22 September 2014
Holly Holder, Fellow in Health Policy, The Nuffield Trust - photo

Holly Holder

Fellow in Health Policy
The Nuffield Trust

After four years of sustained pressure on local government, cracks are beginning to show. Concern is rising for levels of unmet need, people’s quality of life and pressure on the NHS. Despite this, information released last week confirms further cuts to adult social care funding (Health and Social Care Information Centre provisional release data, 2013/14).

Home and day care spending by councils has fallen by almost a third, equating to £618 million.

Our work to date has focused on the services provided to older adults (people aged 65 and over). Since 2009/10 - the year before the government first announced public sector cuts - there has been a 16 per cent real terms reduction in older adult social care funding (to 2013/14, net current expenditure, excluding expenditure on the Supporting People programme). This amounts to almost £1.3bn. 

The result is that fewer people receive support. Some of the most striking figures from 2009/10 to 2013/14 are:

  • Almost 300,000 fewer older adults receive publically-funded community based services, a 30% drop.
  • Home and day care spending by councils has fallen by almost a third, equating to £618 million (real terms, net current expenditure, comparing 2013/14 to 2009/10). The result is that 82,000 fewer older adults receive home care (an 18% reduction) and the number receiving day care has almost halved (around 46,000 people).
  • The number of older adults receiving meals at home continues to decline, with almost 70% fewer older adults receiving meals compared to 2009/10 (around 64,000 people).
  • Councils are still prioritising those who have the highest need, with those receiving ten or more hours of care and overnight care continuing to rise.

The consequences of an increasingly restricted social care service is that people will either be paying for their care themselves (for those without much resource this may be creating other unmet needs), relying more heavily on family and friends or going without support and becoming more reliant on the NHS when problems arise.

Half of the directors of adult social services felt that the savings being made in social care were increasing pressure on the NHS. 

It remains difficult to monitor these consequences. However, there is evidence from those working on the ground that the impact of these budget cuts is being felt, and increasingly so. In the recent ADASS budget survey, half of the directors of adult social services felt that the savings being made in social care were increasing pressure on the NHS (up from a third the previous year). And almost a quarter felt that users’ quality of life was getting worse (an increase from only five per cent the previous year). This is despite the fact that local governments have increased the proportion of their budget spent on social care for all ages - from 30% in 2010/11 to 35% in 2013/14 - according to the same survey (excluding ringfenced education services).

The response from central government is that it has recognised this pressure by transferring funds from the NHS (which has been relatively protected from funding cuts compared to most departments). However, critics doubt whether investing money from the NHS into social care will realise the savings needed to the NHS to make it effective. And in terms of access to social care, the impact of the recently passed Care Act is dependent on where the government decides to set the national eligibility threshold.

In the meantime, it appears that the pressure on local governments will continue, fewer people will receive publically funded support and the health and social care system will remain unable to monitor how this is impacting the health and wellbeing of people living through these experiences.

About this data

Figures are author's calculations based on the Health and Social Care information Centre social care data collections: ‘Personal Social Services: Expenditure and Unit Costs, England - 2013-14, Provisional release’ and ‘Community Care Statistics, Social Services Activity, England - 2013-14, Provisional release’. Real terms expenditure was calculated using GDP deflators from the ONS, June 2014.

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