Adult social services directors expect fewer people to receive care, increased pressure on the NHS and a rise in legal challenges as a result of this year’s budget cuts.
The annual budget survey by the Association of Directors of Adult Social Services (Adass) found councils in England have had to make cuts of 26% in their social care budgets, or £3.53bn, once inflation and demographic pressures are taken into account.
This year the amount councils spend on services will fall by 1.9 per cent or £266m to £13.68bn excluding charges levied on service users and money from other public bodies for particular projects.
Budgets will get even tighter next year as government funding for councils fall by a further 10%, Adass added. It said this would create further instability as councils implement the the Care Act 2014 reforms and the Better Care Fund to pool £3.8bn of health and social care funding.
Adass president David Pearson said the survey showed the sector had reached the point where it was “unable to absorb the pressures” of rising demand for services and falling public spending.
Demand growing but fewer people getting sevices
Adass said the number of people looking for adult care support from their council rose by 14% from 2010 to 2014, but the proportion deemed eligible for council-funded services dropped by 5.8 per cent last year alone and has fallen by 28% since 2008-9.
The largest drop in people deemed eligible in 2013-14 was among older people receiving services in the community.
“We are concerned about what is happening to people who may not be having their needs met,” said Pearson. “There needs to be investment in social care to make sure people get the quality and extent of care they need and deserve.”
Nearly half of directors surveyed by Adass think fewer people will be able to get care services as a result of the reductions, the same proportion expect people will get smaller personal budgets and 50% say there will be greater pressure on the NHS. Over half of directors said care providers would face financial difficulty as a result of the budget pressures and nearly 60% expect there to be more legal challenges of councils by care providers and users.
Procurement survey raises quality and pay concerns
Meanwhile another Adass survey published today found 8.6% of residential and nursing home providers and 6% of home care providers are under enhanced monitoring by councils because of fears about the quality of the service.
Adass’s procurement survey said these concerns led councils to cancel contracts with 41 residential and home care providers over the past year.
It also found that about 15% of home care visits were 15 minutes long, a practice that has been much criticised for leading to rushed visits to deliver personal care.
Adass found that most 15-minute visits were not for personal care but to check on someone’s wellbeing or prompt them to take medication; however some were for other tasks. Adass said councils needed to “reassure themselves” that the length of the visits were suitable since short appointments may not be adequate to help people with washing, dressing or going to the toilet.
While 71% of councils thought the the domiciliary care companies they used paid the minimum wage or more, just 3% were confident the firms paid the living wage, which is higher. Adass said councils should tell HM Revenue and Customs if they believed the companies paid less than the minimum wage.
Just 5% of councils were confident that the providers paid their staff for their travel between appointments at their standard hourly rate and only 16% thought the firms paid travel expenses to their staff. Adass said councils should work with providers to establish the true cost of care and local and national government should recognise that improving services will have rising costs.
Adass and the Local Government Association will publish a guide to commissioning services based on outcomes rather than time and task in the autumn.
Government places responsibility on councils for reductions
A Department of Health spokesperson said: “We have given an extra £1.1bn to councils to help protect social care services this year — that’s on top of significant additional funding in recent years. Councils are ultimately responsible for deciding how to spend their budgets but we agree that we all need to work differently to respond to the challenge of our growing ageing population — the Care Act and the Better Care Fund will focus resources on helping people to live independently, which can save money and prevent people from needing more support.”
The DH also said councils could use their reserves, reduce fraud and increase council tax collection in order to put more money into services.
The £1.1bn is the latest tranche of an annual transfer of NHS resource to fund social care services that help relieve pressures on the NHS and drive integration, which will be replaced by the Better Care Fund next year.
However, Richard Humphries, assistant director for policy at health think tank The King’s Fund, said Adass’s survey showed half of the NHS transfer was being used to protect social care services from cuts, not support integration.
“Using NHS funding as a sticking plaster does not deal with the significant challenges facing social care, nor does it help address the emerging funding pressures facing the NHS. With the NHS and social care budgets under huge strain, questions about funding are becoming increasingly urgent – politicians must be honest about the scale of these pressures and initiate a public debate about the sustainability of the health and social care system before, not after, the general election.”
2015 is ‘make or break’ year for social care
Merrick Cockell, chair of the Local Government Association, called for a bigger Better Care Fund lasting five years to support integration of social care and health. He said: “Next year will be a make or break for local services provided by councils and for the NHS and it will be the most vulnerable families and older people in our communities that will feel the brunt of such a severely underfunded service. Less money in social care will have an inevitable impact on councils’ ability to relieve the pressure on a similarly squeezed NHS by keeping people out of hospital and in the community. Too many older people are being let down by a broken system which leaves them languishing in hospital beds while they wait for an alternative, or consigned to residential care because we lack the capacity to help them live independently.”