Personal budgets and the costs of care

In the autumn the Public Accounts Committee published a report entitled "Oversight of User Choice and Provider Competition in Care Markets". The report comments on the use of personal budgets, and the Government's aim that all eligible care users be offered a personal budget by April 2013. It also states that a number of local authorities are "dragging their feet" in offering personal budgets, and suggests that a solution may be to introduce legislation giving people the right to a personal budget.

The Committee expressed concerns about the Department of Health's inability to prevent providers becoming too dominant in the market; and the level of debt which some providers currently have. It said that the Government should do more to monitor the finances of English care home companies in a market worth £23bn a year, most of which comes from public funds. The Committee also said that the Department must ensure that people have access to the information and support that they need and that it has arrangements in place if large providers get into financial difficulty.

The Department of Health published, in October 2011, a discussion paper on the oversight of the social care market and is to publish a White Paper in spring 2012 on reforming social care delivery, with a progress report on funding reform.

Local HealthWatch bodies

The Government has announced the introduction of Local HealthWatch bodies which will replace Local Involvement Networks (LINks), probably in April 2013. Local HealthWatch will have a seat on the new health and wellbeing boards, to ensure that patient and other service users' views and experiences are taken into account when decisions are made regarding the local provision of health and social care. Local HealthWatchs' role will be similar to the work done by LINks. However, they will have greater powers, including the ability to report local concerns to HealthWatch England, which will be a national body which will use the collective views of patients and service users to influence central policy.

Breach of human rights

A recent report by the Equality and Human Rights Commission has criticised the care which is being provided to older people in their homes, and has concluded that treatment which some of these people have received breaches their human rights. These breaches include physical and financial abuse and a failure in the complaints system. At present, the Human Rights Act 1998 does not apply to people receiving care in their own homes from private organisations, so the Commission has recommended that this loophole is closed. However, the report noted that many of these problems could be solved if local authorities used their commissioning powers to ensure that private companies providing care agree to comply with the Human Rights Act. Age discrimination was also highlighted as a significant barrier because older people receive less money towards their care than younger people with similar problems.

The Sefton case

The High Court has recently ruled that Sefton Council acted unlawfully in freezing the fees it paid private care homes for residents it had placed in those homes. The ruling establishes two important principles. First, that local authorities must properly consult before making such a decision and, second, that the rates which local authorities decide to pay must relate to the actual cost of the care which is being provided.

In a similar case, Pembrokeshire Council was also recently told by the High Court to review the fees that it pays to a number of care homes after the homes said that the fees were insufficient to meet their costs. The Council has said that the new fees will mean additional costs of almost £1.5 million.


A number of local authorities have outsourced or hived off the provision of various social care and support services. For example, Optalis has been set up as a Wokingham Borough Council-owned company to provide care and support services to older people and adults with a disability. Essex County Council has moved towards being a commissioning body where services are sourced via voluntary organisations, the private sector and user led groups. Essex Cares is owned by the Council and provides a range of adult social care services.

CQC criticised

The Care Quality Commission has been criticised during the Mid Staffordshire Hospital inquiry by, amongst others, a serving board member, for a "bullying target-driven culture". Such criticism is likely to increase the pressure on the Department of Health as it completes its internal review of the delivery of social care. Kay Sheldon, a non-executive director and patients' champion, said in evidence to the enquiry that strategy at the CQC was reactive and led by reputational management and personal survival.

The CQC has also been separately criticised for failing to meet its timetable for inspections. The National Audit Office found that the Care Quality Commission had carried out just 47% of planned reviews between October 2010 and April 2011. At the end of September 2011, 14% of posts were unfilled - including 100 inspectors' posts. The NAO also said that inspectors were diverted from assessing providers in an attempt to meet that timetable.

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