The London Care Funding Dilemma

How do we financially sustain an ever-ageing population and a population living with more complex needs than ever before? This is a monumentally important and difficult question which contains a degree of nuance that could fuel the writing of a book, nevertheless a blog. However, SweetTree’s position of providing care throughout the London Boroughs and Greater London area, working across several fields (Live In/Dementia Care/Brain Injury/Learning Disabilities etc) and working with an array of different types of funders (Private/Local Authority/NHS/Insurance/Solicitors) does give us an informed perspective on what we see as at least part of the solution. The good news is that ultimately the efficient cost solution could, if done well, create a more effective system of care.

Before we look at how, let’s wistfully move the pandemic to one side for the moment and make one thing clear – as a whole, social care funding is unsustainable in the way it is currently provisioned and has been moving in this direction for quite some time. The detail behind this statement is vast, countless national commissions and inquiries have tirelessly concluded this time and again. In the London Home Care market, in particular, the UKHCA (United Kingdom Home Care Commission) declared the minimum cost of care in London to be £25.11 per hour (prior to the pandemic), this is around £10 more per hour (or 40% more) than many Local Authorities are able or willing to pay as their maximum. The funding problem is not a recent one either, since the recession in 2008 care providers have been financially squeezed year on year as wages grow at a faster rate than fees are able to rise, whilst regulatory requirements (and subsequent administrative strain) have only continued to increase. Add in the problems of COVID-19 and subsequent further costs, such as obtaining PPE, and there appears to be a bleak picture being painted. Unfortunately to many, this bleak picture has recently been very real indeed.

In spite of the above, there is room for optimism here. SweetTree is lucky enough to have a real voice on these issues and be involved with key stakeholders across the care industry. Though it’s understood that ‘more cash’ is an obvious short-term solution, it is limited in its effectiveness on its own. We feel much of the longer-term solution is actually contained in our own original mission statement, which is to empower the individual. Simply put, at SweetTree we aim for and celebrate a scenario where our clients don’t need us as much and are able to manage by themselves more confidently, this is our idea of success. This of course is not always possible, but the principle and goal here is not only altruistically sound but it also vastly reduces cost. So how can this happen on a greater scale?

i) Being wary of minimum provision
At SweetTree we come across individuals who have heartbreakingly been ‘bounced’ around the care system as their needs continuously don’t get met by the lowest bidder. Not only is this horrible for the individual involved, but it also means this person has less chance to be empowered to manage better by themselves. Creating a higher quality service that focuses on empowerment not only is a fantastic outcome for the person involved but a strategy that can ultimately save vast amounts of money in the long term.

ii) Scheduling to meet individual needs
If a support worker is scheduled to be with somebody who does not require any support at that moment in time, this inefficiency results in someone having to come back at a time where support is required. In Home Care, scheduled visits that don’t align with a persons need or outcome goals in an effective way mean that costs will be spent inefficiently and ineffectively, with little benefit to the person receiving support. A rigorous assessment of need and subsequent organising of the right support worker to be with the right person at the right time for the right length of time not only benefits the person receiving the care, it vastly reduces cost!

iii) Effective Technologies
The potential of effective technology to tackle this issue is phenomenal and requires a blog to itself. However, in brief, there are two major parts here, the first is technology’s ability to more effectively manage the ‘care monitoring’ provision, this means having remote technology alert an issue rather than commissioning someone to wait for an issue at a high cost. The second significant cost saving here is through prevention, understanding an issue through technology that if left unresolved, would only result in more care being required (e.g. using technology to prevent UTI’s by noticing increase usage of the bathroom during the night). SweetTree believes in this solution so wholeheartedly that it set up a sister company, SweetTree Connect, to push this forward (feel free to read more about SweetTree Connect here)

It is heartening to know that amidst a somewhat bleak period, many of the solutions to the funding problems may actually lie in simply providing better, more effective care. There are also encouraging signs in the care world that we are not alone in our thinking and that the solution to this incredibly complex issue may ultimately benefit those who require our help most. There is a long way to go, but there are definitely reasons to be optimistic and SweetTree fully intends to be part of the journey.