The government must protect adult social care from further cuts to avoid substantial increases in unmet need, large numbers of providers leaving the market and significant extra pressures on carers and the NHS.
That was the message from sector leaders from local government, charities, the provider sector and the NHS in what they described as an unprecedented joint call for the government to safeguard funding for the sector over the coming years.
The submission to the government’s spending review, which reports on 25 November and will set spending limits in England from 2016-20, said year-on-year cuts since 2010 threatened the dignity of older and disabled people and their carers and the sustainability of the care market and the NHS.
It said that ministers had to ensure that councils could protect social care funding against inflation, the increased demand from the rising number of people in need each year and the costs of new policies, notably the so-called “national living wage”, which will substantially increase employment costs in the sector.
Were the government not to take this step, Association of Directors of Adult Social Services president Ray James said the consequences would be stark:
We would see councils forced to ever more tightly ration care. Fewer people would get services; the size of packages would reduce. Some care providers would exit the market.”
The submission was signed by the Adass, NHS Confederation, the Care Providers Alliance, which represents provider umbrella bodies, and the Care and Support Alliance, a coalition of charities and other organisations supporting older and disabled people.
James said this showed that directors setting adults’ services budgets, charities seeing the effects of cuts on service users’ and carers’ lives, providers worried about their bottom lines and health chiefs concerned about the impact of social care cuts on the NHS, were of one mind about the need to end cuts.
The social care funding crisis in numbers
- From 2009-10 to 2014-15, total adults’ services spending by councils fell by 8% in real terms, official figures show, despite councils receiving annual transfers of cash from the NHS for social care from 2011-12 onwards.
- But this understates the impact on unmet need because of substantial rises in the number of people with care and support needs, due to demography. The number of people with multiple long-term conditions is expected to increase by more than 50% from 2008-18, said the submission.
- Because of these demographic pressures councils would need an extra £700m a year every year up to 2019-20 to maintain access to services at current levels, according to the Local Government Association.
- The number of adults receiving social services from councils fell by over 500,000 from 1,782,000 to 1,273,000 people from 2008-9 to 2013-14, official figures show.
- It is not clear whether council spending on adult social care will fall in 2015-16 in real terms, as this will depend on the extent to which cuts in direct government funding to councils were mitigated by the transfer of NHS resources to council care budgets through the Better Care Fund.
James said he thought the seriousness of the funding problems facing social care was starting to be understood by government, but the impact of this on the spending review was unclear.
“How much they fund, what strings will be attached and whether they fund the growing gap as well as the cost of the living wage remains to be seen,” he added.
More cuts to come
The purpose of the spending review is to eliminate the government’s public spending deficit by 2019-20 by reducing annual spending by £20bn. While some funding areas are fully or partly protected from cuts, local government is unprotected. The government has asked departments responsible for unprotected funding areas to model real-terms savings of 25% and 40% to budgets by 2019-20.
The NHS is one of the protected areas and has been promised an increase of £10bn in funding in real-terms from 2014-15 to 2020-21, in response to calls from NHS England chief Simon Stevens for increased resource to tackle mounting pressures on the service.
Since 2011-12, the NHS has been mandated to transfer some funding to councils to spend on adult social care, and this is now enshrined in law through the Better Care Fund (BCF).
There is some expectation that the government will use the extra funding being directed at the NHS to help adult social care mitigate the cuts expected to local government through the BCF. However, James warned that Stevens’ estimate of NHS resource requirements was predicated on social care funding being protected – not of NHS resources being recycled to help social care.
“I am sure colleagues in the NHS will say that they need all of that extra money,” he added.