The Competition and Markets Authority (CMA) has published a new report based on its year-long market study of care homes across the UK.

The review focused on whether the care home sector is working well for older people and their families.

The report’s general findings include:

  • The current system for providing care is not sustainable without additional funding. The CMA’s financial analysis of the sector has identified a funding shortfall of £1 billion a year across the UK because councils are paying fee rates for the residents they fund which are below the costs care homes incur. This has led to care homes propping up their finances by charging higher prices to those who pay for their own care (self-funders). On average, self-funders’ fees (£44,000 per year) are around 40% higher than those paid by councils (UK average).
  • Beyond the challenges of continuing to meet existing needs, the sector must grow substantially as the population ages. However, uncertainty about future funding, including whether council fees will cover the full costs of care, currently means that there is not enough investment in new accommodation for council-funded residents.
  • Many people choose care homes during an emotionally traumatic time, but the basic information and support needed is often not available to help them navigate the system and make informed choices.
  • There needs to be greater protection in place for people in care homes. Residents and their families often find it difficult to raise concerns or make complaints, and the systems for redress and feedback need to be improved. There is also too great a risk of residents being treated unfairly, and in breach of their rights under consumer law. Examples of the CMA’s concerns include where homes are not being clear enough up front about their prices or terms and conditions, do not protect residents’ deposits effectively against the risk of insolvency, are not fair when asking a resident to leave or when they ban visitors.

Throughout the study, the Competition and Markets Authority have engaged with Scottish Care and members to better understand the particularities and nuances of the Scottish care home sector: its challenges, developments and how it operates differently to other parts of the UK.  This has included focus groups and multiple telephone interviews, plus the sharing of Scottish Care’s research and reports.

Based on the CMA’s engagement with various stakeholders in Scotland, the final report includes a Scottish summary of the market study’s findings.

It identifies two broad areas for improvement in Scotland:

  • Those requiring care need greater support in choosing a care home and greater protections when they are resident. Current and prospective care home residents must be able to make the right choices, and must be protected if things don’t work out as expected;
  • Issues around state-funded care and the provision of sustainable capacity – the market must support the state’s intention to ensure that all those who have care needs have them met. This requires that the industry must be sustainable and incentivised to invest and modernise to meet future needs.

In light of these areas, the CMA have made a number of recommendations to the Scottish Government, the Care Inspectorate, local authorities, IJBs and the care home sector.  These include:

  • A programme of actions around clear and accurate information, supported decision making and awareness raising to enable people to make informed decisions about their options when choosing a care home and to ensure they are aware of their entitlements.
  • Safeguarding actions to protect against infringements on consumer law, such as the development of detailed guidance for care homes and residents, stronger regulatory oversight of consumer law compliance and the use of model contracts between care homes and prospective residents.
  • Improvements to complaints systems such as a review of access to advocacy services and closer inspections of feedback mechanisms.

The report also gives particular focus to the issue of state funded care and its sustainability currently and in the future.  It clearly recognises the shortfall in state funding in meeting the cost of care and recognises the importance of investment in the care home sector.

Recommendations are made in this area for other parts of the UK.  However for Scotland, the CMA explicitly welcome the ongoing development of a cost of care model for local authority-funded care and the planning and commissioning roles of IJBs.  The CMA has therefore opted not to make specific recommendations other than to stress the importance of the ongoing assessment and monitoring of these actions to ensure they are delivering the changes required.  The report emphasises:

“Our concerns around the delivery of state-funded social care are important, as the delivery of an effective and sustainable social care system must be maintained.”

Scottish Care will continue to work with partners and stakeholders around these recommendations.

Dr Donald Macaskill, CEO, said:

“Scottish Care welcomes the publication of the CMA’s market study, particularly in its articulation of the reality long described by Scottish Care – that there is significant and damaging underfunding of social care in Scotland and the rest of the UK.  It highlights the impact of stripping tens of millions of pounds out of social care by Westminster and by Scottish Government, which can only serve to negatively and disproportionately impact on our older and vulnerable citizens.  Current rates of as low as £3.42 an hour to support an elderly person with multiple and complex needs for 24 hours, 7 days a week in a care home in Scotland in no way meets the true cost of providing high quality, sustainable care.  It is absolutely essential that this funding reality is addressed as a matter of urgency in order that everyone who requires care home support can receive this in a way that promotes equality, transparency, dignity and respect.”

The full CMA report can be accessed here: https://assets.publishing.service.gov.uk/media/5a1fdf30e5274a750b82533a/care-homes-market-study-final-report.pdf 

The Scottish summary can be accessed here: https://assets.publishing.service.gov.uk/media/5a201ae7ed915d458b922ec6/scotland-short-summary-care-homes-market-study.pdf 

The CMA’s financial report, published in September, can be accessed here: https://assets.publishing.service.gov.uk/media/59b2bb0ae5274a5cfcda2d18/financial_analysis_working_paper.pdf