Care home boss Mandy Thorn speaks out on the problems families face:

It’s the conversation she dreads more than any other. And it usually goes something like this . . .

Mandy Thorn will have shown people around her care home, The Uplands, at Oxon, near Shrewsbury.

She will have asked about the wellbeing of an incoming elderly resident, who will soon make the traumatic transition from independent living to being cared for in one of The Uplands’ comfortable rooms.

Mandy will have spoken with the resident’s family, offered tea and sympathy and been as empathetic as possible. “We really do try to find out what a particular person needs,” she says. “It’s important that we understand the people who will be living with us so that we can make them very welcome.”

Having spent so long painting a rosy picture, the discussion turns to money. Pounds and pence enter the conversation like the thud of a dropped book in a library. “It is the most difficult conversation of all. People are usually quite surprised by how much care costs.”

On occasions, families will realise they cannot afford to pay for the care that Mandy has so lovingly described. And then, she will have no choice but to tell them that her services are not available.

“That is heart-breaking; really, really heart-breaking,” says Mandy. “It is terrible, because I will have got to know a particular family and then have to turn them away. It is even more heart-breaking for the family, because they will not know what is going to become of their much-loved elderly relative.”

Mandy’s Shropshire care home is thriving, happily, though many others are not. As the vice chairman of the National Care Association, a body that protects the interests of the independent care sector, Mandy regularly talks to other care home owners who are struggling. Across the sector, fears are continuing to grow that the nation faces a repeat of the Southern Cross care homes crisis.

Britain’s biggest care homes operator was crippled during the summer, causing turmoil for more than 30,000 elderly and vulnerable people. The firm had to pay a £250 million rent bill as councils sought to cut fees in the wake of the first credit crunch. An influential group of MPs warned yesterday that neither Whitehall nor local authorities were monitoring the financial health of providers, and some companies were racking up huge debts.

Mandy says: “I don’t want to paint a picture of crisis, because things are not quite that bad. Nor do I want to disparage any care home in Shropshire, or scaremonger: ours is doing very well, for instance.

“But we are in a position where we really need to start looking at this area now. We need to have an intelligent, grown-up debate about what we do next. We are in the middle of the biggest recession that many people have every experienced.

“The care sector is suffering a double whammy because we have more demands being placed on us but less funds available from the Government.

Local councils are getting less funding from the centre, so the burden is falling on the individual who purchases the care.”

Mandy believes the Government can help us out of the mess. It can stop charging care homes VAT, for a start. “It is ridiculous that we have to pay VAT on things like incontinent pads,” says Mandy. Secondly, it can ring-fence money distributed to local councils – as it does in education – thereby ensuring funds are spent as intended. Finally, it can introduce a more stringent programme of inspection so that standards in homes don’t fall.

“We hear a lot from the media about care homes,” says Mandy. “But usually the media only report on things when they go wrong. There is a lot of red tape, but in some ways we don’t mind that. The majority of care homes provide exceptional standards, we’d like there to be better reporting of inspections so that that message gets across. The outcomes from inspections are generally positive.”

The thorny issue of cost is one that Mandy believes will be forever part of the equation. “Yes, it is expensive,” she says. “But then when you look at what people receive, it’s really no surprise. People are receiving a high standard of accommodation, round-the-clock care, all sorts of facilities and amenities, meals and much much more. Somebody has to pay for that.

“So many people think that care for elderly people is free at the point of delivery, but it is not.”

Yesterday’s report on social care from the Public Accounts Committee made a number of recommendations. Chairman Margaret Hodge said:

“The Department of Health must get to grip with the very real risks to the social care market, if we are to avoid another Southern Cross.

“No one, government or local authorities, really knows what is going on locally or whether one provider is becoming too dominant. Effective oversight of the care market, including market share of large providers at the local and regional level, is essential to protect social care users and taxpayers.”

Mandy adds: “The care sector is largely well run and managed, but we really do need the Government to help us through difficult times.

“There are simple steps that could be taken that would make a huge difference to people as they enter a care home.”