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National standards, local risks: the geography of local authority funded social care, 2009–10 to 2015–16

A significant number of adults with mental or physical ill-health or disability require support with the routine activities of daily living – such as cooking, cleaning and dressing themselves – or to ensure their safety and welfare (and the safety and welfare of others). That is, they require some form of ’social care’.

The majority of care for these people is provided informally, by friends and family.1 Other individuals, especially those with more substantial needs, and perhaps without a relative or friend with sufficient time or ability to care for them, are in receipt of formal care by paid carers. Some of these individuals will have purchased formal care privately.2 However, public funding in England is available for those above a threshold level of care need and with assets below a certain level.

This publicly funded social care is organised largely by the approximately 150 LAs with social care responsibilities (the metropolitan and London boroughs, unitary authorities and counties). Historically, while all LAs were required to satisfy a number of statutory duties in relation to adult social care, there was substantial variation in assessment and eligibility criteria around the country (at least in terms of care needs). Following the Care Act 2014 though, we now have nationally defined criteria and processes for assessment of ‘care needs’ and national minimum eligibility criteria, to go alongside a set of common financial means-test thresholds.

However, LAs are able to use more generous eligibility criteria than the national minima if they so wish. They also have some flexibility over the quality of care provided to those who meet their eligibility criteria, and the level of co-payment fees they charge. Alongside differences in the local need for and cost of providing social care, and differences in the cost-effectiveness with which care is organised and provided, these factors mean that there can be significant differences in the amounts different LAs are spending on adult social care.

In this report, we examine the extent to which the level of LA social care spending per adult varied around England in 2015–16, and the extent to which these spending differences correlated with local demographic and socio-economic characteristics, and assessed local relative spending needs for adult social care as of the last official assessment in 2013–14. We also consider how social care spending changed between 2009–10 and 2015–16: a six-year period during which LAs saw an average real-terms cut to their overall budget for local services of 20%. Previous work by Institute for Fiscal Studies (IFS) researchers (Luchinskaya, Simpson and Stoye, 2017) has already shown that at a national level, social care spending was relatively protected, falling by 6.4% in real terms  (after accounting for financial transfers from the NHS to support social care services). However, big differences in cuts to overall service budgets in different LAs (Amin Smith et al., 2016), and the different choices made by LAs on how to allocate these cuts across service areas, mean that changes in spending on social care also vary significantly across England. We again examine the correlation between these changes in spending and local demographic and socio-economic characteristics.

The rest of the paper proceeds as follows. In Chapter 2, we describe how social care is organised and funded in England. Then, in Chapter 3, we examine how spending on social care organised by LAs varied across England in 2015–16, and in Chapter 4 we show how this had changed since 2009–10. We conclude in Chapter 5. Further information is provided in five appendices: in Appendix A, we explain how we construct our measure of LA social care spending; in Appendix B, we discuss the role of the NHS in organising and funding the care of some of those with the highest medical needs, through its Continuing Healthcare programme; in Appendix C, we provide information on recent changes to local government finance in England, which will have affected the amounts different LAs have to spend on social care; in Appendix D, we provide information on variation in unit costs paid for adult social care services around the country; and in Appendix E, we provide further statistical analysis of the spending and spending change correlations discussed in Chapters 3 and 4.

Readers should note that this report provides descriptive evidence on how LA-organised social care spending (and changes in this spending) varies across England, and how this correlates with local demographic and socio-economic characteristics, and a proxy for local needs. We do not know how true need for social care spending varies across the country, nor do we examine how these differences in funding translate into differences in service quality or access. Furthermore, we do not make any judgement on whether differences in the levels or changes in social care spending are ‘fair’ or not.