Challenges to changes: Adult Social Care flagged as biggest strain

  • Every local authority service and function is being examined, but adult social care is rapidly making its way to the top of the to do list.

    As arguments continued over recommendations made by the Dilnot Commission on how to pay for all this, the Department of Health pressed ahead with the social care white paper, Caring For Our Future: Reforming Care and Support, in July. This has been criticised by some as having a financial vacuum at its heart.

    With local authorities taking on more and more functions from the NHS as part of the government's drive to integrate services, senior managers will have to quickly work out how to remodel services and where the funding will come from.

    LGC's survey, completed in the main by adult services directors, chief executives and senior managers, revealed some of the challenges councils are having to face up to.

    Click here to download a copy of the survey report

    Where cost pressures will be

    Unsurprisingly, services for older people were flagged up as the biggest strain on council resources over the next five years, with dementia close behind.

    Learning disabilities ranked third. According to a New Local Government Network report last year, funding for learning disability services was the fastest growing part of the adult social care budget, accounting for more than 23% of the overall budget.

    The Winterbourne View private hospital scandal also highlighted the need to deliver more personalised and localised services for people with learning disabilities.

    In 2011-12 £648m was transferred from the NHS to local authorities to help pay for social care. But a report by consultants MHP, An Atlas of Variations in Social Care, found just 4% of this was spent on mental health.

    As mental health came fourth on survey respondents' lists, this may reveal concerns over future delivery expectations raised in the government's mental health strategy and taking on responsibilities from primary care trusts and other NHS services. There are also indications that as services become increasingly joined up, new pressures on council resources are revealed.

    Service areas not included on the questionnaire but highlighted by respondents included homelessness, housing and transition between children's and adult services. Several also flagged taking up public health responsibilities in general.

    Delivery priorities

    When asked for their top three delivery priorities, more than 86% of respondents said allowing people to stay in their own homes. Reducing hospital admissions/ readmissions was second, with more than 68%.

    The MHP research backs this view. It estimates that if all councils reduced the number of emergency hospital readmissions for over-75s within 28 days of discharge to the level of the best performing authorities, about £318m could be saved a year.

    In comparison, scores on the LGC survey for delivery priorities associated with personalisation were considerably lower, echoing a degree of uncertainty in answers to specific questions on personalisation.

    Improving social networks for clients was the lowest priority, with almost 18% of the vote.


    A healthy 61% of respondents had strong plans to establish more re-ablement services to maximise service users' independence, with a further 29% saying some planning had been done.

    Comments included "integration of rehab, re-ablement, equipment and telecare/health to reduce admissions and enable earlier discharge" and "integrated strategy around telehealth, assistive technology, extra care housing, home care and local community support".

    Innovative learning disabilities services were mentioned in addition to those for older people and those with physical disabilities.

    One respondent said: "We also have pilots running in learning disability and mental health, which we hope to roll out to become the universal offer."


    Personal budgets, self- directed support and direct payments are all being pushed forward by the DH white paper. But serious questions remain over whether councils will be able to make the transition without struggling financially and organisationally.

    The government has given councils until April 2013 to get all its social care users on personal budgets. There have been conflicting reports on whether this will be met.

    LGC's survey points to a significant number of local authorities admitting they are not likely to meet the deadline. Nearly 22% said they were not on track and about 44% said they may make the deadline. Only 34% were definitely on track.

    The LGC survey also found uncertainty over the implementation costs of personalisation. Some 23% of respondents were definitely expecting to make efficiency savings as a result, but many more - nearly 37% - were not expecting any savings.

    Sarah Pickup from Adass said: "Efficiency is not the driver of personalisation. Sometimes a personalised service will deliver better outcomes or a lower cost but this is not the purpose. Personalisation is the context within which we are driving services forward and delivering efficiencies and savings is not in itself an initiative to save money."

    Tightening eligibility

    No matter how services change, with less money available many people may have to expect less from social services.

    The survey found some councils still plan to make eligibility criteria more restrictive, but 57% of respondents had no current plans for tighter criteria.

    Richard Humphries, social care and local government senior fellow at the King's Fund, says this will affect the ability of councils to manage the widening gap between needs and resources.

    He said: "With 82% already limiting help at ‘substantial' levels of need, far from heralding an end to the postcode lottery, this change will simply close the door long after the horse has bolted."

    Read full analysis of results at LGC:





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