Elephant in the room

Mario Kreft, chair of Care Forum Wales, says institutional prejudice against privately-run care homes is an issue that needs to be addressed

Mario Kreft, chair, Care Forum Wales

It’s been the elephant in the room for three decades and more. The institutional prejudice against privately run care homes has been a constant and annoyingly persistent theme.

The recent reception at the Senedd (Welsh Parliament) in Cardiff to mark the 30th anniversary of Care Forum Wales, which represents around 500 providers, was a great reminder of how far we have come – but also of the stark fact that we have been unable to conquer the discrimination we continue to face.

While we have been able to develop a positive, collaborative relationship with the Welsh government, the same cannot be said for the crazy patchwork of 22 local authorities and seven health boards which commission the vast majority of social care in Wales. It’s tantamount to financial abuse that wouldn’t be tolerated by any other commercial enterprise.

Sadly, this is not a uniquely Welsh phenomenon. We were founder members of the Five Nations group which represents providers across Wales, England, Scotland, Northern Ireland and Ireland and my colleagues from the other nations also experience the exact same prejudice against the private sector.

The exception that proves the rule is Conwy Council in North Wales. Hitherto, it had abided by the machinations of the North Wales Regional Fees Group – which is essentially a fee- fixing cartel – set up by the region’s six county councils (Anglesey, Conwy, Denbighshire, Flintshire, Gwynedd and Wrexham) and Betsi Cadwalader University Health Board.

But after years of campaigning by Care Forum Wales, it has broken away from the other North Walian authorities and finally used the toolkit designed by social care finance experts LaingBuisson to calculate the fees for the different categories of care.

And lo and behold, it has introduced fee increases of between 18% and 20%, bringing the rates a lot closer to being a realistic reflection of the true cost of providing care.

Senedd reception to mark 30th anniversary of Care Forum Wales

Compare and contrast this with the approach in neighbouring Denbighshire County Council – with leader Jason McLennon and chief executive Graham Boase at the helm, who are are determinedly keeping their heads firmly in the sand. As a result, Denbighshire has come up with a miserly 8.8% increase, one that has been immediately wiped out by inflation and the cost of living crisis.

To put this in context, Denbighshire was already paying the lowest care home fees in the whole of Wales, so it started from a rock bottom base.

We have ended up in the ludicrous position where the annual fee in Denbighshire to provide nursing care for an elderly, vulnerable person with dementia in Rhyl is £9,200 less that you would get for providing exactly the same level of expert care in neighbouring Kinmel Bay in Conwy.

In a 40-bed care home that equates to a disparity of nearly £370,000 a year which could mean the difference between staying open and being forced to close for care homes that are already struggling financially.

The stakes are high. In the past 18 months, we’ve lost at least four homes in North Wales: Trewythen Hall in Gresford, Bay Court in Kinmel Bay, Gwastad Hall in Cefn y Bedd and Morfa Newydd in Greenfield – with 163 much-needed beds.

All of this has played out against the backdrop of Conwy Council getting just a 2% increase in overall funding from the Welsh government which was the lowest in Wales so there’s no excuse for Denbighshire or any other authority in Wales or elsewhere not to follow Conwy’s example.

All we want is fairness in line with the Welsh government’s ‘Let’s agree to agree’ guidance.

We’ve had a generation of injustice and institutional prejudice and discrimination against the private care sector – and Denbighshire Council is the embodiment of this.

As the former First Minister of Wales Mark Drakeford pointed out, social care provides a scaffold for the NHS, so this mean, shortsighted approach is also going to have a detrimental effect on our hospitals – as if the beleaguered Betsi Cadwalader Health Board in North Wales didn’t have enough problems already.

Politics is about making choices and Conwy Council has shown it’s possible to take a much more sensible, long-term view to protect the social care network from collapse.

What’s particularly shameful is that you have a Labour-run council in Denbighshire which is saying that fair fees are a bridge too far for them. It’s also incredibly short-sighted. Underlying most care home closures is an inadequate funding issue. It’s bizarre that the situation is within the commissioners’ grasp by funding correctly, when hospitals need these beds to ease their pressure.

That’s a pattern that’s being repeated across Wales even though the fact of the matter is the quicker someone leaves hospital the better it is, not just for the patient but for the local authority as well.

The need for care home beds has never been greater because our hospitals are at breaking point because of so-called bed-blocking with patients unable to be discharged after their medical treatment has been completed.

As a result, there are very few hospital beds available for incoming patients, many of whom have to endure being kept in ambulances outside or on trolleys for hours on end.

What makes this all the more shocking is this an avoidable catastrophe that’s been caused by the disgraceful mismanagement of local authorities and health boards in Wales which commission publicly funded social care.

It feels very much like there’s a deliberate campaign to undermine and ultimately destroy the independent sector so that it’s no longer sustainable, giving the opportunity for local authorities to take social care in-house.

In the meantime, irresponsibly low care fees add up to an outrageous stealth tax on decent, hard-pressed families who will inevitably have to fund the shortfall themselves.

We now have a new First Minister in Vaughan Gething and a new minister for social care, with Dawn Bowden following in the footsteps of the wonderful Julie Morgan, with the promise of a new national approach.

I very much hope they will follow Mark Drakeford and Julie Morgan’s example in thinking of social care provision as a value and not as a cost. I wish them all the best as they take the helm in challenging times.

Local authorities respond

We asked the members of the North Wales Regional Fees Group for a response to Kreft’s allegation that they operated a fee fixing cartel.

Alwyn Jones, chief officer social care at Wrexham Council, said: “North Wales authorities and the local health board work together to propose fee rates across North Wales for care home provision. These are recommendations only and each organisation uses discretion to set their specific local fees within the context of their local market and resources available.”

A Cyngor Gwynedd spokesperson said: “We work with all North Wales local authorities and representatives of the care sector, including Care Forum Wales, to follow Welsh government guidance to agree care home fees. It is disappointing to hear of the Care Forum’s colourful claims regarding this transparent and open process and the attempt to present a complex and sensitive matter in the form of a crude ‘league table’. As a council, we are dedicated to delivering the best possible care and support for the county’s most vulnerable people and note that residential placements are only one part of the care market and that other aspects demand greater fees.”

We asked Denbighshire to respond to Kreft’s criticism of its fee rise.

A spokesperson said: “Considering that this is significantly more than the 3.8% increase received in our settlement, this decision reflects that, even in the face of significant financial challenge, the council is prioritising the provision of care in the community.

“Denbighshire currently spends around £13 million on approximately 364 placements in 82 homes. With this increase, expenditure is set to increase by over £1 million.

“This strives to strike the delicate balance between navigating challenging financial constraints and ensuring that we are maintaining a sustainable future for the care sector in Denbighshire and whilst this decision comes with financial implications, it reflects our priorities as a council, and upholds our commitment to prioritising care provision in our community.

“We value our care providers in Denbighshire and remain committed to fostering an open and fair relationship with them.”

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