Hertfordshire’s adult care boss highlighted some major issues facing the care system at the House of Lords.

Iain MacBeath, director of adult care services at Hertfordshire County Council, says it feels like a ‘sellers’ market’ in the system, where care providers can pick and choose which residents to take.

He says the current means test to determine funding is “unfair” and a two-tier market is now emerging, for those residents that ‘self-fund’ and those that don’t.

Meanwhile he has also highlighted the significant funding that he believes needs to be injected into the system and the fragility of some providers.

Mr MacBeath – who is also resources co-lead of the Association of Directors of Adult Social Services (ADASS) – was giving evidence to the Lords’ Economic Affairs Committee, as part of an ongoing inquiry into social care funding in England.

The session heard funding for adult social care had fallen by three per cent since 2009/10 – which is equivalent to a nine per cent drop per person.

And with much of the spending now allocated to younger disabled people – who have fewer assets to pay for their own care – it was estimated that spending for over-65s could have fallen by around 25 per cent per person.

Mr MacBeath said councils had taken steps to protect social care from funding cuts – with social care now accounting for 38 per cent of council budgets, compared to 30 per cent in 2010.

But he said a number of short-term grants – amounting to £23million in Hertfordshire alone – would end in 2020.

And he pointed to a national ‘shopping list’ of around £13 billion, that he thought was needed for social care – in order to increase wages, meet inflation and the demands of a growing population.

A further £2 billion, he said, would also be needed to implement the cap set out in the Dilnot review.

During the two-hour session, Mr MacBeath said care providers were now picking and choosing people to live in their care homes or be part of their home-care rounds who had less complex needs.

And, he said new care homes were now opening up that were solely focused on the self-funder market – highlighting one in Hertford that charged residents £2,500 a week, compared to the council’s budget of £560.

He said the ‘nicer’ care homes were becoming “the sole place where self-funder people go”. And he said councils had a role in ensuring the quality and the environment remained good for all.

Mr MacBeath also told the committee that the current means test for financial help with care costs – set at £23,250 –  was “unfair”.

He said it ‘really hits’ those who develop long term conditions – a disease or suffer an accident – in late middle age or who develop dementia early.

And he said: “There is a perverse disincentive to save, knowing that your assets and your savings could be taken away if the lottery happens to fall in such a way that you need social care and your neighbour does not.

“The system that we have at the moment is far from satisfactory.”

Looking to social care provision in the future, Mr MacBeath highlighted an alternative housing model – which can be set up in conjunction with housing associations or private developers – known as ‘extra-care housing’.

And that, he said, could be an efficient way of delivering care.

“People might sell their home or give up their social housing tenancy, they move to alternative premises and the care team is on site to deliver their care,” he said.

“Usually it is a mixed economy of people with low needs, medium need and high needs.

“That is quite an efficient way of delivering care, and a lot of councils I am aware of have put savings into their budgets to try to attract people to move into an extra-care development rather than stay at home with their rather inefficient domiciliary care market model.”

During the hearing Mr MacBeath also highlighted the steps taken in Hertfordshire following the withdrawal of Allied, who traded in the authority as Goldsborough Care – in finding alternative employers for the 210 staff to keep care provision for the 487 residents.

“We cannot afford to lose one of them, because every home-care worker we lose means that a round does not take place and four people do not get their care that morning,” he said.

“It is a delicate operation to make sure that we transfer the people and the staff and seamlessly and keep the people with their care workers. People say that continuity of care is the most important thing to them.”

The Lords’ inquiry is focusing  on funding challenges in the sector and how they can be overcome. Mr MacBeath gave evidence to the latest session of the inquiry, which was held on December 11.