Can care and profit live side by side?

THROUGHOUT 34 years of my delivering social care there has been one issue that has kept surfacing again and again and that is money.

I’m not talking about money that is spent nationally on social care – by the time you read this we will know whether the Chancellor had any financial help in his Budget for social care this year.

No, I’m talking about what the owners of care groups earn and whether care should be delivered by profit-making businesses at all. It surfaced recently when I was asked during a panel discussion whether I felt it was right for the owners of huge care companies to take large dividends or salaries.

There have also been some wellpublicised calls recently for care to be first and foremost delivered by notfor-profit organisations in the future.

To deal with these issues in turn, the first thing to say is that they are not new. For as long as I can remember there have been questions about whether care and profit can live side by side.

It is worth remembering that the bulk of care is not provided by huge companies but by small to mediumsized providers who are just about making a living – and in some cases at the moment, failing to do even that. It would need an enormous, seismic shift in the way this country delivers care for not-for-profit providers to be able to meet all current demand, let alone future need too. I think there is room for all types of care provision in the marketplace.

Starting and growing a care business represents a huge risk, with many people risking their life savings and borrowing money to proceed.

Many, like me, began small by taking on a home to care for just a few residents and delivering the care myself whilst living ‘over the shop’.

All care providers have to make a profit, or a surplus in the case of notfor-profit providers, otherwise the Care Quality Commission will not let you operate. For most, a tremendous amount of that profit is reinvested back into the business to keep improving the quality of their care, maintain the fabric of their buildings and to meet ever-rising bills.

Delivering care is a hugely expensive enterprise, particularly for those who provide mostly public sector-funded care. It is well documented that the price commissioners pay for care has been squeezed to the point where it fails to cover the cost of delivering care and it is hard to survive.

The first results of the muchpublicised Cost of Care Exercise have revealed that in 2021/22, the government paid at least £2.88billion less than the actual cost of delivering care to people in their own homes, and in care homes for those aged over 65. The data, already out of date, suggested that on average residential care fees were £218 a week and nursing homes fees £231 a week, below the fair cost of delivering that care.

One London borough reported an average potential gap of up to £375 a week for care home fees and £4.31 an hour for home care.

Trust me, if the majority of modest sized providers were not putting people before profit, they would have exited the market a long time ago.

For me, it has always been about care and whilst I make a living from my business I also invest in sustaining and improving the care I offer and in paying my staff as well as I can, given the huge financial pressures we face, particularly in these times of rapidly rising fuel and utility costs.

One of the arguments made in favour of not-for-profit operators is that such providers are better regulated and inspected and more accountable.

Well, I would struggle to find a tighter regulated sector than social care, subject as we are to close scrutiny from the Care Quality Commission and our local authorities and the NHS amongst others.

The implication from this assertion is that private providers put profit before the standard of their care.

There are, sadly, examples of poor care, poor performance and poor value for the public purse in the public sector just as there are in some profit-making care businesses.

There are many working in the public sector and not-for-profit sector earning very good salaries from their posts, just as there are within corporate providers.

The question should surely always be, are they doing a good job, delivering good care and justifying that remuneration?

I find these arguments divisive and a distraction from what we should be united in seeking, which is a fairer deal for all social care providers, small, medium or large, profit making or not-for-profit.

Instead of internal discussions or disagreements we should be turning our collective fire on the Government and stepping up the fight for better funding for social care and proper reward for all of our combined workforce.