Public Expenditure on Health and Personal Social Services 2009 - Health Committee Contents

4.  COMMISSIONING

4.1.6  What has net expenditure by central and local government on community care been in each year from 1997-98? Can the data be broken down by residential and non-residential care and include social security and housing expenditure contributing to community care objectives? (Q32)

Answer

  1.  Table 32 provides details of the net national expenditure on services for community care in England from 1997-98 to 2007-08, the latest year for which figures are available. All figures are in nominal (cash) terms. The table includes expenditure by the NHS, by local authorities, and central government on adult social services (community care).

  2  The table shows that there has been an increase in net expenditure by central and local government on community care between 2006-07 and 2007-08. This reflects the policy direction as taken forward by the NHS and local authority commissioned social services. For example, work has recently begun to transform adult social care and NHS community services so that they provide modern personalised and responsive care of a consistently high standard which is closer to a person's home.

  3.  Both the NHS Next Stage Review: Our vision for primary and community care and the Our Health, Our Care, Our Say White Paper set out a vision to provide people with good quality social care and NHS services in the communities where they live.

  4.  The NHS Next Stage Review sets out a vision for primary and community care where people shape services, giving people more say, more choice and more control over their own healthcare, and promoting healthy lives and equal access to all.

  5.  Our Health, Our Care, Our Say sets out a vision to provide people with good quality social care and NHS services in the communities where they live. NHS services are half way through a ten-year plan to become more responsive to patient needs and prevent ill health by the promotion of healthy lifestyles. Social care services are also changing to give service users more independence, choice and control.

  6.  Community care expenditure is taken to mean expenditure on non-residential and residential care provided or arranged by local authorities for adults with social care needs; community health services provided by the NHS for adults; certain social security benefits which support community care objectives; and certain (but not all) expenditure on housing. The Department of Health has now included "Supporting People" expenditure in these tables as well as the strategic management costs, which increase the reported figures from previous years. Local authorities also report expenditure data on "other client groups", but this has not been included as it cannot be broken down by residential and non-residential care.

  7.  From 2004-05, the data required to calculate NHS hospital and community health services expenditure by service sector ceased to be collected. Instead, the Department of Health initiated a replacement data collection to collect expenditure on a programme budgeting basis. Therefore, comparison of the data in table 32 from 2004-05 onwards is affected as a consequence of discontinued data collection in respect to community health expenditure.

  8.  The time series for local authority residential care expenditure and income support expenditure on residential care is affected by the transfer of residents with preserved rights to higher levels of income support to local authority funding in April 2002, the abolition of the residential allowance in income support and Part III rate of income support in October 2003 and the transfer to the NHS of responsibility for funding nursing costs in care homes from April 2003.

