The National Care Forum (NCF) – the leading association for not-for-profit social care has
responded to the publication of the Care Quality Commission’s report on the state of health
care and adult social care in England.

Vic Rayner, NCF CEO commented: “The CQC report lays bare the reality that the notion of a
‘care market’ was flawed from the outset. The outcome of systematically underfunding local
authorities, who in turn have not paid the actual cost of delivering care, has brought us to a
place where profound health inequalities for individuals and communities are now
compounded by profound care inequalities. The CQC’s unhelpful adoption of market
terminology around services means that we are faced with a government regulator
explaining that inequities are fuelled by providers not delivering publicly funded care
because it is ‘less profitable’. The reality is that providers are not able to provide care at the
rates that local authorities can pay, nor can they provide quality services at these
unsustainable rates. They cannot staff services where they do not have enough funding to
pay staff, nor can they innovate and invest in buildings and technology to ensure that we
have care services we are proud of and are fit for the future, as well as for the present. They
are also unable to deliver the services those who draw on their services want. The language
of profit, and the extraction of profit have no place in the delivery of public services. Yet, the
persistence of a market ideology enables politicians at a national and local level to stand
back and watch. The report makes absolutely clear that the market cannot regulate itself,
and that Local Authorities have a sustained inability to fund services for the actual care that
they deliver. This has embedded a level of disadvantage and exclusion that is unfair.

Furthermore, the CQC report highlights the systemic failure of market forces and suggests
that ongoing efforts to address the ways in which systems work will never succeed until we
move away from allowing the notion of profit making in care to hold sway as an acceptable
response to meeting a statutory, and moral, right for the most vulnerable members of our
communities to receive care.

“Over the last 10 years, since the vital review by Sir Michael Marmot, we have got better at
understanding the long-term impact on people who are experiencing health inequalities.
This report begins to unpeel the realities of living with care inequality, and the long-term
prospects for people and communities who are already excluded from receiving the quality
care that they need. These inequalities and the absence of rights, fairness and choice for
people and their families have to change which is why we have included calls for a national
care covenant as part of our social care must haves for the next government.

Professor Rayner concluded: “The report also demonstrates the failure of local systems to
nurture strategic partnerships with care providers, something the Nuffield Trust pointed out
as a priority in the summer following our joint roundtable event. Now as we feel winter’s
bite, sadly we’re no further forward in addressing the pressures the coming season will
bring for the people giving care, those receiving it and those trying to access it.”