Social care funding: 'a bleak outlook is getting bleaker

Association of Directors of Adult Social Services
Date: Monday 6th May 2013
Embargo: 00.01hrs Wednesday 8th May 2013

A substantial squeeze on services for older people, people with disabilities and on fees to providers, has been recorded by the latest annual survey of social care budgets carried out by the Association of Directors of Adult Social Services.

The survey* shows that, despite much welcomed resources being transferred from the NHS to local authority-funded social care, directors of adult social services are planning to save another £800 million in the 12 months to April.

Overall, in the three years since the beginning of the current austerity programme, some £2.68 billion savings will have been made by adult social care - 20 per cent of net spending. And although many of these savings have been achieved by increased efficiencies, social care leaders have been quick to point out that these efficiencies werent simple `back-office adjustments, but were gained by "providing different, more cost effective packages of care, or reduced levels of care, to many elderly or disabled people."

According to ADASS President Sandie Keene, "gazing into the next two years, without additional investment from that already  planned, an already bleak outlook becomes even bleaker."

Two of the most marked trends indicated by the survey show that some 13 per cent of the planned savings (£104 million) will result in direct withdrawal of services, while nearly a fifth of councils thought that a reduction in the levels of personal budgets would be 'highly important'.

Mrs Keene went on: "Directors everywhere are well aware of the difficult economic choices the country is facing and having to make. And we are well aware of the enormous help given to our departments by inward transfers of NHS funds. Social services departments, too, have gone many an extra mile to make their services more efficient although, as our survey shows, these efficiencies are sometimes nowhere near so `painless as they sometimes seem.

"However, taking all these views and developments into consideration, it is absolutely clear that all the ingenuity and skill that we have brought to cushioning vulnerable people as far as possible from the effects of the economic circumstances cannot be stretched any further, and that some of the people we have responsibilities for may be affected by serious reductions in service with more in the pipeline over the next two years."

The ADASS survey shows that areas likely to be 'highly important' as aids to saving resources in the coming year include:

  • Shifting activity to cheaper settings (40 per cent)
  • Increased personalisation (47 per cent)
  • Better procurement practices (68 per cent)

Only 14 per cent of directors anticipated increasing charges to users as highly important, while 65 per cent reckoned that increased prevention and early intervention would provide significant savings opportunities.

However, when asked which areas had been affected by savings to date, some 30 per cent of directors said that fewer people can access services, and nearly 50 per cent said that providers are facing financial difficulties. 45 per cent of councils did not increase fees to care homes at all.

Significantly, and on the brighter side, 86 per cent thought that the quality of life for services users had not been lowered, while only 5 per cent thought that the quality of care was lower. However, looking to the next two years, the prognosis is clearly more severe. Half (55 per cent) of directors feel that the quality of life for users will not worsen: a near-fifth, though, (19 per cent) think it will.

Equally, 50 per cent of ADASS members think that fewer people will be able to access adult social care services in two years time. And 50 per cent fear that people will be getting smaller personal budgets. 57 per cent think providers will be facing greater financial difficulty and 42 per cent anticipate more legal challenges.

Mrs Keene concluded: "Our survey this year has drawn a mixed picture of our departments. It isnt all bad news: there is a clear belief that the pressures on services on the ground will be mitigated by the ingenuity, competence and professionalism of our staff.

"But it is equally clear that we continue to need a comprehensive reform of our social care and health system a reform which brings in and adequately acknowledges the implications of funding change, and which successfully brings together the fully-focused and effectively integrated resources of both local authority and NHS services."

ENDS

For further information contact:
Sandie Keene, ADASS President, 01132 478700
John Jackson, Joint Chair, ADASS Resources Committee, 01865 323574
Drew Clode, ADASS Policy/Press Adviser, 020 8348 5023/07976 837755

Pictures of Sandie Keene and John Jackson available on request

* The survey was conducted through April 2013. Of the 152 top-tier social services authorities in England, 145 responded

Editorial Notes

The Association of Directors of Adult Social Services (ADASS) represents directors and senior managers of adult social services departments in English local authorities. Directors (DASSs) have statutory responsibilities for the social care of older people, adults with disabilities and adults with mental health needs.

In many authorities ADASS members will also share a number of responsibilities for the provision and/or commissioning of housing, leisure, libraries, culture, and community safety on behalf of their councils. Nearly a third of DASSs are also the statutory director of childrens services for their authority.

A personal budget is a clear, upfront amount of funding from adult social care which individuals can spend on the services and support they need to help them live more independently. It can be used to buy services from both the council and other providers, mixing and matching whats available from different organisations.

Anyone aged 18 or over who is eligible for social care support can have a personal budget - but it is down to individuals whether they manage their budget themselves or whether someone else does this on their behalf.

The Department of Health survey of adult social care 2010/2011 showed that:

* 62% of service users who responded said that they were extremely or very satisfied with the care and support services they receive.

*28% said they were quite satisfied, 7% said they were neither satisfied nor dissatisfied and the remaining 3% said they were dissatisfied.

*26% reported their quality of life was so good, it could not be better or very good.

