LD Market Impact Study – Scoping work
Andrew Price (SCC LD Commissioning Team) and David Holmes (Ashcroft) are leading a study to
understand the drivers of change which current impact LD providers, or will do so in the future. This
work aims to ensure that we have a good understand of issues now so that actions can be taken to
minimise their impact in the future. It is one of several initiatives being supported by SCC to ensure
that Surrey has a high quality, vibrant future market place for LD services.
The study is being carried out by a postgraduate student at the Tizard Centre at the University of
Canterbury, under the guidance of Professor Peter McGill.
Andrew and David have done some preliminary work to ensure that the study is properly scoped and
focused in the right direction. A pilot survey has already been carried out, and subsequent to this
David Holmes took the opportunity to do some more scoping work with providers at the LD Provider
Network Meeting on 26 November 2013. This sought to identify some of the less obvious threats to
the future of wellbeing of delegate organisations.
This is what delegates came up with (raw, with DH notes in italics):
Driver of change
Impact
DH example:
As the economy starts to grow
businesses will recruit at rates of
pay higher than my organisation
can afford to pay.
Some existing staff will leave and it will be difficult to recruit
new staff of the right calibre at the rates of pay we can
afford. This may restrict our ability to develop new services
and may also affect the viability of current services.
Quality and quantity of staff
available to recruit
Decline in quality of service you can offer
(Noted by one CEO that quality of candidates and recruits
coming through is declining)
Financial pressure exerted by new
higher pension contributions and
payment for sleep-ins
Inevitable erosion of margins
(No new funding for increased employer pension contribution
or requirement to pay minimum wage for sleep-ins)
Dearth of high quality Service
Managers
Impact on quality of services
(As all Providers know, services are only ever as good as their
Managers. Noted that it is becoming very difficult to recruit
high quality Managers, without whom it is not possible to
operate high quality services. Some providers noted that they
have resorted to head hunters, which destabilises existing
services and drains money out of the sector)
Mature clients leaving services,
being replaced by young clients
with high needs
Client needs will not be met
(Points to Surrey’s structural issue of having the wrong
services in the wrong locations to meet needs of changing LD
population)
Level of investment too low –
sector no longer seen as attractive
Sector will not grow to meet future needs
(Investment constrained by several factors – reduced
margins, reduced liquidity, level of existing debt in care
businesses, bank behaviour, diminution in business values etc.
Major investment in Surrey seems to be in large private
elderly homes. Seems to be much less in LD)
The cost of putting staff on training
is increasing.
(Also noted that grants available to
support training seem to be drying
up)
Have to train people before they can start to work with
people. People drop out after training.
Expectation put on providers, with
reduced funding and support
(Noted that expectations of all
stakeholders is increasing, notably
the people we support and their
families)
(Implication is that Providers will increasing fall short of
meeting expectations)
Different standards for monitoring,
sign up.
Threat of contracts being reduced
Can’t plan. Frightened to invest.
This has impact on staff training.
(Mismatch here between the long term nature of investing
and the short-term nature of many contracts (particularly
where tendered))
People being placed out of the
county at high fees whilst rates are
being capped in Surrey.
Private equity/Venture Capitalist
(Risk is that this will be the main
source of investment)
Commercial vs Care and Support
(PE/VC funding is predicated on a financial return in a 3-5
year timescale – creates risk to quality and potential
instability as businesses are bought and sold)
Demographics
(More people needing services in
the future)
Staffing – Surrey high cost
(Implication is that Providers won’t be able to staff services to
meet demand)
Initiatives and over-regulation
Overheads are going up, whilst funding available for support
is going down.
(Also noted that requirement for other overheads also
increasing – IT, quality management etc)
Tendering is driving quality down
Price vs quality
(Some scepticism about whether tendering processes which
purport to apply 60% weight to quality actually do so)
Door to door selling (ruthless)
Awareness of needs
Election in two years
Can’t predict what will happen
(Uncertain environment in which to make decisions, notably
about investments)
What happens to quality when we
can’t pay staff?
Cleaners get more money – what does that mean?
(Noted by one provider that cleaners get £4/hr more than
they can pay care staff)
Peoples’ expectations of
employment
Funding to support this reduction
Squeeze on costs when filling voids
More for less in regards to what is expected to be provided
for fees – no day care cost included.
(Noted that support fees used to exclude day care, but that
this is now expected to be provided)
Providing a personal service
Personalisation of service provision takes up-skilling of staff
delivering service with no additional funding available.
Service specific training
(Threat is that this is expensive, so
being replaced by cheaper
alternatives)
Move to be more efficient and move money has forced a
drive t e-learning. Reduction in face to face and servicespecific training.
CDH, 27/11/13