion today.
With the social care fee structures currently in place, things are not going to get any better.
In the last two years regulatory requirements, energy, staff costs, Brexit and covid have all made providing care more expensive, but this is barely reflected in the fees received by local authorities and Care Commissioning Groups (CCGs).
State funded care homes receive only £550- £650 per resident per week - 2.5 times less than in other parts of Western Europe. This is totally insufficient to cover care staff, food, and accommodation costs.
Unless we take decisive action now on ringfencing care fees and funding, beds will continue to be lost across the country
The real cost of providing all-inclusive care in a care home is closer to £950 per week.
With a margin for surplus, regulatory working capital and capital expenditure, Local Authorities/CCGs must pay a minimum of £1100 in the current inflationary environment which would be far lower than the £3500 per week cost of a hospital stay.
This fee, index-linked with inflation and ringfenced to ensure it reaches care homes, will allow social care to survive and for pressure on hospitals to ease.
For the sake of the NHS and those who need hospital care, decisive action must be taken to address the critical issue of a fair fee for care.
Without a viable social care sector, health care costs will not reduce. It is high time Government realises the close link between the two and takes decisive action to prevent abuse of market power. Regulation should be enacted immediately to pay a fair fee for care.
Unless we take decisive action now on ringfencing care fees and funding, beds will continue to be lost across the country. Our vulnerable older population will bear the greatest burden of a national crisis and our hospitals will not have resources to care for those who most need acute medical attention.
With the pandemic and Brexit over, it’s high time we got to work getting social care done once and for all. And the first step is introducing a fair fee for care.
Care Quality Commission market oversight was created to monitor financial viability of large social care providers. However, without a fair fee for care, it is irrational to expect viability of the sector and beds will continue to be lost putting further pressure on the limited 150,000 NHS beds.
Dr Sanjeev Kanoria [FRCS, MBA, PhD] Founder &
Chairman Advinia Health Care | Advinia Health Care Ltd
Sanjeev is an entrepreneur, banker, scientist, and liver transplant surgeon who worked in the NHS for over 20 years and owns 3300 care beds throughout the UK, employing c. 4000 people.
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