* 31% reported it was good, and

*33% reported it was alright.

* 10% reported their quality of life was either bad, very bad or so bad it could not be worse

ADASS Budget Survey 2013 Summary FINAL

Key Facts

  • Annual savings of 20% (£2.68bn) of reductions will have been achieved by March 2014 from adult social care budgets £795m savings are planned for 13/14 on top of the £1.89 billion achieved in the last 2 years
  • Adult social care budgets remains at just over 1/3 of total council budgets (34%)
  • Councils are reporting a demography pressure of 2.7% (£372m) of ASC budgets in 2013/14. We believe that this figure is understated and is at least 3% of budgets (the figure identified in the last 2 budget surveys)
  • Only 76% (£282m) of calculated demography pressures have been funded by local authorities for 2013/14 , compared with 82% last year.
  • 82.3% of savings made in adult social care are through efficiencies (£651m) compared with £688m last year.
  • 4.6% of savings are through increased income (£36m) compared with £77m increased income last year.
  • The remaining 13% of savings are service reductions (£104m) compared with £113m last year.
  • Eligibility thresholds within councils were only changed in three councils who increased their eligibility from 'moderate' to 'substantial'.
  • 87% of councils have set their eligibility for 2013/4 at substantial or above.
  • Only 37 councils (25% of councils) formally agreed with their respective PCTs a plan on how to spend the health re-ablement monies.
  • Spend on prevention (£588m) in 2013/14 represents only 4.2% of adult social care budgets.
  • 45% of councils gave no inflation to older people's care homes in 13/14. 60% gave nothing for PD, 64% nothing for LD and 65% nothing for homecare.
  • Of the £806m reported as received by councils from the NHS Transfer in 2013/14 (out of a total of£ 859m), 32% has been allocated to avoid cuts (£253m). 14% allocated to cover demographic pressure (£113m), 18% allocated for investment in new services (£140m), and 36% has yet to be allocated (£291m).

Qualitative information

This year we asked Directors for their views on where they were making savings, what they thought was happening locally and what they thought might be happening in 2 years time. The results are set out below.

 14. How important are these area of savings for 2013/14?

not relevant

low

medium

high

Rating
Count

 reduced bureaucracy

10.4% (14)

21.6% (29)

31.3% (42)

36.6% (49)

134

 better procurement

0.7% (1)

4.4% (6)

27.0% (37)

67.9% (93)

137

 increased personalisation

8.0% (11)

18.2% (25)

26.3% (36)

47.4% (65)

137

 control wage increases

31.1% (42)

28.9% (39)

24.4% (33)

15.6% (21)

135

 expand independent sector provision

8.8% (12)

24.3% (33)

38.2% (52)

28.7% (39)

136

 shift activity to cheaper settings

8.1% (11)

11.1% (15)

40.0% (54)

40.7% (55)

135

 reduce level of personal budget

32.6% (44)

33.3% (45)

17.0% (23)

17.0% (23)

135

 stop unnecessary services

14.0% (19)

24.3% (33)

23.5% (32)

38.2% (52)

136

 reduce number of people in receipt of care

20.6% (28)

19.1% (26)

27.9% (38)

32.4% (44)

136

 increase prevention / early intervention

2.9% (4)

8.0% (11)

24.1% (33)

65.0% (89)

137

 increase user charges

19.7% (27)

44.5% (61)

21.9% (30)

13.9% (19)

137

 

 15. As a result of the savings you have had to make which of the following statements are true?

 to date

 

yes

no

don't know

Response
Count

 there are no or minimal impacts

51.7% (62)

46.7% (56) 

1.7% (2)

120 

 fewer people can access adult social care services

29.8% (36)

70.2% (85)

0.0% (0)

121 

 people are getting smaller personal budgets

28.5% 35)

69.9% (86)

1.6% (2)

123 

 quality of life for care users is worse

7.8% (9)

86.2% (100)

6.0% (7)

116 

 there is increased pressure on the NHS

28.2% (33)

61.5% (72)

10.3% (12)

117 

 quality of care is lower

5.3% (6)

93.0% (106)

1.8% (2)

114 

 providers are facing financial difficulty

48.4% (59)

39.3% (48)

12.3% (15)

122

 there are more legal challenges

39.2% (47)

56.7% (68)

4.2% (5)

120

  

 next 2 years

yes

no

don't know

Response
Count

 there are no or minimal impacts

19.5% (22)

64.6% (73)

15.9% (18)

113

 fewer people can access adult social care services

50.0% (58)

35.3% (41)

14.7% (17)

116

 people are getting smaller personal budgets

49.6% (59)

38.7% (46)

11.8% (14)

119

 quality of life for care users is worse

18.8% (21)

55.4% (62)

25.9% (29)

112

 there is increased pressure on the NHS

36.5% (42)

38.3% (44)

25.2% (29)

115

 quality of care is lower

12.6% (14)

69.4% (77)

18.0% (20)

111

 providers are facing financial difficulty

57.3% (67)

16.2% (19)

26.5% (31)

117

 there are more legal challenges

42.6% (49)

24.3% (28)

33.0% (38)

115