Direct Payments, Care Markets and Competion

There is a lot of conversation about giving people the right to independence,  choice and control through personalisation. My personal experience of running a team of seven carers on a 24/7 basis, all employed via DP (Direct Payments) over ten years makes me agree that this is a positive step. 

Not only does personalisation give me independence, but I am less of a financial burden on the state. I even contribute by running a small business. At least one third of my costs (if not more, if you count savings to manage my health) goes back to the government system by Tax and National Insurance. The rest of the money creates local jobs and the money is used and spent locally. There is little waste or profit margins. However, I do not agree that the current system does not allow direct payment users like myself equity, a market share or even that it  allow us to participate as competitors in the Care Markets.

The Care Act is clear on Market Responsibilities for Local Authorities. Yet I have seen little work in trying to run a proper competitive market; particularly for local organisations. The Social Value Act (which was introduced in 2013) recommends that local solutions are encouraged and supported by local authorities. It is never mentioned or considered. Over the years, some national organisations have bid for big contracts in our public authorities, won them due to having the resources of bid writers, legal, and technical help. This then inevitably results in large chunks of money being siphoned off to head office, leaving little for front end services in our county. In one case a few years ago, up to 60% of the money on the cost of the contract went towards costs for running the head office.

Authorities are also responsible under the Care Act of producing Market position statement. This document was supposed to be a way of the social care service showing how they are helping to ensure the local market has the necessary variety and choice. The ones that I have seen are very poor. They do not cover what they have done or look at, where opportunities are for investment etc, but just act as a very basic catalogue of a few services. 

One of the major issues that is easily rectifiable is in the Care/PA employment market. If you are an agency, you can claim and sometimes get more than twice the amount than if you are an individual personal budget holder. Why is this? The only argument we have heard is that they have additional costs? When queried about what the additional costs and as we have shown here by virtue of evidence from the industry itself:

https://haloabletec.blogspot.com/2022/03/draft-letter-for-uplift-of-payment-for.html  

The diagrammatic representation in the letter clearly shows that we all have the same expenses, except CQC registration and profit. Also, as often stated in economic terms, the bigger their costs are they should be reduced due to economies of scale (ie. the bigger you are, your costs should be less). In reality, those on direct payments costs are therefore substantially higher if you take this into consideration. This is something not taken in to account or paid for.

Another argument is that these are businesses so they have additional paperwork. Anyone who thinks running a DP does not involve paperwork is in for a shock. I and my fellow users will happily show you boxes and boxes of folders and receipts that we are expected to keep for years. Even though the statutory guidance talks about and suggests ways to reduce this, I have yet to see anything put in place. In fact over the years it has gotten worse and the forms and paperwork for DP seem to grow year in year out; with regular checks and form filling, demanded via continuous changes to department polices.

All things considered, this still does not make us a business in the eyes of Social Care.  Even though we will have to comply by all of the legal requirements of  such, as the taxation, National Insurance, obtain liability insurance for staff, keep staff records, monitor sickness, health and safety and everything else that goes into running a proper Direct Payment or business. The only thing I do not do is make a single penny profit and I do not want to. 

This is clearly unfair, it is not equitable, it does not allow us to compete or have a bite of the market share.  

If the authorities would just invest in local people and allow them to run their own services fully (with minimum paperwork and interference, allowing us equal share or even properly supporting users with advice and guidance and paying us money just below what other care agencies get not 150% below but say 20% below), we could actually solve a lot of the issues for social care by managing it ourselves.

Particularly around staff recruitment, we would use this money to actually pay staff a proper wage that they have long deserved. The real question is therefore who wins? Only the care companies. If you feel they are struggling feel free as I do regularly to have a look at their records and annual returns on the companies house website (it is free). It not only shows you who runs these companies (a few surprises there) but how much they turnover and more importantly how much profit they receive. 

I do not like politics. However, I do believe in equality. It does beg the question that if this Governments core political beliefs are as they say they around open free markets and ensuring everyone could compete equally, without interference from the state. Why do we not get the same level playing field, if we run our own care? Why not in Social Care?