A bit of a rant...

Another week goes by, and here in Wales we are no closer to any sort of clear plan being put in place to support the Welsh Assembly Government’s ideological target of removing profit from children's social care. I did attend a recent market sounding event in Cardiff, which did little to reassure me that the market will be ready to move to a non-profit model in time to meet the assembly's aims. At least one provider left the event early on, convinced we are seeing the unfolding of a self-made disaster for children's social care in Wales. Like many providers I have been in contact with, he's given serious consideration to leaving the sector. We know that no local authority in Wales is in a position to meet the needs of children who may be in desperate need of somewhere to live once these providers close.

The conversations I have had with local authorities suggest that they too lack an appetite for this change. Some of them have openly stated to me that they do not care if those people looking after their children are making a reasonable profit or not, so long as the quality of care is good. All of the research into this area seems to confirm there is a negligible difference between the cost of care provided by the local authority and care provided by private companies; and there is no difference in the quality of care either. Good practise and poor practise exist regardless of which sector the children's home operates in.

What we're seeing is unpopular and ideologically driven change being forced through without adequate planning or funding to ensure the children looked after in the system remain safe. I believe that if the government genuinely wants to remove profit from social care, it should grab the bull by the horns and ensure local authorities have the funding and support to run their own internal services, rather than hoping that a hodgepodge of good intentions and poor planning will somehow magically meet the needs of the most vulnerable children in the country.

The care and support of children who are traumatised, have been abused, or have complex learning difficulties, is a difficult and demanding job. Good quality care is expensive - to use a metaphor, you can't expect a Mercedes-Benz for a Kia price. A lot of the rhetoric we're seeing in this “debate” is apparently focused on addressing the profiteering which does exist in a small sector of the Welsh market. However, what I'm seeing is this element of dubious business practise being conflated with the cost of care. The whole sector is being punished for the sins of a few. A good company charging what lay people may see as a high amount for care is not the same as profiteering. We need to root out the profiteering elements in the marketplace, there is no doubt about that. But many people are commenting on what they see as the high cost of care, without any idea of what care should cost. Every children's home needs a staff team; some children may need two or more staff with them at all times to meet their needs. That staff team will need to be trained, inducted, supervised, and some will need to be put through relevant qualifications. Some homes employ waking night staff on top of their day staff. Some homes offer education. Some homes offer specialist psychological and therapeutic input. Somebody adequately skilled and experienced has to oversee and manage the home and care package. And I truly believe that the low status of care in this country means that people do not understand the knowledge, skill, and complexity that goes into good quality residential childcare. None of us would dream of walking into an operating theatre and telling the lead surgeon that we think he charges too much, and asking whether he really needs to cut so deep, and does he really need all these other people around him, and does he think he's wasting too much soap when he cleans his hands, and isn't this all rather expensive? Surely there is a cheaper way to do it? Why then, without any experience in the sector or any knowledge of how difficult and demanding the job can be, and without any knowledge of the support and care many of these young people need, do people feel entitled to jump in and tell us in the sector that we're charging too much for something they're not prepared to do themselves? I'm talking here largely about the way the debate has spilled into social media, but I've met many professionals not directly involved in the running of children's homes who do not appreciate the skills their colleagues bring to work every day; and there exist many more decision makers in government who are clueless about what the job of caring entails and what the sector actually needs.

Disclosure: I have been a left-wing voter all my life. Given the choice, I would have all children's social care provided by local authorities, in the local area, by well-paid and trained staff, wherever it is possible to meet children's needs (as I believe privatisation should have no role in the NHS). If we are looking to remove private companies from the care sector, this is the model we should be following - doing it properly, not in some half-arsed attempt to massage the market in the direction the Senedd wants.

But even under such a model children will need specialist care that it is simply not cost effective to provide in every region, and so some children will still end up moving further from home than they would like. And (pie-in-the-sky thinking)  if this were to be funded and planned and executed properly by the government, we still would not meet the main aim the government wants to achieve - that of reducing cost. Staffing is the most significant cost faced by any care organisation. Good quality staff are difficult to find, difficult to recruit, and difficult to retain. Again, this comes back to the low regard that we have for carers in this country. Such staff should be a lot more expensive than they currently are. We should be rewarding them far more than we currently are. If you think this is wrong, compare the rewards offered to carers and children's homes managers with the packages offered to any other profession in the country. If you need to recruit a teacher, you are not competing with Lidl and Aldi for the same pool of staff. Yet that is the reality faced by those looking to staff care homes. The obsession with driving down costs means that this is unlikely to change anytime soon. 

Forcing those who make a small profit (many providers have a profit margin of around 6%) out of the marketplace will not be the universal panacea for all the industry's problems many people are proposing it will be. It is not going to reduce costs. It is not going to save the government any money. It is not going to improve the quality of care across the sector; in fact with the unavoidable skills drain caused by many people leaving the sector as companies leave and are not replaced, we are likely to see a dip in the quality of care offered to young people. We may even see increased costs, as the lower number or providers remaining in the sector will mean more competition for a smaller number of beds.

It is a worrying time for all concerned.
 
Further reading:
https://nation.cymru/feature/owners-of-private-childrens-homes-fear-impact-of-plans-to-eliminate-profit-from-sector-in-wales/
 
https://www.icha.org.uk/Public/Document/Download/2257?fileName=97ab9545-c790-4945-8710-833deb74ba92.pdf
 
https://assets.publishing.service.gov.uk/media/62287a3a8fa8f526dba3430a/Wales_summary.pdf
 
https://www.gov.wales/removing-profit-care-children-looked-after-board-discussion-july-2024-html