Too special to fail?

Most social care is provided by third parties. Sometimes those providers fail. Sometimes they fail because they basically run out of money and sometimes because they’re not providing good enough services. Whatever the cause, when failure is stark and sudden councils can find themselves scrambling to get people new places in care homes and to provide cover for those cared for in their own homes.  We’ve been working on contingency planning guidance for social care provider failure with ADASS and the Department of Health. This guidance will help councils prepare for those times.

This is important because new duties under the Care Act 2014 mean that councils will have a temporary duty of care for everyone who receives care in their area, if  a provider goes under. No matter whether someone is a funded social care client, a self-funder who’d had no previous contact with the council or someone who has been placed in a service by another council, they’ll have to ensure that they’re looked after. And this is right.

Transitions between care providers are never easy. Continuity of care is important in and of itself. Disruption of care, including physical disruption – moving people from one home to another – can have devastating consequences when people are old, frail and vulnerable.There isn’t a straightforward answer on the effect of moving people between care homes, but Jacquetta Holder and David Jolley looked at a range of studies and found that increased mortality can range from 0 to 43% following the closure of a care home.

Because of the very human cost, as well as the financial costs, of managing transitions, sometimes councils will work with providers to avert closure.

But sometimes people have to be moved. If a care home goes under and must shut its doors, people have to be moved. If a care home cannot provide good quality care and improvements cannot be made by the current owner or even a new owner, then people must be moved. In those circumstances, we may even expect to see an improvement in outcomes.

This presumes, of course, that there’s a new place to go. For specialist care, this may not be the case.

In our research, we’re finding that local authority staff who work with care providers are particularly concerned about specialist providers in the context of contingency planning for failure. And with good reason.

Specialist services such as residential support for people with learning disabilities who have challenging behavior, for example, or people with complex learning and physical disabilities, are increasingly rare because most people are helped to live in the community. Specialist units draw their clients from a range of different places – and it’s not unusual for no one to be a resident of the host authority. This means that the usual business intelligence gathering through contract management or social work visits that could give indication of trouble on the horizon simply doesn’t take place.

It’s also pretty likely that there won’t be alternative provision elsewhere in the local authority or anywhere nearby. Instead of scramble for places within a few mile radius if a provider goes out of business, the hunt for places may be national – exacerbating stress for clients, carers and family members.

Specialist providers may also be particularly vulnerable to financial risk. If they support people with complex and infrequently occurring sets of needs, they may be small units. If one client leaves, because their needs change, or they die or a place opens up with another provider close to home and family, this may put the financial health of the provider in jeopardy through no fault of their own. Counter-intuitively, our research indicates that specialist care providers are less likely to fail.  My hunch is that this is because they’re too special to fail.

Case study councils we’ve spoken to have worked closely with specialist providers to avoid closure because there wasn’t an acceptable alternative, in terms of type of service or location. In one case, they helped a specialist provider redesign its services which meant provision could continue and most clients could stay on. In another, a provider wanted to exit the business because it did not fit with the wider strategic objectives of the parent company. But because of the strategic importance of the service, the council worked closely with the provider for eighteen months while a new buyer could be found. Yes, the company exited the market, but the service continued.

Our guidance doesn’t specifically cover how councils can work with providers to avoid or postpone a specialist care failure. But we’re very interested in how councils have handled it when it happens. We’d love to hear from you if you have had experience in this area. If you haven’t, but you’re interested in this guidance, we’d still love to hear from you. You can join our virtual reference group which means you’ll be kept up to date and be able to comment on and shape the developing guidance.

Consultation is open now on the guidance outline, so there’s still time to shape the final product.

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