Personalisation, outsourcing and less residential care – how adult care is being cut

England’s councils are now finalising their budgets for 2013-14, the third consecutive year in which they have faced reductions in their budgets. In the past two years, almost £2bn has been cut from adult social care in real terms, according to surveys by the Association of Directors of Adult Social Services.

And there are no more “easy options” for reducing services, warned a report this month from sector coalitions Think Local Act Personal and the Towards Excellence in Adult Social Care programme. Authorities face tough trade-offs, it said, for example between sustaining investment in preventive services and meeting the growing costs of supporting people with the most complex needs.

Against this backdrop, Community Care examined savings proposals from 18 local authorities – two from each region – to identify how authorities are cutting back.

Cutting back on residential care

One source of savings could be found in almost all of the 18 councils was a reduction in their spending on residential care services through investment in less expensive alternatives such as supported living, reablement, telecare provision or short-term crisis support.

Croydon council in London, for example, expects to save £750,000 in 2013-14 and £500,000  in 2014-15 by moving people into supported housing from residential care, while Peterborough hopes to trim £250,000 off its 2013-14 budget by finding ways to move people with learning disabilities from out-of-area care homes located outside to alternative forms of support based locally.

Sarah Pickup, president of the Association of Directors of Adult Social Services, says this trend is good for people and council budgets. “It is good practice to support people in the community rather than in care homes,” she says. “Not only is this better for them, but the evidence is that this is normally less expensive.”

Personal budgets savings

Another area where councils believe there are savings to be made in is the move to and use of personal budgets: 12 out of the 18 have identified some savings from self-directed support for the coming year.

Bristol has pencilled in savings of £566,000 for 2013-14 through the closure of five day care units and the use of personal budgets to deliver “a more creative and flexible model of day opportunities”.  Croydon expects making better use of personal budgets to yield savings of £50,000 in 2013-14 and £150,000 in 2014-15.

Meanwhile, Rochdale believes that the implementation of personal budgets means its assessment and support planning teams can function with fewer social work qualified staff. It aims to save £250,000 in 2013-14 by moving to an average ratio of 40% professionally qualified to 60% non-professionally qualified staff in such teams.

Cutting bureaucracy

Martin Routledge, head of operations at In Control, the social care charity that pioneered self-directed support, says there is potential for councils to save money and improve outcomes by removing unnecessary bureaucracy from the personal budgets process.

The 2011 National Personal Budget Survey, which polled 2,000 service users and carers on their experience of personal budgets and was co-produced by In Control, found outcomes were better when service users had freedom over how they spent their budgets.

“A real problem is that in too many places, unnecessary processes and rules are adding costs,” says Routledge. “If these were removed, councils would save money.”

But, he adds, there is a danger in treating personalisation as a way to reduce budgets. “It seems clear that some councils are justifying savings that would have been made anyway by saying that they can do this because personalisation is cheaper,” he says. “This risks turning personalisation into something that people feel they have to resist rather than embrace – it is really unhelpful.”

Personalisation leading to social work reductions

Of the 18 councils examined, Rochdale was the only one to explicitly identify that personalisation could save it money by allowing the authority to use fewer social workers in its assessment and support planning activities.

This follows a controversial report last year by the Audit Commission, which called for councils to replace social workers with non-professionally qualified staff in assessment and reviews, on the basis this would save money without hurting quality. While Routledge believes social workers can be deployed differently under personal budgets, he is wary of cutting back on professionals.

“We do believe that some of the things traditionally done by social workers can sometimes be done or supplemented by others for some people – including much more involvement of peer support or disabled user led organisations in support planning,” he says. “But let us be really clear – this does not imply a reduction in social workers – rather the use of social workers in different ways and focusing their time and skills in some important priority areas, including complex situations and where people don’t have a local supportive family for example.”

Outsourcing

A third area where a few of the councils examined have earmarked savings is in the transfer of their remaining in-house care services to new providers. Rochdale believes it can save £500,000 in 2013-14 by setting up a social enterprise to run remaining in-house services, mostly community-based support services for people with learning disabilities.

The council says in-house services are currently more expensive than those provided by external providers and would not be sustainable without reduced costs. Setting up a social enterprise would enable this, it believes.

Meanwhile, Newcastle council is proposing to set up a care co-operative to run its remaining in-house services, which currently cost £13.6m a year. It believes this would secure the future of these services by “enabling them to trade in the open market”. Expected savings would total £524,000 in the second year of the co-operative and £994,000 in the third.

Increased flexibility

Craig Dearden-Philips, the chief executive of social enterprise consultancy Stepping Out, says social enterprises can potentially save councils money by being more flexible in service delivery and employment, including through the use of volunteers.

“You have to be very careful about that and very organised about that but you can do that and there is a very valid role for volunteers in social care,” he says. “Remember most social care is provided by people who are not being paid and so it’s really about acknowledging that and supporting it properly.”

Dearden-Philips says he wants all councils to follow Rochdale and Newcastle’s approach: “In my view there is no reason why councils should still be in the business of providing services to local people. What they should be doing is commissioning services properly and safeguarding people properly. Sometimes councils are so tied up with the business of providing that they are not doing the other stuff around commissioning and safeguarding very well.”

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