The Spending Review and social care

Andrew Cozens

4 November 2010 www.local.gov.uk/improvementanddevelopment

The key components

• NHS support to social care: £800m rising to £1bn over 4 years – including £300m for reablement (via NHS)

• New social care allocation £530m rising to £1bn over 4 years (un-ringfenced in RSG)

• Existing social care grants (£2.4 bn by 2014) wrapped up and inflation-proofed (un-ringfenced)

• New transfer of responsibility grants (but not new money) for learning disabilities and health reform, and for public health.

Good news but…

• Good news were we in a settled state

• Demography, pay and price inflation is fully funded (if the baseline is right)

• Important change in mood music in relationships between NHS and social care

Known unknowns

• Distribution arrangements and formulae

• Conditions of NHS grant and for public health

• Who will hold it after PCTs go?

The wider context

• Local government facing reduction of 26% in grant funding over SR period

• Distribution issues for grant create disproportionate effects

• Central government contributes 62% of social care through grant, councils contribute 38% through council tax

• Adult social care is 40-50% available budget for top tier council

The wider pressures

• NHS settlement is worst since 1951 (IFS) – knock-on consequences

• Unsettled NHS

• Impact of cuts in related council areas – housing, Supporting People, family support, leisure etc.

• Unknown impact of benefit changes on demand

Closing the gap

• Estimated share at 25% + 4% demography (LGA submission to SR) is £6.33bn over 4 years

• Offset by £2bn in SR by 2014 if fully passported

• Agreed 3% efficiency savings (from telecare, reablement, different service patterns, review of business processes etc.) £1.7bn

• Gap to close £2.63bn or £657m per year

Closing the gap

• Simplified grant funding and greater freedoms

• Reduction in burdens of performance management

• Community budget pilots

• Wider local government productivity programme – shared services, outsourcing

Adult social care implications

• Recognising how much is ‘untouchable’

• Managing the delicate ecology of care and support

• Progress with personalisation

• Search for productivity and efficiency gains

• Review of eligibility criteria

• Increased charges

Adult social care implications

• Information and advice to support good decision making by self-funders

• Step up efforts with NHS (PCT and consortia) to reduce emergency admissions and crisis response and reablement and better management of long-term conditions

• Process redesign and simplification• Collaborative commissioning with providers to

design new services (extending range and type?) that do more for less

Interdependence

To promote the joining up of local NHS services, social care and improvement, we need:

• The relationship between councils and the proposed NHS Commissioning Board to be clearly defined.

• Councils are given adequate financial support to carry out their local health improvement role.

• Outcomes frameworks for the NHS, public health and social care need to reflect linkages between and across the system – and translate into commissioning outcomes for new GP consortia.