JimKenThe recent report from the National Audit Office has added an authoritative voice to the growing concern about funding for the social care sector. Given that there is no obvious sign in the budget of a substantial rescue plan, CareKnowledge editor Jim Kennedy ponders how much worse can things become before they get any better?

The recent report from the National Audit Office (NAO) has, in common with a number of similar reports, a pretty low key title. It arrived just before the budget statement and makes for pretty devastating reading.

In summary, the report says that government does not know if we are approaching the capacity limit of the care system, especially so if it continue to absorb numerous pressures. It warns that major changes to the system, which is needed to improve outcomes and reduce costs, will be challenging to achieve. I’ll say.

And that’s where the budget statement becomes important. Headline information doesn’t tell us a great deal about the detail of planned spending, but given that the focus remains firmly on cutting the budget deficit – it seems hard to imagine that we’ll see significant new investment in adult social care – and pressure on the NHS will make it increasingly difficult for that budget to reach out across the system.

In fact, one of the points made in the report is that the cut-backs in social care spending are already placing increased demands on the acute health sector.
Looking at the NAO’s report may simply seem to confirm what those closely associated with social care have known for some time. But this is a further authoritative voice pointing out the real dangers that lie ahead. And, even if any impact is likely to have to wait until after the next election, it’s worth having these carefully-worded notes of caution in place for whichever group of politicians is going to have to tackle them after 2015.

So what does the report say?
It reminds us of the sheer size (and by implication) economic impact of the sector, noting that £19bn is spent on adult social care, yet reminds us that publicly funded care makes up a minority of the total value of care, and that proportion is decreasing. Most care and support is provided, unpaid, by family, friends and neighbours (informal care), while many adults pay for some or all of their formal care services.

The report confirms, though, that publicly funded care is still valued by its users, with 64% of local authority adult social care service users very or extremely satisfied overall with their care and support.

The report tells us that 9% of adults in England are limited ‘a lot’ in day-to-day activities by illness, disability or old age. It says there are an estimated 5.4 million unpaid informal carers, that 1.5 million people work in adult care, that £10 billion is the estimated spending on care and support by self-funders, and that £55 billion is the estimated value of informal care and support.

Key concerns discussed in the report, focus on:
• The fact that 87% of adults live in authorities where the threshold for publicly supported care is set at the ‘substantial’ or ‘critical’ level;
• The fact that local authorities have reduced the total amount of state-funded care provided through individual packages of care every year since 2008-09;
• The conclusion that rising needs, reducing local authority spending, and reductions in benefits may be putting unsustainable pressure on informal carers and acute health services;
• The finding that the health and care system is not good at promoting effective transfers for individuals across its component parts;
• The conclusion that the Care Bill will bring significant changes for local authorities, but these are difficult to plan for, because of short timescales, and a lack of information and evidence on what works in some areas;
• The conclusion that the cumulative impact of changes across the public sector could shift costs and demand between services without reducing overall public spending – for example as health and care services respond to the effects of cuts in the benefit system;
• The finding that safeguarding vulnerable adults from abuse and neglect remains a major risk throughout the sector, with safeguarding referrals recorded by local authorities rising by 13% between 2010 and 2013;
• The emerging concerns amongst local health commissioners about the impact of taking £2 billion from NHS acute care for the Better Care Fund (designed to support the provision of more integrated services).

Overall, the report paints a picture of high-risk challenges lying ahead, with pressures on the care system increasing, the need for care rising while public spending falls, rapid change programmes being introduced and with uncertainties over the evidence-base for making improvements, and over the likely impact of changes to the regulatory and monitoring regimes.

We’re already in a situation where the vast majority of adults have to have needs at the substantial or critical level if they are to receive support from social services. Demographic change will see huge additional demand develop over the next few years. Additionally, local authorities must be coming close to the money-saving limits of the techniques they have been using so far – changing contractual agreements, paying lower fees, negotiating bulk purchase discounts, and commissioning less care.

How much longer can we go on watching the elephant in the room grow and grow, without accepting that we’ve somehow got to find the money for a – considerably – bigger house?