My father would be 100 this year if he was still alive so perhaps we are thinking about him more than usual. My mother’s affectionate claim “he wouldn’t know the price of peas” reflected his very traditional role as provider, not shopper. The peas arrived on his plate without discussion about their cost or value. Fast forward to 2018 and consideration of price – food, consumables and services – is the business of us all. Easy access to information and price comparison through our mobile devices allows informed choices. Customer reviews and even the basics versus finest labelling give us some indication of the quality we might be paying for.
Access to this world of price information and comparison is not, alas, as readily available when it comes to the cost of social care. And yet for all councils, personal budget holders and an increasing number of self-funders, these costs have hugely significant implications for the planning and quality of life for some of the most vulnerable individuals. The cost of care is part of the essential fuel required for discussion and debate at a national level about future funding and priorities.
Considerations of cost and price can become interchangeable when we are shopping but that’s not an option for social care commissioners. The need to identify and to understand the complex relationship between cost, price, value and quality of services is paramount to their purchasing decisions; what and how much of it can be provided, at what quality and from whom. This coincides with the need to reduce the current fragility of our social care market and the number of providers – some of whom we would consider amongst “the best” – who feel they can no longer sustain their business.
Councils are working hard with their local providers to understand – together – the cost of care. Not an easy discussion, requiring a much greater level of transparency than may have characterised the relationships with providers in the past. Complete data about cost base – the fixed, semi-fixed and variable elements – must be available and understood. I know from my work with Health and Wellbeing Boards that access to accurate data enables partners across different organisations to have a shared view of a complex issue, better informing difficult discussion and decision making.
Transparency can be an issue for some larger providers who have the resources and incentive to prioritise the bottom line. For some smaller providers having sufficient grip on costs proves to be more troublesome. These are the social and third sector enterprises I described in my last blog and which we all know have so much to offer regarding the provision of local choice, quality and personalised services. I said I would consider procurement of these small providers; well it’s from this cost angle. Do we think their grasp of their costs is sufficient? I am not sure I do. I think for very many it will be – it is – a challenge to develop the capability needed to have a chance of ensuring they can play the role we require for the future in shaping and delivering the best care services possible.
A challenge for you – what is your council doing? Are you making progress? Could you do more? Small local providers and commissioners need to feel confident that costs have been accurately identified and understood. This must precede discussions about fees, funding, and contractual relationships. It’s a basic requirement.
Councils have been helping the community and voluntary sector build “business” capacity in all sorts of ways and perhaps particularly through local infrastructure organisations. Is the challenge now about priorities? Could the local CVS be doing more? What about the council employing someone to take on responsibility across a number of small providers and re-charged their cost?
Whilst the price of peas may not be my – or your – greatest concern, we all need to start feeling more confident that we are getting a grip on the cost of our social care. It must go higher up our list of local and national priorities
Strategic Director, Health and Social Care Integration