Health CommitteeWritten evidence from the Association of Directors of Adult Social Services (PE 05)
1. The Association of Directors of Adult Social Services (ADASS) represents Directors of Adult Social Services in Local Authorities in England. As well as having statutory responsibilities for the commissioning and provision of social care, including the safeguarding of vulnerable adults, ADASS members often also share a number of responsibilities for housing, leisure, library, culture, arts, community services, and increasingly, Children’s Social Care within their Local Authority.
2. Adult Social Care makes a vital contribution to our individual communities and society at large, supporting vulnerable people and communities, encouraging and facilitating personalisation and accountability, seeking effective early intervention and prevention solutions and working collaboratively with stakeholders to create a seamless health and wellbeing response and resource.
3. Adult Social Care is facing widely acknowledged unprecedented demands, with estimates of 4% per year cost pressures (fuelled by exponential growth in demographics and rising socio-economic pressures) and despite year-on-year close budgetary management with local councils making savings of more than £3 billion between 2005 and 2008 and a further £1.7 billion in 2008-09 (demonstrating Adult Social Care effective models of delivery and management), the gap between resources and demand are not matched and is widening at a rate of 2% per year (based upon councils making on average 7% savings over the spending period – Kings Fund).
4. The ADASS Budget Survey 2011,
5. As stated in previous consultation responses, ADASS urges the Coalition to seek broad political consensus and to positively respond to the Dilnot Commission recommendations for a sustainable social care funding solution. Any delay in a solution will only exacerbate this gap between demand and resources and inadvertently widen this to the disadvantage of both immediate and future generations.
The impact on the provision of adult social care of the 2010 spending review settlement and the removal of ring-fencing for social care grant.
The ability of local authorities to make the necessary efficiency savings.
6. ADASS Directors welcome the increased flexibilities offered within the settlement and the ability to localise commissioning decisions to reflect local priorities and circumstances and ADASS is working closely with partners and Government Departments to maximise this flexibility against a backcloth of increased local accountability, integration and focus upon improved outcomes and personalisation.
7. ADASS also welcomes the policy agenda set out in the Health and Social Care Bill where local accountability and commissioning is embraced and advanced, particularly the proposed enhanced role of the Health and Wellbeing Boards in coordinating local integration around local agreed outcomes as described in health and wellbeing strategies, and the increasing application of personalisation in the health and social care environment.
8. ADASS welcomes the recommendations of the Dilnot Commission in “levering” in resources through advocating the partnership model, in which personal contributions and/or insurance models persist as a counter to the reductions in funding that are adversely combined by increasing demand. ADASS firmly believes that these recommendations will provide a long term sustainable solution, creating real co-production and accountability with local communities.
9. The impact of the spending review has clearly removed the extent of resources available to councils (the LGFG as a whole being reduced by an average of 26% in real terms over the spending review and according to figures from the Office for Budget Responsibility, council budgets will decrease by 14% once projections for council tax are taken into account) and with increased flexibility, councils have taken differing positions as to how to allocate planned reductions across their differing portfolios. Indeed, the ADASS Budget Survey 2011 analysis illustrates this variation, with for example, 17% councils not funding demographic pressures, 42% partially funding and 41% funding in full. However, the critical point remains that Adult Social Care makes up the largest proportion of “discretionary” spending by councils (The Local Government Group estimates that Adult Social Care makes up 25% of council spending) and consequently the extent of impact of reduced resources is disproportionately felt by Adult Social Care where there is little opportunity to make reductions of such magnitudes from other smaller council portfolio’s.
10. The ADASS Budget Survey 2011 analysis confirmed the extent of pressures being faced by Adult Social Care, identifying £1 billion worth of reductions from 2011-12 Adult Social Care budgets and a corresponding movement in raising the eligibility threshold, with 13% councils raising eligibility and 82% councils now only providing services at significant or above levels of eligibility. This shift restricts the extent of future headroom for “planned” reductions over the spending review period being absorbed by “efficiencies” as opposed to service reductions. NB the ADASS Budget Survey 2011 identified that 69% of the 2011/12 reductions were found from efficiencies and the question remains as to how much more can be gained from this area going forward without impacting upon front line services?
The impact on NHS plans of decisions currently being made by local authorities.
The use of the additional £1 billion funding for social care made available through the NHS budget.
Progress on making efficiencies through the integration of health & social care services.
11. ADASS welcomes and shares the Coalition’s Vision for Adult Social Care and a mainstay of this vision is prevention, early intervention, personalisation and focus on improved outcomes and in this context, these themes are driving the integration agenda with health and other stakeholders.
12. ADASS is proud of its long history of joint working with health and the maturing relationship which has seen integrated commissioning and existence of joint teams becoming common-place and the development of a shared, integrated outcomes framework binding the focus of health, public health and councils together. The attention upon the “patient pathway” and the mix of the health model of treatment alongside the social model of care has created an environment in which the inter-dependencies between two different cultures /organisations are now understood and evolving.
13. The recent transfer of £648 million from Primary Care Trusts (PCTs) to councils (2011-12) is seen as a positive move in this shared understanding, and the ADASS 2011 Budget Survey affirmed that this allocation has been largely transferred across, of which 24% is to be deployed to avoid cuts to services, 10% to cover demographic pressures, 9% to spend on additional services, and 57% yet to be decided. ADASS is aware of the Secretary of State’s recent request for PCT Finance Directors to give account of this allocation and ADASS Directors will be linking up with their PCT colleagues to discuss this analysis.
14. ADASS remains concerned as to the status of the £400 million over four years announced by the Coalition given to PCTs to fund carers breaks. The support of carers is critical to allowing individuals to remain independent in their own homes with minimal state intervention; however the ADASS Budget Survey 2011 was unable to establish amounts held by PCTs from this announcement and commitments to the provision of carers breaks.
