17th October 2018
The following information provides an overview of the current financial and demand pressures facing adult social care, along with some proposals as to how adult social care could be placed upon a more sustainable footing in the short, medium and long-term.
- ADASS has repeatedly warned government that funding reductions in social care would lead to fewer people getting care, provider failure, and would impact on the NHS. It is equally the case that much needed investment in prevention, digital technology and wellbeing services is being hindered by ongoing reductions to adult social care and wider council services.
Short-Term Financial Challenges
- Adult social care needs a minimum of £2.358 billion in 2019/20 to support local authority revenue budgets.
- This is made up of LGA’s £1.5bn calculation to stabilise the care market, £108m in recognition of the overspends against adult social care budgets in 2017/18, £250m of the council reserves used to support local authority budgets in the same year and expected financial savings of approximately £500m from adult social care budgets in 2019/20 as a result of ongoing pressures on local authority budgets.
- Adult social care will also require an additional £1bn per annum from 2019/20-2020/21 to match the pay increases already awarded to the lowest paid NHS workers of up to 29 per cent. This will provide parity between low-paid social care and NHS staff, otherwise existing recruitment and retention challenges will only be further exacerbated.
- This situation could have been significantly worse without the introduction of time-limited funding streams such as the Adult Social Care Precept, the improved Better Care Fund and recently announced £240m to address winter pressures. This funding, whilst welcome, has only served to temporarily relieve, rather than resolve, the long-term funding requirement for Adult Social Care.
Impact of Ongoing Financial Challenges
- The ongoing financial challenges facing adult social care could have significant consequences on the delivery of statutory duties. Respondents to the recent ADASS Autumn Survey either had no confidence or partial confidence that their social care budget will be sufficient to meet statutory duties relating to Market Sustainability (88.66%) by the end of 2019/20.
- The fragility of local care markets has resulted in providers ceasing trading across home and residential care in more than 100 council areas in the past six months, impacting more than 5,300 people. It has also resulted in providers handing back contracts to more than 60 councils, impacting just under 3,000 people in 2018/19. This fragility is further highlighted by the well-publicised financial challenges faced by two of the largest care providers nationally, Allied and Four Seasons.
How can adult social care be placed on a sustainable footing?
- A significant uplift in funding levels will be required in the next Spending Review period to meet the existing and ongoing funding gap facing adult social care, as well as to implement a reformed system post the government’s Green Paper. This could vary from £5-7bn per year, dependent upon the type and scale of reforms agreed by Government.
- Health and social care are interdependent, as such failure to address the challenges facing social care will have a direct impact on the success, or not, of the NHS Plan delivering upon its objectives. Investing in the health service without investing in social care is like pouring water down a sink without leaving the plug in.
- There is no quick-fix, or single option, that will address the multi-faceted financial challenges facing adult social care. Reforms must provide clarity and certainty for all. Certainty for people – regardless of age – as to what we can expect from the state in terms of care, support and safeguards. In turn it must be clear to individuals and their families what they are responsible for and what, if anything, they might be expected to pay.
- ADASS advocates a greater pooling of risk across society and believe the state should extend its role in securing sufficient resources to place adult social care on a stable and sustainable footing.
- Funding should cover the range of needs, be fair and based on the best balance of taxation, potential re-prioritisation of other benefits (pensions and non-means tested benefits), an individual’s contribution and private insurance. There should be fairness between and within generations (noting that the nature of home ownership is continuing to change and such capital sums as are currently available to some of the older generation may not be in years to come).
- Government in developing reforms should also recognise that the areas of England have different geographies, rurality, demographic and socio-economic influences. Funding solutions should be long-term and capable of being adjusted at periodic intervals.
- It is likely that we will need to double acute hospital provision over the next 15 years to meet growing demand if there is not more care in the community and closer to people’s homes. To counter this, we are of the opinion that the NHS Long-Term Plan must focus on shifting care and resources away from acute settings to investing in community-based care, mental health and preventative services, with consideration given to providing local government with greater influence over the commissioning of these services in order to minimise duplication and deliver efficiency savings to local systems.
The Association of Directors of Adult Social Services is a charity. Our objectives include:
- Furthering comprehensive, equitable, social policies and plans which reflect and shape the economic and social environment of the time
- Furthering the interests of those who need social care services regardless of their backgrounds and status and
- Promoting high standards of social care services
Our members are current and former directors of adult care or social services and their senior staff.
If you have any questions regarding this submission please do not hesitate to contact Michael Chard, Senior Staff Officer- Policy on 07887491004, or firstname.lastname@example.org