Social care provision: from bad to worse?

"Councils in England will have lost 20% of budget since 2010 despite rising demand from ageing population, figures show"

The Guardian, 8 May 2013

Today the Coalition announced legislation designed to overhaul the social care system, with new money promised to fund the proposals. However, that has not prevented local authorities from arguing that the pressure on their services is intensifying and that, despite the Government's vision for reform, the situation looks set to worsen.

England's local authorities, which are responsible for providing social care, are facing an increase in their elderly populations at the same time as they're being forced to make substantial cuts to their budgets.

"Bleak, and getting bleaker"?

This is the outlook for England's social care services, in the words of Sandie Keene, president of the Association of Directors of Adult Social Services (ADASS).

Today ADASS published the results from its annual survey of England's social services departments. It's these figures that form the basis of the Guardian's report.

According to ADASS,

"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% of net spending."

Will councils have lost 20% of their social care budget?

We've already looked at the size of the cuts to social care. Since the Spending Review of 2010, the Government has already excised some £1.88 billion from social care budgets. And, as ADASS explain, local authorities "are planning" to save another £795 million in the next financial year. 

This means we're dealing with a potential cut of some £2.7 billion by the end of the 2013/14 financial year.

According to the Department for Communities and Local Government (DCLG), the total budget for adult social care across England's local authorities amounted to some £14.8 billion in 2012/13. 

This means that £2.7 billion would amount to an 18% saving for 2013/14 (based on the figures from 2012/13's budget).

Local authorities are already free to prioritise their spending as they see fit, provided that they meet their 'statutory responsibilities'. Adult social care typically absorbs about a third of a local authority's overall budget and so it follows that it's an obvious target when a council needs to cut costs. It's easier to reduce one department's large budget than abolish a local service altogether.

This means that in a bid to cut their costs the majority of local authorities have restricted access to social care. They've achieved this by tightening their eligibility criteria. 

In 2012/13, 83% of local authorities in England only provided care for those with "substantial" or "critical" needs. This figure now stands at 87%. In these areas, anyone with "moderate" needs will not be able to apply for local authority help.

Does less money mean poorer provision?

England's population is ageing (see our factcheck here). The Office for National Statistics (ONS) predicts that, compared to 2010, by 2030 there will be 51% more people aged 65 and over in England. Meanwhile, the number of people aged 85 plus will double.

This elderly population is asking more of social care services. According to one model projection, which formed the basis of the Dilnot report into reforming the way social care is funded, the number of people aged 65+ living with some kind of disability is set to increase by 2% each year.

But while more people need social care, local authorities are focusing their attention on those with only the most severe needs. 

Of the 145 local authorities which provided information for the ADASS survey (which equates to a response rate of 95%), a third of senior managers said that as a result of savings, fewer people were accessing social care.

But 70% suggested that this was not an issue in their area.

At the same time, those who are receiving care from local authorities are more satisfied than we might expect given the funding restrictions. According to the Adult Social Care Survey for England (2011/12), 63% of respondents were extremely or very satisfied with the care that they received from the local authority. Only 4% said they were dissatisfied.

This chimes with the results from ADASS' budget survey, with only 5% of senior managers suggesting that their local authority had provided a lower quality of care in the past year.

Crisis? What crisis?

Some of the evidence suggests that the cuts to local authority budgets have not been felt too severely on the frontline.

This is in part because since 2010 local authorities have been able to achieve most of their necessary savings through "service re-design and efficiency". This accounted for 82.3% of last year's total savings, while only 13% of savings were achieved via "service reductions". On top of this, a third of directors think that they can make further efficiency savings next year.

However, it's likely that local authorities will be asked to pay the cost of administering the new cap on social care costs. Given this double helping of more demand and less money, it might be ambitious to assume that there's a lot of fat left to trim from local authority budgets.

Furthermore, the ADASS budget survey and the Adult Social Care Survey fail to account for what's described as 'unmet' need - those who need help but who aren't eligible for it under the current system and aren't counted in local authority figures.

While the impact of the cuts has so far been more limited than many might have expected, it may be that we've arrived at a tipping point. ADASS (and others) are warning that the current setup is not sustainable. With an increase in the number of people needing social care, the extra costs of administration and further cuts down the line, many in the sector will continue to sound the alarm.