Council overspend on social care doubles as savings targets missed

Councils significantly overspent their adult social care budgets last year after some savings targets proved “impossible” to deliver, directors have warned.

The annual budget survey by the Association of Directors of Adult Social Services (ADASS) found councils spent £14.2bn on adult’s services in 2016-17, £366m more than was planned. This was more than double the £168m overspend reported in 2015-16.

Councils plugged the overspends last year by transferring funds from their reserves or other departments. But the association warned that directors were finding it “increasingly difficult” to implement planned cuts in practice, with less than a third (31%) confident of delivering savings for this year.

‘Ongoing pressure’

ADASS said the “ongoing pressure” facing services would affect the impact of the £2bn extra funding for social care announced by the government in the March budget.

The survey found that the “negative consequences” of service cuts had already been felt on the frontline. Three quarters of directors reported care providers in their areas were in financial difficulty, 70% said providers were struggling to maintain quality services, and 74% said the NHS was under more pressure.

Just over a quarter of directors (27%) also said that life for carers was worse, and 17% said the quality of life for people using social care services has deteriorated. A third said they faced a rise in legal challenges over social care last year and 38% expected a further increase in coming years.

Cathie Williams, associate member of ADASS, said the legal challenges were a mixture of individual and corporate cases, but included Deprivation of Liberty Safeguards cases and cases where a person’s care package had been reduced or withdrawn following assessment.

Iain MacBeath, co-chair of the ADASS resources network, added: “I think directors are looking at their neighbours and thinking ‘that could be me next’. I’m certainly in a situation in Hertfordshire where one of my neighbouring authorities is being challenged by their care provider association over their standard rate for older people’s residential care.

“In Hertfordshire I know we have a robust process that proves that what my council pays roughly equates to the cost, with a respectable profit. Other councils can’t prove that so they’re not quite in that territory and are being either judicially reviewed or challenged in some way.”

Prevention

In 2017-18, directors have to find a further £824m of savings from adult social care, bringing the total savings to £6.3bn since 2010, accounting for inflation and demographic pressures. Last year, 39% of directors said they would target personal budgets and care services for savings, but this fell to 19% for 2017-18.

Increasing preventative services is now seen by directors as the most important way of realising savings, the survey found, followed by better procurement practices and shifting care provision to cheaper settings.

However, ADASS said the spend on prevention had reduced in previous years and as budgets are cut further “it becomes harder for councils to manage the tension between prioritising statutory duties and investing in services that will prevent and reduce future needs”.

Delayed discharges

For the first time since the survey was launched, directors were also asked whether or not their council had received fines from the NHS for delayed discharges from hospital. This is legal under the Care Act, but the Local Government Association warned earlier this year that the practice was “completely counterproductive” and would not solve the problem.

The survey found the NHS had imposed fines on 16% of councils, while a further 8% said the ‘intention to fine’ had been expressed.

The survey also found the proportion of council spending on adult social care is due to increase to 36.9% this year, compared with 35.6% in 2016-17.

Margaret Willcox, president of ADASS, said the planned increase showed that councils were “determined to protect adult social services budgets as much as possible”.

She added: “The welcome £2bn in funding will help close the funding gap facing adult social care, but councils still plan to make further savings of £824m this year, which will impact on those who receive care. With providers continuing to close or return contracts back to council, more people are struggling to access the care they need and depend on.

“To help remedy this worrying situation, the new government needs to tackle the chronic underfunding of adult social care, which still remains on a cliff edge.”

Vicky McDermott, chair of the Care and Support Alliance, said the ADASS findings showed the “grave threat” facing social care.

“Despite the government’s injection of cash, collapse of the whole system is still a significant risk,” she said.

“The election showed that people are deeply concerned about social care. The government needs to accept that there is not enough money in the system and that plans for a green paper need to be a priority that addresses both the needs of older people and working age disabled adults.”