Social care cuts damaging the health service, warn NHS finance chiefs

Delayed discharges are going up and an increasing proportion of them are the responsibility of social care, says King's Fund report

Photo: Business Images/Rex Shutterstock
Photo: Business Images/Rex Shutterstock

Social care cuts are damaging the health service in England, warn the vast majority of NHS finance chiefs.

Eighty eight per cent of NHS finance directors and 80% of clinical commissioning group finance leads said that pressures on local authorities were adversely affecting the performance of health services in their area, in a survey for the King’s Fund.

The findings came in the health think-tank’s quarterly monitoring report on the performance and finances of the NHS, which painted a pessimistic picture of the state of the health service. Other findings included that:

  • 58% of CCG leads and 37% of trust directors felt patient care had worsened in their areas in the past year.
  • Almost two-thirds of NHS trust finance chiefs predicted a deficit for their organisation by the end of 2015-16.
  • 94% of trust directors and 90% of CCG leads felt fairly or very pessimistic about the financial state of the local health and care economy in their areas over the next year, the highest figures in the 17 quarters since the King’s Fund’s monitoring reports began

Delayed discharge rise

An apparent driver of NHS finance chief’s concerns about local authority cuts was the rise in the number of delayed discharges, an increasing proportion of which are attributable to social care.

Since April 2015, the total number of delayed days spent in hospital by patients per month has been running at 11% above the level for the same period in 2014, according to analysis by the King’s Fund. In August 2015, 30.8% of delayed days were the responsibility of social care, up from 26.8% in August 2014, show NHS England’s monthly statistics on delayed transfers of care.

The figures follow an 8% real terms fall in gross spending by councils on adult social services from 2009-10 to 2014-15 during which it is believed the need for care in the population has increased significantly due to increasing numbers of people with multiple long-term conditions, dementia and learning disabilities.

“With winter approaching, the NHS faces a toxic mix of widespread deficits, rising waiting times and low morale,” said King’s Fund chief economist John Appleby. “There is now clear evidence that cuts to social care budgets are affecting the NHS, as well as reducing services for people that need them.”

Funding gap

He called for the government to protect social care from further cuts in the forthcoming spending review, which will set government spending limits from 2016-20. Appleby said ministers should reinvest the money that had been earmarked for the now delayed Care Act funding reforms in social care. This is worth £3.4bn from 2016-20, though the Local Government Association has warned that, on its own, it would not be enough to stop a funding gap opening up by 2020 between the resources councils had available and those they would need to meet inflationary, demographic and other pressures, such as the new national living wage.

Ministers are facing united demands from council chiefs, charity leaders, NHS bosses, providers and think-tanks such as the King’s Fund for more resources for social care in the forthcoming spending review. But they have given no indication that such resources would be made available, as local government and social care are not among the areas that the government has pledged to protect, in full or in part, from cuts in the spending review.

Minister in the dark

The pessimism around the spending review was added to last week when care minister Alistair Burt said that he did not know what the funding settlement for local government and adult social care would be.

Speaking to the annual National Children and Adult Services Conference, Burt said that he would find out what the settlement was when chancellor George Osborne delivered it on 25 November.

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