‘Integrate health and social care budgets to avoid conflicts’

Health and adult social care funding in England should be integrated nationally and locally to prevent each sector being hit by cuts in the other, a King’s Fund report said today.

Government cuts to councils – worth 28% in real terms from 2011-15 – risk reducing the number of care home placements and home care packages, which could result in increases in avoidable admissions to and delayed discharges from hospital, said the think-tank.

At the same time, pressures on the NHS – arising from a real-terms funding freeze and the need to find £20bn in efficiency savings from 2011-15 – could increase pressure on adult social care.

However, it said the current funding system – with resources for health determined nationally by the Department of Health and funding for adult care set locally by councils – “hinders rather than helps” joint working.

Just 5% of the combined £121bn health and adult care annual budget in England is spent through joint arrangements, it said.

The report said this resource should be considered as a whole, with the government possibly providing the two services with a single funding settlement over three- to five-year periods.

Locally, it suggested that local authority budgets should be merged with those for GP consortia – which will take over responsibility for health commissioning in 2013 – “to enable a completely integrated local approach to the funding and commissioning of services”.

The report pointed to measures taken by government to promote integration, such as the allocation of £1bn in annual funding to the NHS from 2011-15 to spend on social care. Most of this will be transferred to local authorities to spend as agreed with PCTs or GP consortia in order to meet common objectives.

While it welcomed this investment, the report echoed concerns from House of Commons health select committee that it would be spent on “certain limited services” rather than long-term improvements in local care systems.

The fund estimated that the government’s cuts would result in a £1.2bn funding gap in adult social care by 2015, to maintain services at existing levels. This is well below the £4bn funding gap estimated by the Local Government Association for the same period. This is because the fund’s calculations are based on the assumption that councils will give adult care some protection from cuts by only reducing real terms funding by 7% from 2011-15.

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