ADASS Budget Survey 2019 Julie Ogley President Cath

ADASS Budget Survey 2019 Julie Ogley, President Cath Roff, Resources Co-Lead

About Us The Association of Directors of Adult Social Services is a charity. Our members are current and former directors of adult care or social services and their senior staff. Our objectives include; – Furthering comprehensive, equitable, social policies and plans which reflect and shape the economic and social environment of the time – Furthering the interests of those who need social care services regardless of their backgrounds and status and – Promoting high standards of social care services • There was a 99% response rate to the budget survey but not all respondents answered all questions. • Survey carried out in April/May 2019.

Key Messages

Adult Social Care- Pessimism, paralysis and potential • £ 700 m savings from ASC budgets 2019/20. • £ 7. 7 bn cumulative savings since 2010. • ASC as a proportion of overall council budgets has fallen from 37. 8% in 2018/19 to 37. 4% 2019/20. • DASSs are increasingly pessimistic about the future financial prospects of ASC

Impacts of short-term uncertainty • Over-reliance on time limited/short-term grants to deliver balanced budgets for adult social care. • Lack of certainty from government has consequences. LAs will give notice to decommissioning services in October if future BCF/i. BCF not clarified. • Without in-year winter pressures funding more ASC departments would have overspent (38% in 2018/19).

Paralysis in national decision making has consequences • Behind each and every closure of a care home, or home care agency, there is a direct impact on a individual. This could quite easily be our mum, dad, brother or sister. • Local and national care markets are failing. • Home care closures impacted upon 7, 019 people in 2018/19. • Care home closures affected 1, 173 people in 2018/19.

Social care and the NHS are interdependent • Without a settlement for social care the NHS will not be able to deliver on the commitments of the Long Term Plan. • Adult social care continues to experience pressure from increased admissions to hospital, as well as the result of premature or inappropriate discharge from hospital. • Investing in ASC delivers results. Delayed Transfers of Care Attributable to Adult Social Care now at lowest level since September 2014. • Investment in prevention almost static, limiting ability to delay/prevent future demand for ASC and NHS.

What needs to happen? Short-Term • Urgent clarity on the continuation of the Better Care Fund and i. BCF, or a similar quantum of funding. Longer-Term • A long-term, sustainable solution for funding adult social care. Cross-party agreement required. • There is the potential for the sector to shape its own narrative, with people with lived experience. What do we want ‘good’ social care to look like?

Behind the numbers there are people … Ref- BBC Panorama

Older and disabled people need dignified, high quality care and support. When properly resourced it transforms lives. As a nation we must make this an immediate priority to avoid more people giving up work to care, our care services and hospitals failing. A thriving economy and a caring nation requires it.

Findings

• Winter pressures funding- £ 240 m • Social Care Support Grantapprox. £ 213 m used for ASC • Adult Social Care Precept Local Government context Funding context- 2019/20 • IBCF- £ 1. 8 bn • £ 2. 1 bn council savings required overall. • £ 699 m ASC savings required • Protection of ASC: now 37. 4% of total council budget (37. 8% last year) Additional need and costs Context • 3. 3% demographic pressures (£ 484 m): increasing numbers of older and disabled people • NLW/NMW costs £ 466 m • NHS support and pressures

Overview Adult Social Care Budgets 2017/18: Adult Social Care Budgets 2018/19: Adult Social Care Budgets 2019/20: ASC Gross Budget £ 20. 8 bn ASC Gross Budget £ 22. 1 bn ASC Gross Budget £ 22. 5 bn ASC Net Budget £ 14. 8 bn ASC Net Budget £ 14. 9 bn ASC Net Budget Outturn £ 14. 5 bn ASC Net Budget Outturn £ 14. 6 bn ASC Net Budget Outturn Variance/ overspend £ 0 Variance/ overspend - £ 83 m Variance/ overspend

Financial Pressures • Increasing concern from DASSs of financial pressures on their budgets related to increasing need, complexity and demand from working age adults. 2017/18 2018/19 2019/20 Older people 19% 12% 11% Working age adults 17% 32% 39% Both, equally 64% 56% 51% • In terms of financial pressures, DASSs ranked Unit price for care packages to support people with increasing complexity of care needs as their biggest area of concern, followed by demographic pressures.

Uncertainty about the continuation of key funding streams • 92% of Directors have assumed that the Better Care Fund, or a similar quantum of funding, will continue into 2020/21. • 75% have planned for the Improved Better Care Fund to continue. • 34% of councils have planned for winter pressures finding to be available in 2020/21. • Only 32% have assumed the continuation of the social care support grant.

Confidence in meeting Statutory Duties • Only 35% of DASSs are fully confident that budgets will be sufficient to meet all of their statutory duties in 2019/20. • For 2020/21 and 2021/22 under 5% are fully confident of their ability to meet all statutory duties • DASSs least confident about meeting statutory duties relating to care market sustainability (62% 2019/20, 79% 2020/21), followed by prevention & wellbeing.

