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The hot topic of top-ups

4 June 2014


NCF blog by Alastair Jackson


Coming into residential care provision from a social housing background, it takes time to adjust to the fact that the level of fees is not regulated by government formula. All the more so in an organisation that takes what it sees as a principled approach that good care should be affordable to everyone.

The issue of top-up fees for residents who qualify for Council funding is much debated. Many of my peers – often wiser than me – take the view that it is not our job to subsidise one person’s care service at the cost of another. That is taxation and the business of government.

However, our financial seams are beginning to burst under the pressure: a 2% increase in Council fee income in three years and an apparently interminable process of consultation; a minimum wage level that has risen 7% in the meantime (our principles cannot afford the Living Wage); and a new core contract with an accompanying Quality Assurance Framework to soften us up ahead of the start of the CQC’s rating system. I understand some not-for-profit organisations are in a position which necessitates around £300 weekly top-up (residents not living with dementia) which could significantly increase our staff care hours per resident.

So I am now learning to re-draw my income generation map and to use the language of segmentation, decision makers, kerb appeal and cross-generational marketing. All good of course, but at some point it will come down to the simple question: can we afford to provide good care at what tax-payers are willing to pay?

I think our care passes the “would my mother like to live here?” test. She does not want to pay for anything fancy, but knows she deserves a good, safe level of care and as fulfilling a life as she can lead. I’m grateful for any offers of value-for-money consultancy, but I think there is not much to squeeze out of our costs. The bottom line is that we cannot provide what my mother deserves for what the taxpayer is willing to pay. So much as I look forward to the next stage of the social care cost capping debate, do we not also need to refresh the discussion about what basic, decent care costs to provide, and whether we taxpayers are willing to pay it?

Alastair Jackson
Chief Executive
Leicester Quaker Housing Association

and NCF Director

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