We’ve spent a year studying the 11,000 plus care and nursing homes that offer residential support to over 65s around the UK.
These homes provide vital services for thousands of older people, and often after they have reached a vulnerable point in their lives.
But there have been long-standing concerns that, while many homes do a good job, and sometimes in challenging circumstances, the industry as a whole was not working well for those who needed it.
So, a year ago we launched our 'market study' into the sector, investigating the different systems operating in each nation of the UK. We found that significant reform was needed.
People need care at a time when they are likely to be under great pressure – it can be a very emotional decision to go into a care home, and potentially an extremely expensive one. This can happen just when illness, accidents or bereavements leave prospective residents and their families least prepared and most vulnerable.
Therefore, it is very important that people are treated fairly and get the support and information they need to make good choices.
Unfortunately, we found that the information available to help people make these choices is often lacking – and often it's fundamental information, like how much someone could expect to pay for their care or whether they are eligible for support from their council.
We also found that, once living in a home, people don’t always get the services they expect and find it hard to complain when they experience a problem. And there was evidence that some homes were not complying with consumer protection law when it came to their fees and contract terms.
Given the sector is so very crucial in supporting people in great need, it is also vital the system is funded properly, to make sure it can meet that need, both now and in the future as our population inevitably ages.
Again, here we found concerns. In particular, that where a council pays for a person’s care, they are often not paying the true cost of what it takes to provide that service. This has led to homes charging more of people paying for their own care, to ‘prop up’ state-funded residents.
With ‘self-funders’ paying on average £12,000 a year more than a council would for the same care, in the same home, we can easily understand why many would view this as highly unfair, and so want to see this imbalance fixed.
Beyond that, it’s also not a sustainable financial model for a such a vital sector, as homes will not continue to serve council-funded residents if fees are not covering costs. This is especially important when the sector is going to require significant investment to improve and expand if it is to be ready to serve the predicted increase in the number of people needing care.
What do we think should be done?
First, where there was strong evidence some homes were not complying with consumer protection law in the way they charged for their services, we have already launched enforcement action. So far this is focused on homes charging large upfront fees – typically several thousand pounds – that we think are not fair or transparent, and/or charging families for extended periods of up to 4 weeks after a resident has died. But we stand ready to take further action should that be required.
We have also recommended that the national care regulators should take a greater role in protecting vulnerable people, helping to ensure that care homes meet their consumer law obligations, and ensuring there are effective systems in place for people to complain.
To further improve outcomes for residents and their families in the sector, we will be producing comprehensive guidance on the standards of behaviour care homes should be meeting to comply with consumer protection law .
We also want people to be able to better plan for their care options, and to get the right kind of support in making these, often difficult, choices. We have therefore recommended to all nations’ governments in the UK that they should work with the NHS, councils, care homes and charities to provide more support to prospective care home residents and their families. And we want local authorities to clearly set out how the care system works, what people’s rights are and the choices involved somewhere easily accessible online. Care homes should also provide better and clearer information on key factors such as potential costs of their services and contract terms.
Thirdly, we have found that the current model cannot be sustained without additional public funding. We believe an extra £1 billion a year is needed from the state to pay for the full cost of caring for the people it funds.
Finally, we also know the sector has to begin building the extra spaces needed to meet the predicted increase in state-funded residents soon, if it is to be ready in time. The CMA is therefore now calling for an independent body to oversee and support planning at a council level in England and Northern Ireland. In Scotland and Wales, measures have already been introduced to improve planning and base fee rates on the full costs of care; these should be kept under close review.
We now expect these recommendations to be acted upon in order to provide the significant reform this industry needs.
Separately, the government in England has already said it will publish its plans next summer to improve the provision of care for the over 65s. We look forward to informing this work alongside the other experts appointed to help shape it.