Local authority funding for social care has been reduced significantly in recent years due to budget cuts. This has led authorities to find savings through efficiencies and reducing some services. As a result, fewer older people are receiving social care support, especially at lower levels of need. While quality of care has reportedly not suffered, the reductions in support may increase pressure on health services in the future. Ongoing monitoring is needed of how cuts are impacting the most vulnerable groups who rely on social care.

1. Focus on access to social care for older
people
Ruth Thorlby and Holly Holder,
Nuffield Trust
23 October 2013
© Nuffield Trust and Health Foundation
© Nuffield Trust

2. Background
Central Government allocations to English local
authorities reduced by 14% in real terms between
2011/12 and 2014/15.
In 2013, a further reduction of 10% was announced
between 2014/15 and 2015/16.
The reductions come at a time when demand for publicly
funded social care had already been rising faster than
funding for several years.
There is concern that reductions in the volume or quality
of publicly funded social care will lead to unmet need and
pressure on health services.
© Nuffield Trust and Health Foundation

3. Research questions
How have local authorities have responded to reductions
in their income?
Can we track trends annually?
Is it possible to say anything how changes in spending
and activity have affected older adults’ health and
wellbeing?
© Nuffield Trust and Health Foundation

4. Method
Background literature review
Exploration of survey data from:
• Social care service users
• Directors of Adult Social Care Services
• Established national surveys e.g. ELSA, HSE
Descriptive analysis of data published annually by
NASCIS
2009/10 taken as a baseline year
© Nuffield Trust and Health Foundation

5. Percentage change in total net current spending
(real terms) by local authority between 2009-10 and
2012-13
Percentage change in net current spending (real
terms), 2009/10-2012/13
60%
40%
20%
Local authority
0%
Average
-20%
-40%
-60%
© Nuffield Trust and Health Foundation
Local authority

6. Trends in other sources of LA income for older adults
Real terms income by source (£000s)
2500
2000
1500
Client Contributions
Joint Arrangements
1000
NHS
500
0
2005/06
2006/07
© Nuffield Trust and Health Foundation
2007/08
2008/09
2009/10
Financial year
2010/11
2011/12
2012/13

7. Change in real terms net current spending nationally
by service area since 2005/6, older people
Net current spending (real terms) by activity (£000s)
3000
2500
Assessment and care management
2000
Nursing care placements
Residential care placements
Supported and other accommodation
1500
Home and day care
Direct Payments
1000
Equipment and adaptations
Meals
Other services to older people
500
0
2005/06
2006/07
© Nuffield Trust and Health Foundation
2007/08
2008/09 2009/10
Financial year
2010/11
2011/12
2012/13

8. Changes in service user numbers for communitybased, residential care and nursing care services
since 2009/10
Chaneg relative to index year (2009/10 = 100)
105
100
95
90
85
Community Based Services
80
Residential Care
Nursing Care
75
70
65
60
2009/10
2010/11
2011/12
Financial Year
© Nuffield Trust and Health Foundation
2012/13

9. Changes in user numbers for different forms of
community based care since 2009/10
Change relative to index year (2009/10 = 100)
120
100
80
Home Care
60
Day Care
Meals
40
Equipment & Adaptations
20
0
2009/10
2010/11
2011/12
Financial Year
© Nuffield Trust and Health Foundation
2012/13

10. How have local authorities responded to the
reductions in their income?
Annual Survey of Directors of Adult Social Services
(ADASS) 2013/14
• 82% of savings from ‘efficiencies’
• 13% of savings from service reduction
• 5% of savings from increased income
Eligibility for publicly funded help:
• 87% of LAs now only give help to those with
‘substantial’ or ‘critical’ levels of need (2013/14)
compared with 63% in 2005/6
© Nuffield Trust and Health Foundation

11. Change in the number of service users in receipt of
high, intermediate and low-intensity social care
support since 2009-10 for all adults
Change relative to index year (2009/10 = 100)
110
100
90
Less than or equal to 2 hours Number of
Service Users
More than 2 hours and less than or equal to
5 hours Number of Service Users
80
More than 5 hours and less than or equal to
10 hours Number of Service Users
70
More than 10 hours inc overnight/live in/24
hour Number of Service Users
60
50
2009/10
2010/11
2011/12
Financial Year
© Nuffield Trust and Health Foundation
2012/13

12. Has quality suffered?
ADASS 2013/14 Survey
• 87% of respondents do not agree that quality of life for
services users has suffered as a result of savings
• 93% do not think quality of care has suffered
• 28% believe that savings have increased pressure on
the NHS
© Nuffield Trust and Health Foundation

13. Where do we go from here?
Three groups we need to watch:
• Social care users facing reduced services/higher
contributions
• People who are no longer eligible for state funded help
• People who were never eligible for state funded help
• .. And their carers!
© Nuffield Trust and Health Foundation

14. www.qualitywatch.org.uk
Sign-up for our newsletter
www.qualitywatch.org.uk/newsletter
Follow us on Twitter:
Twitter.com/Quality_Watch
23 October 2013
© Nuffield Trust and Health Foundation

15. www.qualitywatch.org.uk