Funding
from it in cash terms, not closer. Every measure examined in this analysis points in the same direction. The aggregate gap is larger, the per resident shortfall is larger, and they remain even when demand is held constant. Nursing care lags further behind, and regional variation has become more pronounced. The single year of improvement in 2023/24 demonstrates that convergence toward the benchmark is achievable when funding growth is allowed
to match cost growth. It was not sustained, and the trajectory since shows a system moving away from the commitment that exercise represented.
How underfunding shapes care, communities, and the NHS A structural gap of this scale does not remain contained within the balance sheets of individual providers. Facing a shortfall on every publicly funded placement they
support, providers are pushed toward a predictable set of decisions, reducing or freezing capital investment in buildings and infrastructure, constraining staffing to the minimum required by regulation, becoming more selective about which placements they can afford to accept, and in the most difficult cases withdrawing from publicly funded care altogether. Each of these decisions is individually rational given the financial position providers face, but their collective effect is a market in which availability, stability and quality all deteriorate together, investment in the workforce and modernising the estate stalls, and progress toward decarbonisation, which requires capital that providers operating on structural deficits simply do not have, is delayed indefinitely. Local authorities sit at the centre of this
pressure in a position of particular difficulty. They carry a legal duty under the Care Act 2014 to ensure sustainable, high quality care is available in their area, a duty but do not have the funding available to meet it. Faced with resources that fall short of what the’ fair cost of care’ exercise establishes as necessary, many councils respond by tightening eligibility thresholds, restricting
Laundry and Dishwashing for Care and Nursing Homes
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