15. In terms of integrated working with health, and the principles of inter-dependencies of financial mutual benefit (early intervention, prevention and joint commissioning) , ADASS welcomes the proposals in the Health and Social Care Bill in the movement of Public Health to councils, creating greater synergy and opportunity to capitalize upon expertise and access to universal services, however ADASS, alongside Council leaders remain concerned that the extend of the Public Health allocation is still not known, restricting forward planning and commissioning activity.
16. ADASS welcomes the proposed Clinical Commissioning Groups (CCGs) as means of increasing local commissioning, accountability and integration across the health and social care agenda, but within these proposals, ADASS seeks reassurances that there will be a degree of continuity between the “long term” commissioning strategies of the current PCTs and those to be undertaken by the CCGs to ensure effective use of resources, as well continued targeting of marginalised communities dealing with long-term health inequalities. In terms of responding to long-term and often deep-rooted health inequalities, ADASS has strongly advocated for the proposed Health and Wellbeing strategies to focus joint effort to in addressing these inequalities and for the Health and Wellbeing Boards to oversee the transformation of the whole system to maximise resources in responding to mutual local priorities.
17. Finally as previously stated, Directors of Adult Social Care are faced with unprecedented demands whilst having to respond to reductions in funding and this is being played out with potential impacts upon the patient pathway, particularly upon delayed transfers from acute hospitals and admissions to hospitals, although ADASS notes (as reported by ADASS in January 2011) that approximately 70% of delayed transfers by the 2nd quarter of 2010 were the responsibility of PCTs, rather than a consequence of adult social care activities, although ADASS is more concerned about collective working to seek improved outcomes for local people and is pleased to note that the level of collaborative working is high, for example the ADASS 2011 Budget Survey confirmed that of the £70 million allocated for reablement services in 2011, 48% of this agreed with PCTs to be spend directly by councils.
ADASS BUDGET SURVEY 2011
Social Care is such a large part of local government spend that reductions are inevitable, although Councils are working hard to offset cost reductions, meet demographic pressures and integrate funding with the NHS. The reduction in spend by £1 billion adds to the known gaps in social care funding and makes it imperative that this Government delivers on its promise to see through the reform of how we pay for long term care.
Councils are reducing their budgets for adult social care by £991 million, representing a 6.9% reduction against a 10% reduction in overall spending by councils.
Councils are reducing by £169 million their spend on Supporting People.
13% of councils are changing their FACS criteria. There are now 78% councils at Substantial in 2011-12 compared to 70% in 2010-11 and 4% at critical only.
79% councils have frozen or increased fees to providers.
The full amount of the reablement resources has been identified with strong levels of agreement with the NHS on areas of spend.
95% of the Winter Pressure allocation was identified, with 89% of councils reporting agreement on how this allocation will be spent.
The full year NHS Transfer is still to be determined with 57% not yet agreed.
£425 million of demographic pressures were identified with 41% of councils fully funding these pressures.
2010-11 Net Budget
Councils are forecasting an under-spend of approx 1.5% of their Adult Social Care Budget.
The survey indicates demographic pressures across all groups totalling £425 million. In 2011-12 demographic pressures have been quantified as £180 million for Older People, £41 million for Physical Disability, and £179 million for Learning Difficulties, £25 million for Mental Health.
17% of councils are not funding demographic pressures with 42% partially funding and 41% funding in full.
Council Budget and Planned Savings Levels (excluding School Grant)
Local Authority budgets for 2011-12 have been set at £39.5 billon which includes savings of £4.4 billion over 2010-11.
Adult Social Care is a substantial part of the overall budget for Councils across the country, representing 1/3 (34%) of Council’s net budgets for 2011-12.
Adult Social Care Savings
Adult Social Care will provide a contribution to savings in 2011-12 of £991 million, representing 6.9% of the 2011-12 Adult Social Care budget before savings. ie £991 million of £14.4 billion.
The £991 million breaks down as follows - Efficiency £681 million (69%), Income £84 million (8%) and Service Reduction £226 million (23%).
Savings from Supporting People Budgets
The survey data identified £169 million savings from Supporting People in 2011-12, a further £66 million in 2012-13 and a further £39 million in 2013-14.
The 2011-12 savings break down as: Efficiency £91 million (54%), Income £50,000 (0%), Service Reduction £78 million (46%).
Reablement (£70 million one-off)
98% of the allocation has been identified:
89% agreement in how this allocation will be spent across Health and Social Care services.
Joint planning of services has seen 48% (£33.2 million) spent directly on Council services, underpinning the importance of reablement to the Health and Social care economy - 20% of councils reported all the allocation was spent on Adult Social Care services provided by the Council.
NHS Transfer (£648 million full year)
99% (£646.9 million) of the total allocation was identified by respondents to the survey.
24% will be deployed to avoid cuts to services.
10% to cover demographic pressures.
9% to spend on additional services.
At the time of the survey, Local Authorities were still planning the use of the remaining funding (57%).
Winter Pressures (£162 million one off)
£154.3 million identified by councils - some discrepancy with matching this with total allocation given to PCTs, but accounts for 95% of total allocation.
87% (£133.9 million) of the identified allocation has been passed to councils from their PCTs.
131 councils had reached agreement with their PCT on how to spend this money, the survey identified that £15.8 million (10%) would be spent on NHS services.
Fees (independent sector)
61% of councils have frozen their fees and 18% have reduced fees, 18% report an increase in fees with 3% still awaiting final decisions.
Fair Access to Care criteria
13% (19) councils changed their eligibility criteria between 2010-11 and 2011-12, of whom 15 councils moved from Moderate to Substantial.
78% (116) at Substantial.
15% (22) at Moderate.
3% (4) at Low.
4% (6) at Critical.