This post is from The King's Fund Blog
Last week leading figures from the social care sector gathered in Manchester for the annual children and adult services conference. As ever the programme reflected the efforts (too often unsung) of the 1,500,000 people working to offer care and support to older and disabled people – often despite, and not because of, the system.
But the overall mood of the conference was sombre – a new survey revealed that in the last six months nearly two-thirds of council areas had experienced care home closures, and home care contracts had been handed back in more than half of areas. Budget overspends are growing and local authority apprehension, if not fear, about financial sustainability and the high risk of legal challenge was palpable.
Many councils have worked hard to remove more than £5 billion from their care budgets over the past five years by adopting better models of care that manage demand and reduce the need for formal services. As I pointed out in my contribution to the Local Government Association’s state of the nation report on social care funding, the existential crisis facing social care is not just about money. But as one experienced director of social services commented, ‘the number of people who need help with getting out of bed, getting dressed, going to the toilet and eating is growing. You can’t manage demand for those things’. In our recent report with the Nuffield Trust, Social care for older people, we concluded that most councils had run out of road in making cuts without damaging access to, and quality of, care.
Since the publication of our report, powerful voices have been added to the almost deafening chorus of concern around social care. The Care Quality Commission’s annual assessment of the state of care has warned of a ‘tipping point’ in social care and the chair of the House of Commons Health Select Committee, Sarah Wollaston, has written to the Chancellor calling for action. This follows the suggestion by NHS England’s chief executive, Simon Stevens, that there is a strong argument for any additional funding to be spent on social care rather than the NHS. I cannot think of a time in my career when so much concern has been expressed by so many, including the remarkable spectacle of senior NHS leaders queuing up to argue that any extra money should go not to the NHS but to social care.
The gravity of the situation is reinforced by our latest independent assessment, with The Health Foundation and the Nuffield Trust, of the funding position for the NHS and social care ahead of the government’s Autumn Statement on 23 November. We estimate that social care faces the prospect of a funding gap of £1.9 billion next year, rising to £2.3 billion by the end of the parliament – based on the government’s very optimistic assumption that every council will levy a full 2 per cent precept on Council Tax every year for the next four years – an unlikely prospect. Even under this best-case scenario, social care spending will rise by just 1.2 per cent per year in real terms over the lifetime of this parliament, falling well short of the 4 per cent annual increase needed just to stand still.
The NHS is struggling too. Funding will flat-line in in 2018/19 and increase by just 0.3 per cent in 2019/20, nothing like enough to maintain standards of care, meet rising demand from patients and deliver the transformation of services described in the NHS five year forward view. The government will need to address the NHS funding settlement in future financial statements. However, our assessment is that looking across the entire health and social care system, the priority for this Autumn Statement is to address the critical state of adult social care, recognising the inter-dependency with the NHS. So we conclude that the Chancellor should bring forward to next year the extra funding it has already promised through the ‘improved’ Better Care Fund – planned to reach £1.5 billion by 2019.
Beyond the Autumn Statement, the NHS and social care together will need increased funding as the Secretary of State for Health has himself recognised. If the government is not prepared to address these longer-term funding challenges then it will need to be open with the public about the consequences for access to services and quality of care.