Where is the customer in residential care services?


Des Kelly OBE, Trustee of the Residential
Forum, reflects on a workshop that asked whether the residential care market
was a myth or reality.  He shares the
flavour of contributions and concludes that the customer can easily get
overlooked in the worlds of regulation, commissioning and procurement.

admit I wasn’t sure that ‘Residential care market – myth or reality?’ Would be
a theme to generate the sort of lively discussion we are used to at Residential
Forum workshops. But it turned out my doubts were completely unfounded and the
debate was a stimulating as ever!

event held on 4 and 5 May 2017 started with presentations from John Kennedy
(The Residential Forum), Margaret Flynn (NISB Wales) and Jonathan Stanley (NCERCC).
Their combined input proved to be more than sufficient to spark the engagement
of the attendees at the workshop.

was universal agreement that efforts to create a market for residential care
services – whether for older people, adults or children or young people – had
not been successful. Whilst splitting commissioning from providing had
introduced competition and stimulated new providers, especially in the
independent sector, the result has been something of an imperfect market which arguably
does not operate in the interests of consumers. The market for residential care
services has always been a monopsony as the local authorities have, and
continue to be, the main purchaser of services.

mechanisms that generally monitor and control the entry and exit from the
market don’t work in the same way in the care sector. Local authorities
effectively set and maintain the price paid for the service. In addition, there
is no financial regulator for the care sector either at local or national
level. There has been little consumer legislation to protect people receiving
residential care and the levers of control remain rather limited. If any
thought is given to the issue at all it is assumed that the inspection process
will pick up any shortfalls.

Flynn argued in her presentation, drawing on a major review of provision and
challenges in Wales, that when safeguarding concerns are overlaid on
residential care it highlights the cracks in the system. She suggested that the
evidence required to close care homes is such that few are actually pursued to
closure with operators exiting the market by other means.

Stanley suggested that residential child care is a socially constructed sector
made up of a series of markets. He felt that there is no real commissioning
only procurement. As price is always the dominant factor and social value
rarely seems to feature. Furthermore, there is little sector development and
limited innovation. The introduction of competition per se was regarded as a
good thing for residential care according to John Kennedy. However, shaping and
managing the market had proved difficult for local authorities and consequently
the outcomes were uneven which has had an impact on supply, choice and quality.

is the customer?

All presenters highlighted the
dominance of price and the lack of meaningful commissioning. The absence of
consumer power in residential care was considered an indication there is not a
true market. Neither choice nor control are sufficiently well-developed. In
fact, agreeing who is the customer in relation to residential care services is
not always straightforward. This compounds the power imbalance that exists.

effective market may depend on the user and the purchaser being the same
person. That would certainly make being an informed consumer more meaningful.
Without a system of consumer- directed influence over residential care, caused
by the dominance of local authorities as the major purchaser, market shaping
and market management has rarely been developed in an effective way. Issues of
consumer power and control are important. So too, the purpose of residential
care services and the availability of alternative forms of community support
services. A market model implies the ability to exercise choice together with a
knowledge of alternatives.

workshop groups explored a range of factors including the role of regulation,
workforce issues, finding, information and marketing. Two key themes emerged:
the need to drive consumer sovereignty and the need for greater leadership for
the residential care sector. Both aspects are vital to create a responsive and
flexible ‘market’ of provision. Some participants felt that licensing providers
and regulating commissioning would be beneficial. The need for citizen-led
approaches was advocated in which residential care facilities might be regarded
as community assets – now that would amount to innovation!

Residential Forum is keenly interested to hear from you – as customers, workers
and stakeholders – how care homes can be a positive choice within the social
care ‘market’. Any suggestions then do click on: submit a post

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