Table 32

NET EXPENDITURE BY CENTRAL AND LOCAL GOVERNMENT ON COMMUNITY CARE

													£ million
			1997-98	1998-99	1999-2000	2000-01	2001-02	2002-03	2003-04	2004-05	2005-06	2006-07	2007-08
A.	Local Authority Domiciliary Care (1) (2)
		Service strategy (3)	84	96	103	77	68	42	42	51	44	49	86
		Assessment and care management	779	810	881	942	1,043	1,170	1,337	1,536	1,650	1,724	1,739
		Direct payments	-	10	41	49	56	82	123	187	267	344	437
		Home care	1,207	1,258	1,351	1,406	1,484	1,585	1,777	1,993	2,240	2,357	2,375
		Day care for older people	171	184	196	235	259	272	285	302	323	335	337
		Day care for other adults	497	532	572	608	640	693	749	763	823	855	865
		Equipment and adaptations	73	65	71	108	122	126	145	163	182	186	198
		Meals	47	46	51	58	58	57	58	57	56	55	51
		Other services	468	497	570	340	353	348	372	463	490	529	552
		Supporting People (4)	-	-	-	-	-	-	571	644	597	558	559
Total A			3,326	3,499	3,836	3,822	4,083	4,374	5,459	6,160	6,672	6,991	7,199
B.	Community Health (5)
		Chiropody	81	91	109	117	150	215	209	-	-	-	-
		Family planning	52	60	73	80	99	132	123	-	-	-	-
		Immunisation and surveillance	3	3	4	4	3	2	2	-	-	-	-
		Screening	53	61	74	80	94	136	149	-	-	-	-
		Professional advice and support	93	115	130	132	61	40	48	-	-	-	-
		General patient care	905	998	1,087	1,061	785	729	686	-	-	-	-
		Community MI nursing	495	551	700	798	815	892	981	-	-	-	-
		Community LD nursing	330	366	426	447	410	434	512	-	-	-	-
		Community maternity	0	0	229	207	299	168	193	-	-	-	-
		Health promotion	48	55	64	66	31	62	75	-	-	-	-
		Community dental	0	0	107	116	75	188	169	-	-	-	-
		Services to GPs	190	220	305	373	484	720	713	-	-	-	-
		Other CHS	260	328	423	487	481	876	1,008	-	-	-	-
Total B			2,510	2,848	3,728	3,969	3,786	4,594	4,870	4,904	5,408	5,584	6,276
Total A plus B			5,836	6,347	7,564	7,791	7,869	8,968	10,329	11,064	12,080	12,575	13,475
C.	Local Authority Residental Care for (1) (2)
		Older people (aged 65 or over)	1,982	2,079	2,206	2,204	2,293	2,711	2,882	3,172	3,284	3,325	3,337
		Adults aged under 65 with:
		A physical disablility or sensory impairment	152	164	179	188	200	274	273	295	315	325	342
		Learning disabilites	572	623	691	764	828	1,122	1,197	1,371	1,494	1,596	1,688
		Mental health needs	153	163	170	192	210	267	271	303	326	344	354
Total C			2,858	3,029	3,247	3,348	3,531	4,374	4,624	5,142	5,419	5,591	5,721
D.	Income Support, Residential Care, Nursing Homes and Residential Allowance Cases (6), (7), (8) (9)		1,825	1,671	1,400	1,363	1,347	646	260	-	-	-	-
Total C plus D			4,683	4,700	4,647	4,711	4,878	5,020	4,884	5,142	5,419	5,591	5,721
E.	Other Social Security Benefits (10), (11), (12)
		Attendance Allowance	2,286	2,360	2,315	2,418	2,561	2,667	2,837	3,017	3,200	3,426	3,678
		Disability Living Allowance	4,368	4,568	4,451	4,845	5,284	5,666	6,088	6,494	6,955	7,370	7,956
		Invalid Care Allowance/Carers Allowance	684	698	695	716	774	825	874	911	991	989	1,075
		Independent Living Fund	100	102	101	106	120	135	152	168	182	205	238
		Social Fund Community Care Grants	84	83	77	79	81	85	92	100	108	110	110
Total E			7,522	7,811	7,639	8,164	8,820	9,378	10,043	10,690	11,436	11,750	13,057
F.	Housing
		Adaptations to all local authority dwellings for older people and disabled people (13)	79	90	93	93	106	114	111	122	134	139	133
		LA Grants; Disabled Facilities Grants (14)	100	107	117	131	145	174	195	210	221	233	250
		Housing Corporations Approved Development Programme (ADP) (15)	61	71	131	121	116	137	176	145	105	160	150
		LA Sponsored RSL (LASHG) (16)	45	51	47	57	50	51	47	-	-	-	-
Total F			285	319	388	402	417	476	529	477	460	532	533
Total E plus F			7,807	8,130	8,027	8,566	9,237	9,854	10,572	11,167	11,896	12,282	13,590
Grand Total A to F			18,326	19,177	20,238	21,068	21,985	23,842	25,785	27,373	29,396	30,448	32,786
Source:
Social Care Finance, DH
RO3 and PSS EX1 returns (A and C)
Housing Investment Programme (HIP) Annual Plan return and Business Plan Statistical Appendix—Annual Monitoring (BPSA-AM) from 2001 onwards. Reported data only hence missing figures from non respond LAs. (F)
Footnotes:
