Councils face steep challenges in delivering required savings in adult social care, particularly in learning disability services, the Local Government Association has warned.
A “significant number” of the 54 councils taking part in the LGA’s adult social care efficiency programme were struggling to deliver on their savings objectives, said an interim report on the programme.
Councils had set themselves average savings targets of 5.7% for both 2012-13 and 2013-14, with savings of 5.3% and 4.9% planned for 2014-15 and 2015-16 respectively. There were particular challenges in learning disabilities, where councils are facing the greatest pressures due to rising life expectancy among the group.
No reablement model in learning disabilities
While other service areas had developed models of support designed to reduce people’s needs for care – such as reablement for older people or recovery in mental health – this had not been replicated fully in learning disability services. While some councils have used employment schemes to offer learning disabled people useful activity during the day, long-term jobs prospects from these were limited.
Amid growing government focus on health and social care integration as a source of savings, councils in the programme had “been disappointed” by efforts to make savings in this area. Where health and social care have worked to achieve specific objectives, for example in improving reablement, there has been evidence of efficiencies.
The report identified a shift in councils’ approach away from slimming down bureaucracy to managing and preventing demand for care in delivering savings. Whereas in 2012-13, reducing bureaucracy, which includes job losses and cutting services, accounted for half of savings, it is only due to account for 43% of reductions in 2013-14.
Shift towards cutting demand, rather than red tape
Managing demand accounted for 20% in 2012-13 and is due to rise to 25% in 2013-14, whereas prevention is due to rise from 5% to 10% as a source of savings.
The report said that policies and approaches that help people live independently have delivered savings. These approaches include ensuring older people are not assessed for support while still in a hospital bed so that decisions are not made at the point of crisis, and providing more support to carers to avoid the additional costs of arrangements breaking down.
“Just being more efficient isn’t going to solve the funding crisis,” said Peter Fleming, chair of the LGA’s Improvement Board. “What we need is a complete rewiring of the way we think about, deliver and pay for care services, starting with much greater cooperation and integration of health and social care services at local level.”
Councils ‘could have saved further £465m in 2011-12’
The LGA’s findings coincide with the publication of an Audit Commission report that suggested councils could have saved an extra £465m of public money during 2011-12 by changing their approach to social care for older people.
The local government spending watchdog’s analysis found that 80% of the variation in spending on older people’s social care was due to factors outside council control, such as the proportion of pensioners receiving income-related benefits, living alone or renting properties.
However, the remaining 20% of the variation in spending could not be explained by demography or socio-economic factors and included many factors that were within councils’ control. These included effective and efficient commissioning, success in reducing or delaying demand for care ad eligibility criteria.
The commission’s report concluded that if higher-spending local authorities had brought their older people’s social care expenditure into line with the average spending of similar councils it would have reaped savings worth £465m in 2011-12.
“There hasn’t been a more important time for councils to understand what influences their spending on social care for older people, to benchmark themselves against their peers and pinpoint areas where savings might be found,” said Jeremy Newman, chair of the commission.
Savings already delivered
But John Jackson, joint chair of the Association of Directors of Adult Social Services’ resources network, said local authorities may have already tapped into the potential savings identified by the Audit Commission’s report.
“Local authorities will have delivered savings of £2.7 billion a year by the end of this year [since 2011],” he said. “It is likely that some of the savings will have come from addressing some of the issues raised in the Audit Commission report, which of course is providing a historical perspective.”
“Further savings will inevitably be required in future years and local authorities will want to examine all areas of possible savings including those suggested by the Audit Commission.”
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