For several years now, as austerity has sucked billions from welfare, Britain’s highly specialized welfare system for adults with complex physical disabilities, learning disabilities and autism has been quietly maintained by the benevolence of charities.
Charities and not-for-profit companies have contributed millions of pounds in reserves to support the allegedly taxpayer-funded services they provide under contract to councils and the NHS. This grant seemed sustainable when inflation was low and replacing underfunded public services did not endanger the charity’s own survival.
This year, as the cost of living crisis has exploded, wages and energy prices have soared and the crisis for social care workers has deepened, many of these charities – themselves at risk of becoming unviable – realized they could no longer afford to operate at a loss. The system, as Mencap claims, is “broken” and it is unclear when or how it will be fixed.
Leonard Cheshire is evicting some of its residents, playing what one observer called “a game of chicken” with council funders over who pays the rising costs. More and more providers are “returning” contracts to provide care packages that are unsustainable at current funding levels. A staffing crisis so acute – a record 165,000 vacancies – that some are dipping into their reserves to fund pay rises in order to attract or retain staff.
It would be a mistake, says a social services insider, to see this as a case of “bad provider syndrome”; rather, it is a lesson in the consequences of underinvestment by the state. “If you don’t fund the system properly, it collapses, and that’s what we’re seeing now,” they said.
One supplier said it was difficult to hire staff because the council’s contracts effectively capped the amount they could pay in salaries at a market rate well below that currently offered by competitors such as Aldi and Tesco. Another said she was ashamed that she couldn’t pay more because some of her caregivers had to resort to food banks.
This “market dysfunction” has become so entrenched over the years, according to a recent report commissioned by a vendor, that “it has so far been widely accepted that some services will always operate at a loss because they are not insufficiently funded.
Private providers would recoil from such unpromising financial choices, but sector charities say they are staying in the market to protect the people they serve: highly vulnerable people who thrive on stable relationships with skilled caregivers, trusted and experienced, who know the people they are caring for inside out.
The reduction in funding for care, along with the minimum service that results from the disappearance of charities and their subsidies, disrupts these relationships and offers a dismal prospectus to service users. “It would be: washing, feeding, dressing, sticking people in front of the TV. Is this the quality of life everyone wants? said Jackie O’Sullivan of Mencap.
Last week’s autumn settlement pledged an extra £3billion a year to local authorities in England over the next two years, much of it aimed at helping elderly patients get out of NHS beds. But that is unlikely to change the climate for this underreported and underfunded social care sector and the people it serves.