Let's establish a fair rate for care

A year ago, Counsel and Care called for a care homes regulator. We were convinced that pressures being exerted by local authorities, in their role as purchasers, were having a bad effect on the care sector. Nothing we have seen since has changed our mind.

Then, homes were under-occupied, leading to business failure, closures and high levels of anxiety for older people living in them. Yet, some older people remained "trapped in hospital beds", either because of a shortage of money to purchase places or the unwillingness of proprietors to take on new residents at clearly uneconomic prices.

The range of homes available to prospective new residents has since decreased, and in some cases homes have refused to accept residents placed by local authority social workers. Of course, if the resident's family can top up the fee paid by social services, then a place can be found. But often close relatives are on low incomes or pensions themselves, with little scope for finding up to ?50 pounds a week.

Major service purchasers have as much power to influence the market as monopoly providers - and the public sector buys around 70% of care home places. As a result of local authorities performing their role "managing the market" in care, there has been a contraction in the number of places and homes, and in the number of homes still prepared to take publicly funded residents.

For a number of years, care home owners in many parts of the country have received increases less than inflation. In extreme cases they have even faced reductions to the fees paid. What this means in practice is that homes are expected to provide full board and personal care for less than most readers would pay to stay in modest bed and breakfast accommodation.

Some councils think there is scope for reducing the amount paid per client, because people are making good profits from their businesses. While that may have been the case in the past, recent economic jitters, a rash of mergers to avoid businesses collapsing, and the lure of selling a large house and grounds for its development potential, rather than as a going concern, suggests that those days are long since over.

It is time for action to set up a body capable of setting and monitoring a fair rate for care. In other industries, such as gas and telecoms, where private companies now provide services which were once public monopolies, privatisation has been accompanied by the creation of a consumer protection body. This has the power to fine or place other sanctions on providers whose services do not meet the agreed standards.

Individual consumers can often shop around. But older residents have few options, assuming their needs even fit with councils' eligibility criteria for admission to care homes and financial support. A further narrowing of that choice should be avoided by setting a minimum price that local authorities should pay for care. Such a price would need to reflect the real cost of providing care to the level soon to be demanded by the implementation of the new national minimum standards for the conduct of care homes.

The brand new national care standards commission, formally established this month, takes full responsibility for registering and inspecting care services from next April. It will make the inspections process more consistent but it will not be able to direct the market as other industry regulators.

There is a strong link between the price paid for goods, and the quality and usefulness of the goods supplied. To ensure that some of our most vulnerable citizens don't end up with "shoddy goods", there needs to be a way of setting fees at a level which will cover decent care. Either the commission or a new care homes regulator should take up this role. Prescriptive? Yes. But logical - and definitely worth a try.

• Les Bright is deputy chief executive of Counsel and Care, a registered charity providing information, advice and advocacy for older people and their families. It also conducts research, publishes the findings and seeks to influence policy and practice