A commentary on the Adass budget survey
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The annual budget survey by the Association of Directors of Adult Social Services is a powerful and timely reminder of how important it is that the timetable for the government’s promised green paper does not slip and any proposals must not shy away from difficult issues.
The survey is littered with striking findings, all of which should serve as a wake-up call to any policy makers still hoping for and quick and easy solution..
Last year overspends on social care budgets doubled, while directors still planned to make savings of £824m this year, despite the extra £1bn announced by the chancellor in the Budget.
Demand continues to rise, with cost pressures higher for younger adults than older people for the first time, highlighting the limitations and risks of a focus on delayed transfers of care and demand on accident and emergency departments.
The survey showed that directors’ confidence that planned savings can be achieved diminishes over time, with just 7% believing targets can be met in 2019-20.
Worryingly, directors also admit that savings will impact on those that require support – both old and young.
Moreover, confidence among directors that integration, once held up as major driver for creating a sustainable system, would deliver savings has diminished dramatically in one year.
Speaking on the day before the report was published, Adass president Margaret Willcox suggested that financial pressures across the health and social care system were not only undermining joint working, but in some cases contributing to significant friction.
The report states that just a third of directors said the extra £1bn available in 2017-18 would be spent on reducing pressures on the NHS. Yesterday, NHS Providers said only one in four NHS trusts had agreements in place with councils that the money would help tackle delayed transfers of care and warned patients would be put at risk this winter without any extra cash.
On Monday, NHS England clinical lead for accident and emergency Clifford Mann said at least £100m of the £1bn needed to be spent on tackling delayed discharges to free up beds and give the NHS a chance of meeting the four hour A&E target.
Ms Willcox said tensions had meant there had been an increase in the prevalence of hospital trusts issuing fines to councils over delayed transfers of care, despite the majority of delays being caused by the NHS.
While the Care Act 2014 enables trusts to do this, Ms Willcox said they had previously been rare as they were accepted as “counter-productive” to joint working.
This understanding, however, appears in some areas to have been sidelined in the drive for NHS efficiencies.
While the £2bn cash injection was welcomed, the scale of the financial challenges faced means the money appears in some areas to have served to create potentially damaging conflict rather than significantly improve the system for the benefit of those who need support.
As Richard Humphries, assistant director, policy, at the Kings Fund points out, the expectation of the government that the new money for social care would “double up by coming to the aid of the NHS was always likely to prove to be a triumph of hope over expectation”.
Ms Willcox told LGC that Adass would look to avoid conflict with the government in order to further the case for finding a sustainable, long-term solution and seek to contribute to the green paper to ensure it addresses a wide-range of complexities.
She also advocated an honest debate on bold taxation options, such as the income tax model proposed this week by thinktank Reform, or a form of social insurance.
The government, particularly in its current predicament, would do well to listen.