ADASS Budget Survey 2017
The ADASS budget survey has tracked social care budgets and expenditure over a number of years. The 2016 survey set out key pressures and drew commentary, later echoed from a different perspective and a separate evidence base, relating to quality, that social care was approaching a tipping point. This was recognised in the Spring Budget in the injection of additional funding of £2bn over three years, with £1bn in 2017/18, the Improved Better Care Fund. This report sets out the results of the 2017 survey, conducted in May and June.
The welcome additional funding and recognition takes place in the context of continuing increases in need, demand and costs. Without this, the planned savings would have caused irrevocable damage in relation to the levels of care for older and disabled people and their families and carers, to care markets and to the NHS.
Need for social care, relating to increasing numbers of older and disabled people, increased by 2.8%, the costs of the National Living Wage and other requirements rose by £378.5m and there were increasing costs associated with delayed transfers of care from hospitals including fines for delays.
Despite council protection, adult social care continues to have to make significant cuts.
The survey data shows that local authorities are prioritising adult social care in their budget setting. The proportion of council spending on adult social care is set to increase from 35.6% in 2016/17 to 36.9% this year, despite councils having to make 8% cuts in overall budgets on top of a number of previous years’ reductions.
Nevertheless, with further savings of £824m – equating to 5% of net budgets - planned in 2017/18, total cumulative savings in adult social care since 2010 will amount to over £6bn by the end of March 2018. With a reported overspend of £366m against budgets for 2016/17, the pressure of which will roll forward, Directors are finding it increasingly difficult to implement planned cuts in practice.
Only 31% of respondents are fully confident that planned savings for 2017/18 will be met and despite the additional funding which has been made available for adult social care, Directors’ confidence falls for future years, to a point where only 7% are fully confident that savings targets will be met in 2019/20.
ADASS has real concerns about the sustainability of the care market
Directors have prioritised meeting adult social care needs (including counteracting previously planned savings) and support to the NHS in relation to planned expenditure of the additional £1bn Improved Better Care Fund announced in the Spring Budget. DASSs cannot additionally plan to pay an hourly rate sufficient to make the care market – particularly domiciliary care – sustainable in the longer term and this will particularly be the case in some parts of the country. Directors continue to report the closure of services and handing back of contracts. Most strikingly, 74% of respondents believe that providers are facing quality challenges.
Support for and pressures from the NHS are increasing and the Better Care Fund is not providing the additional resources social care needs
Although the extra money from the adult social care precept and the Improved Better Care Fund, it is important to note that except in very few areas the existing Better Care Fund is providing no more resources in real terms than the existing NHS transfer to adult social care in 2014/15.
Both the NHS and adult social care are fragile systems, and there is increasing support going into planning and emerging pressures from the NHS, including fines for delayed transfers of care being levied, discussions about reductions to Continuing Healthcare payments, increased demand from people with very high needs not being admitted to hospital and pressure for healthcare activity to be undertaken by social care staff.
The increasing care needs of working age adults are having an growing financial impact
The fact that there are increasing numbers of older people continues to have an impact, and savings are being applied particularly to services for older people. However, the financial effect is now less than it is for the increasing care needs of younger adults with learning or physical disabilities or mental health problems. This year older people’s services account for 1.1% of the total of nearly 2.8% reported pressures on adult social care budgets, with those people with learning disabilities accounting for a higher percentage at 1.2%. The remaining pressures are from people with physical disabilities or mental health needs.
Prevention is recognised as a major way of making savings, but it is impossible to prioritise
Moving towards prevention and early intervention is the most important priority area for making savings, as it was in 2016/17. However, as budgets reduce it becomes harder for councils to manage the tension between prioritising statutory duties towards those with the greatest needs and investing in services that will prevent and reduce future needs. Spend on prevention forms 6.3% of budgets this year: this is both a decrease as a proportion of budget and a decrease in cash terms from the previous year. This raises the critical question of whether the investment in prevention is sufficient to realise the ambitions for its impact expressed by Directors.
There is still an urgent need to find a long term sustainable solution for funding adult social care
Only nine of the 138 Directors who responded feel at all optimistic about the future financial state of the local health and care economy in their own areas. This is only marginally better than last year.