1.  Local authority expenditure for 2000-01 and later years is obtained from the PSS EX1 return; individual service lines include overhead costs. For years prior to 2000-01 it is obtained from the RO3 current expenditure return but with a share of overhead costs allocated to service lines on a pro-rata basis. Figures for 2000-01 and later years are therefore not strictly comparable with those for earlier years. The RO3 return was redesigned in 1998-99 and equipment and adaptions and meals were made memorandum items leading to some under-recording and consequent inflation of the other services expenditure; data for these items for 1998-99 and 1999-2000 are therefore not strictly comparable with those for earlier years. Expenditure on direct payments was only recorded from 1998-99 onwards.
2.  Assessment and care management, although included under local authority non-residential care in Part A, also includes expenditure which is relevant to residential care (Part C).
3.  Figures are estimates of Service Strategy net expenditure in services for adults. Total net expenditure on service strategy has been apportioned between adults and children's services on the basis of shares of net expenditure.
4.  The Supporting People programme was launched on 1 April 2003. Figures only include Supporting People net expenditure for services for adults reported by councils on the PSS EX 1 returns.
5.  Data up to and including 2003-04 was derived from the old programme budget information collected on TFR2 forms (provider data). This data collection ended in 2004-05. Data from 2004-05 onwards uses a different breakdown; so only totals are reported from 2004-05 onwards. Data was provided by DH (Resource Planning & Acquisition Branch, Finance & Operations Directorate).
6.  Expenditure is based on Preserved Rights Residential Care and Nursing Home cases and Residential Allowance cases for England. From April 2002 claimants in Residential Care and Nursing Homes had preserved rights abolished and became the responsibility of local authorities. With the introduction of Pension Credit residential allowance rate of Income Support was withdrawn to all claimants in October 2003 and became the responsibility of local authorities. Data excludes unemployed claimants who are provided for by Jobseekers Allowance.
7.  Figures for 1999-2000 onwards are on a Resource Accounting and Budgeting basis. 2003-04 figures are based on latest actual data. Figures may not sum due to rounding.
8.  All figures are based on information received from DWP Information Directorate (IFD) for caseload and average weekly amounts which was used for the Country and Regional Analysis 2006, (apart from Social Fund which is based on annual expenditure).
9.  Discontinued 2004-05.
10.  Disability Living Allowance replaced Attendance Allowance (for people under 65) from 1992 onwards.
11.  Invalid Carers Allowance was renamed Carer's Allowance in April 2003.
12.  Sources: DWP administrative records with final totals controlled to expenditure outturn. Forecast figures are controlled to DWP Budget 2007 forecasts (provided by DWP Forecasting Division), except for Social Fund sourced from DWP Social Fund Policy, Budget and Management Information System (DWP Social Fund Analysis team).
13.  Source from 2001 onwards: the "Housing Investment Programme (HIP) Annual Plan return and Business Plan Statistical Appendix—Annual Monitoring (BPSA-AM) from 2001 onwards. Reported data only hence missing figures from non respond LAs." Figures provided by the Department for Communities and Local Government (Housing Analysis & Surveys Division—Stock Condition and Decent Homes Monitoring).
14.  Figures for 2005-06 and 2006-07 provided by the Department for Communities and Local Government, Private Sector Renewal & Housing Adaptations Branch.
15.  Housing Corporation ADP approvals for schemes by Registered Social Landlords (mostly housing associations) in respect of home for rent and sale to certain client groups (frail elderly, people with mental health problems, learning, or physical disabilities) and one "general needs" group (older people residential with warden support). This covers the Corporation's own programme and joint schemes, but excludes local authority-sponsored schemes using LA Social Housing Grant (LASHG). Figures are approved and not actual expenditure.
16.  Discontinued 2004-05.

---

---

Prepared 20 January 2010