Deeper cuts to adult social care packages planned
Service users face reductions to support and extra charges for services under council savings plans for 2014-15, finds Community Care
Service users will face deeper cuts to their care packages and more charges for support under plans by under-pressure local authorities to reduce adult social care budgets by an average of 4% in real terms this year, a Community Care investigation has found.
Our analysis of 2014-15 budgets from 55 of the 152 local authorities in England found that planned spending on adult social services was an average of 2% down in cash terms from the previous year. When inflation is factored in, this amounts to a reduction of 4% in real terms.
The government insists it has "prioritised social care support" but local councillors told Community Care that the combination of a fourth consecutive year of reductions in central government funding and rising demand for social care is forcing local authorities to make "heartbreaking" cutbacks.
While our investigation found that councils are still trying to find back office efficiency savings where possible, the relentless pressure to make year-on-year cost savings is also seeing a reduction in frontline care for vulnerable adults, including those deemed to have 'critical' care needs. We found that councils plan to:
- Put strict limits on care packages: East Sussex council plans to save £3.2m by limiting social care packages to 'personal care needs' only. "This will mean that a number of individuals will have their funded support packages reduced," a council report states.
- 'Recalculate' personal budgets to reduce contributions: Cambridgeshire council plans to save £1.3m by reducing the cost of personal budgets for people with learning disabilities who have critical and substantial needs. "There is a risk that the allocation will not be sufficient to meet the assessed needs," a council report states.
- Cut care hours and respite for carers: Knowsley council plans to save a combined £830,000 by cutting five hours of supported living care per service user and two days of day care support per week for 50 service users. Plans to cut 278 weeks' worth of respite care for people with learning disabilities, older people and their carers will save a further £140,000.
- Introduce caps to limit council spend on care: Bromley council plans to save £1.45m by capping adult social care costs and allocating budgets directly to care managers to make sure frontline staff "understand fully the implications of their decisions" on finances.
- Increase charges to service users: Derbyshire council plans to save up to £3m by raising the cap on service user contributions to care from the current level of up to 50% of disability living allowance or attendance allowance to 60%, 75% or 90%. The move is currently out to consultation. Cornwall council plans to save £750,000 by removing a maximum charge for home care subject to a consultation.
- Restrict service user choice: One local authority plans to save £500,000 by "limiting service users' choice of support to the most cost effective" care.
Mitigating the impact
Clare Neill, Derbyshire's lead cabinet member for adult social care, told Community Care she has to make up to £65m of cost savings – equivalent to 30% of her current budget – between now and 2017-18. The council’s saving plans for this year include proposals to cut £3m from the cost of personal budgets and a further £2.25m by raising the social care eligibility threshold from ‘higher moderate’ to 'substantial'.
"We've agreed as an administration that we need to set a balanced budget, which means I've got to make the cuts. That's not what I came into politics to do and it's absolutely heartbreaking," she said.
"We're trying to mitigate the impact on people but clearly taking £65m out of a service that supports vulnerable people doesn't mean that need goes away. What I'm trying to look at is who else can meet that need when we withdraw from some services. I appreciate how difficult it is for social workers to engage people they've known for a long while in a conversation about reducing a service or potentially taking it away."
Local authorities are also targeting substantial savings by squeezing care providers or outsourcing council-provided services to the independent sector. For example, Barnet council is seeking to save £3.5m through renegotiating existing social care contracts and learning disability packages. Cornwall council plans to save £2m by tendering out a care at home service.
A national funding crisis
Our findings follow a series of reports warning that social care is seriously underfunded. Earlier this month a report by the King's Fund's Barker Commission concluded that "too little money is spent on social care", exacerbated by "draconian cuts by the coalition government". In December, research by the London School of Economics estimated that rising eligibility thresholds for care and cuts had meant that 453,000 fewer people received social care in 2012-13 than would have done in 2005-06.
Bernard Walker, chair of The College of Social Work's adults faculty, said: "There has to be a national solution to this [the funding crisis]; it cannot go on the way it is…People have to recognise the human consequences of the cutbacks in social care funding. Local authorities have picked the low hanging fruit in terms of efficiency. The difficulty is demand is growing."
The pressure on council budgets is also putting frontline staff in a difficult position, said Walker.
"Because of the cutbacks in staff…and with finance being the priority, core social work elements and the building relationships with people are no longer possible in many instances. Social workers have to be honest with people and say what the consequences of austerity are, which is they cannot help them in the way they might need to be helped," he said.
Bridget Robb, chief executive of the British Association of Social Workers, said central government policies had created a "very, very tough climate" for social workers and service users.
"But there is not the national dialogue to help people in communities to understand that. Government want to talk about the revival of the economy nationally, local government do not want to say 'our council is bankrupt and will cut half its services or more' because councillors want to be re-elected. It is not in anyone's interests to tell the public what is going on.
"People have got used to expecting support to be able to go out and have relief from care and have a quality of life. That is being pulled away from them," she added.
Sandie Keene, the outgoing president of the Association of Directors of Adult Services (Adass), said: "The risks [of cutbacks] are that we are cutting out a range of people who would have got services before and are not getting them now. We are also in danger of cutting prices so quality is affected. That has an impact on the need for services in the health service. It puts pressure on the NHS."
Keene added: "Reports like the Barker commission are coming to the conclusion there isn't enough money in social care and health, and the money isn't always used to best effect. That drives the agenda for integration of heath and care, which is the way we would want to go, but those reports also look at potential solutions. It might be around charging for health as well as social care services, redesigning services and different tax arrangements."
A spokesperson for the Department of Communities and Local Government said: "This government has prioritised support for social care by £2 billion above inflation as well as increasing the NHS budget in real terms. From next year our £3.8 billion Better Care Fund will invest new funds into the sector and help councils and local health services to work better together."
Analysis: Why care is being cut In its 2010 comprehensive spending review (CSR), the government announced "an additional £2bn funding a year by 2014-15" for adult social care that it claimed would, when combined with efficiency savings and reforms such as personalisation, enable local authorities to improve outcomes and prevent them from having to restrict eligibility for care.
Roughly half of this money was channelled through the NHS, mostly to be transferred to local authorities to spend on adult care, but also for the health service to spend directly on reablement services.
The other half - roughly £1bn a year – formed part of the government's funding settlement for local authorities for 2011-15. However, this was to be cut by 28% in real terms over these four years; the role played by the £1bn a year for adult social care was to ensure that this 28% cut fell less heavily on councils with social services responsibilities than it did on district councils.
Since then, the government has announced further cuts to its funding to local authorities, enabling the Local Government Association to say that core funding from government will have fallen by 40% in real terms from 2010-15, a period that also includes the Coalition's first year in power, before the CSR cuts began.
Councils do have other sources of funding - as well as the money transferred from the NHS, there is council tax and other local sources of revenue, and these have tended to rise since 2010. However, the overall impact on councils is that the money that they have available to spend on services has reduced.
By the government's calculations, the overall budget available to councils with social services responsibilities fell in cash terms by 4.7% in 2011-12, 3.3% in 2012-13 and 1.7% in 2013-14. For all councils, the reduction due in 2014-15 is 2.9%.
Adult social care has generally been more protected than other services from these reductions. However, these government figures do not take account of inflation, nor do they take account of the impact of demographic pressures - the growth in the number of older and disabled people with unmet eligible needs each year.