Increased fees maintaining the status quo? • Majority of councils increasing fees by between 3. 0 -4. 9% for the third year in succession. • Highest % increases in fees- home care for people with learning disabilities and physical disabilities and for older people. 20% LAs increasing fees by 5%+ in all cases. • Fee increases not likely improve financial sustainability of providers- simply gives increase in line with 2019/20 cost pressures, e. g. NLW, inflation. • 81% DASS think providers are facing financial difficulty a result of the savings made to ASC budgets to-date.

Care Markets- Home Care • Average fees paid to home care providers have increased from £ 15. 93 to £ 16. 77 (+5. 3%). • However, this is 13% below UKHCA recommended hourly rate of £ 18. 93. • No. of councils experiencing home care closures has increased from 48 in 2017/18 to 72 in 2018/19 (+50%). • Closures impacted upon 7, 019 people in 2018/19, up from 3, 290 in 2017/18 (+113%). • 38 councils had contracts handed back by providers, impacting on 3, 464 people, up from 2, 664 people in 2017/18 (+30%).

Care Markets- Residential & Nursing • No. of councils experiencing care home closures has decreased from 58 in 2017/18 to 52 in 2018/19, with 124 providers closing in total across these areas. • These closures impacted upon 1, 173 people in 2018/19, down from 2, 095 people in 2017/18. • 12 councils had contracts handed back by providers, impacting upon 310 people, up from 292 people in 2017/18 (+6%).

Recruiting & Retaining a Caring, Valued & Skilled Workforce • Workforce concerns remain, intensified by Brexit and lack of updated/funded ASC workforce strategy. • Current context- high employment/rising inflation = increased difficultly for providers to recruit staff. • DASSs view increasing salary and improved working terms and conditions as the two most important factors in the recruitment and retention of care workers. • National living wage/other pay pressures/workforce (recruitment/retention) seen as key drivers of unit costs for residential and home care.

Prevention- Turning aspiration into reality • 82% of DASSs view the development of asset-based/self-help approaches as the most important approach to delivering savings, followed by prevention/early intervention (74%). Spend on prevention % spend on prevention as % of budget Difference in spend from previous year 2017/18 2018/19 2019/20 £ 1, 201 m 8. 3% N/A £ 1, 187 m 8. 0% -1. 2% £ 1, 251 m 8. 4% +5. 4% • 52 councils (35%) stated that they were less than confident in meeting their statutory duties relating to prevention and wellbeing in 2019/20. • However, 57 councils (38%) stated that their authorities strategy is focused on investing in preventative services. While 53% stated they are maintaining existing levels of expenditure on prevention.

Better Care Fund • 55% of DASSs believed that adult social care received an adequate level of protection in 2018/19, with 49% believing this to be the case in 2019/20. • 36% believed that ASC did not receive an adequate level of protection overall, although they believed that it was a reasonable proportion of the BCF, this increased to 42% in 2019/20. • 9% believed that ASC did not receive an adequate level of protection overall in both 2018/19 & 2019/20, and that it was not a reasonable proportion of the BCF.

NHS Related Pressures Options 2018/19 2019/20 Percentage (Number of Councils) Increased demand for social care due to increased acute / community hospital activity Increased demand for healthcare activity to be undertaken by social care staff Increased demand for social care from people inappropriately not being admitted to hospital (e. g. elective surgery cancellations) 95% (138) 87% (130) 54% (79) 47% (71) 16% (24) 25% (37) Increased demand for social care as a result of inappropriate / premature hospital discharge The NHS seeking to reduce the contribution locally to adult social care from the Better Care Fund Reductions to Continuing Health Care, shared care or health contributions to s 117 Insufficient primary, community (including incontinence support) or Mental Health services Other (please specify) 62% (91) 60% (90) 20% (29) 19% (28) 65% (95) 73% (109) 68% (99) 71% (107) 18% (27) 17% (26)

Continuing Healthcare • 79% of Directors felt that their local authority has been subject to additional costs as a result of the NHS reviewing their application of CHC Do you feel that your local authority has been subject to additional costs as a result of the NHS reviewing the application of CHC? 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Yes No Do not know

Overall Prospects for Health and Social Care • Only 15/148 Directors who responded feel at all optimistic about the future financial state of their local health and care economy, slightly higher than last year (9). Response Very optimistic Fairly optimistic Neutral Fairly pessimistic Very pessimistic 2017/18 0% 7% 19% 56% 19% 2018/19 1 council 6% 23% 58% 13% 2019/20 0% 16% 62% 12% • However, an increasing proportion report feeling fairly pessimistic, perhaps reflecting the uncertainty that exists as a result of the Adult Social Care Green Paper not being published to-date, as well as Spending Review yet to take place.

Conclusion • The issues highlighted in last year’s report have not been addressed. • Widespread agreement that current situation is unsustainablerising costs, increasingly complex needs, fragile provider market, etc… • Funding solutions which were intended to be short-term are now an integral part of councils’ budget planning. • Serious risk that some LAs will start decommissioning services in Autumn 2019 as lack of clarity on the continuation of key funding streams, e. g. BCF, i. BCF, etc… As they have insufficient reserves to manage a cliff edge.