Public Expenditure - Health Committee Contents


Annex - Survey of Local Authorities


Summary

1.  As part of its inquiry the Committee conducted its own survey of all social care authorities in England on, amongst other things, levels and sources of funding, changes to service provision and plans for efficiency savings in the current year.

2.  This report presents the findings of this survey. We surveyed all 152 local authorities in the course of June 2011. A total of 67 local authorities responded, a response rate of 44%. Appendix 1 provides details about our data analysis and Appendix 2 provides the survey that was sent to local authorities.

Key findings

  • 63% of local authorities were reducing their social care budgets by an average of 6.6% (between 2010/11 and 2011/12).
  • Across all local authorities that responded, the social care budget was reducing by 1.1% (between 2010/11 and 2011/12).
  • Most local authorities were planning to reduce expenditure on care home placements (63% of local authorities), long-term support in the community (63%) and universal and preventative services (61%), but were planning to increase expenditure on reablement services (55% of local authorities).
  • On average, budgets for care home placement in 2011/12 were reducing by 3.1% compared to actual expenditure in 2010/11, budgets for community support were reducing by 9.2%, budgets for universal and preventive services fell by 0.3%, and budgets for reablement were increasing by 9.6%.
  • User charges were increasing from 13.0% to 13.5% of the total social care budget.
  • Many local authorities had increased their charges for services, either moderately or substantially between 2010 and 2011. For example, 35% had increased their maximum personal charge for social care, 38% had increased their charges for residential care, and 49% had increased their charges for non-residential care items such as hourly rate for home help. Very few local authorities (0-2%) had reduced charges in these areas.
  • Most local authorities reported that levels of service provision had remained about the same between 2010 and 2011—residential care (80%); community care (72%); and reablement services (39%).
  • 59% of local authorities had increased levels of reablement services, probably as a result of a one-off £70 million government fund for reablement.
  • Local authorities were making fewer efficiency savings in social care (3.8% in 2010-11) than across the whole organisation (4.2%) and proposed increases in efficiency savings between 2010-11 and 2011-12 were less for social care (91% increase) than for local authorities as a whole (120%).
  • In 2010-11 the most useful approaches for achieving efficiency savings were reducing payments to private sector providers, improving back-office efficiencies and increasing reablement services to reduce dependence on care.
  • In 2011-12 local authorities anticipate that the most useful approaches will be reductions in payments to private sector care providers, increases in reablement services to reduce dependence on care and more efficient use of staff time.

Distribution of funding

3.  Across all local authorities that responded, social care budgets were reducing by 1.1%, between 2010-2011 and 2011-12. Some local authorities noted that a recent change in accounting standards which had increased notional expenditure on pensions meant the like-for-like reduction might be greater. Almost two-thirds (63%) of local authorities were reducing their social care budgets, by an average of 6.6%.

4.  There were a number of elements that made up these budgets (see graph below).

  • User charges were increasing from 13.0% to 13.5% of budget, between 2010-11 and 2011-12.
  • Contributions from primary care trusts were reducing from 12.5% to 8.1% of budget, at the same time as grants from the Department of Health are increasing from 2.5% to 8.0%. These changes are probably the result of a number of specific grants (e.g. care of people with learning disabilities) that were previously distributed by primary care trusts and are now distributed directly by the Department of Health.
  • The Social Care Reform Grant was reducing from 1.6% to 0.1% of budget, between 2010-11 and 2011-12. The last year of Social Care Reform Grant funding was 2010-11.

Makeup of social care funding

Distribution of expenditure

5.  We asked local authorities to provide social care spending in the following categories: care home placements (excluding respite care); long-term support in the community (including personal budgets); reablement services; and universal and preventative services. We also asked them to provide the number of people who received adult social care on 31st March 2011 and estimate the number of people who will receive adult social care on 31st March 2012 for all these categories apart from universal and preventative services, where identifying numbers can be difficult. From this data we have calculated a 'spend per patient day' figure (see table below). This is only a rough estimate, as it is based on the assumption that throughput is constant throughout each financial year.






n = 56Care home placements (excluding respite care) Long-term support in the community (including all personal budgets) Reablement services Universal and preventative services
Average actual spend 2010/11 per local authority (£ million) 60.551.93.7 12.7
Average actual recipients on 31st March 2011 1,7546,695406 No answer
Average 2010/11 actual spend per recipient day, assuming constant throughput (£) 942125 No answer
Average estimated spend 2011/12 per local authority (£ million) 58.650.24.1 12.6
Average estimated recipients on 31st March 2012 1,7076,654580 No answer
Average 2011/12 estimated spend per recipient day (£) 942119 No answer
% change in spend per local authority -3.1%-3.2%9.6% -0.3%
% change in care recipients -2.7%-0.6%42.7% No answer
% change in spend per care recipient -0.4%-2.6%-23.2% No answer

6.  Most local authorities were planning to reduce expenditure on care home placements (63% of local authorities), long-term support in the community (63% of local authorities) and universal and preventative services (61% of local authorities), while 36% of local authorities were increasing expenditure on all these services. For reablement services, 39% were reducing expenditure, 55% were increasing it, and for the remainder, expenditure is remaining the same.
Changes between actual expenditure in 2010/11 and budgets for 2011/12
Reducing Staying the same Increases
Care home placements (excluding respite care) 63%2% 36%
Long-term support in the community (including all personal budgets) 63%2% 36%
Reablement services 39%5% 55%
Universal and preventative services 64%4% 36%

User charges

7.  We asked local authorities to identify whether user charges for adult social care, between 1st April 2010 and 1st April 2011, had decreased (moderately or substantially), had stayed about the same, or had increased (moderately or substantially) for three categories: the maximum personal charge for social care; charges for residential care; and charges for non-residential care items such as hourly rate for home help.

8.  The graph below shows that the maximum personal charge for social care was increased either moderately or substantially by 35% of local authorities, and kept the same by 46% of local authorities. The remainder did not have a maximum personal charge for social care. No local authorities reduced their maximum personal charge over this period. For residential care charges, there is a similar pattern: 38% of authorities had moderately increased their residential care charges, 58% had kept the charges about the same, while only 2% had moderately decreased their charges. The pattern is, again, very similar for charges for non-residential care items: 49% of local authorities had increased charges either moderately or substantially, 46% had kept charged about the same, while 2% had decreased charges either moderately or substantially.

9.  The respondents also provided details of changes to other charges, such as those for transport, day care, meals and other areas such as respite care. These responses also show that these charges also increased moderately or substantially in number of local authorities.

Levels of care

10.  We asked local authorities to identify whether, between 1st April 2010 and 1st April 2011, the levels of care provided to a typical service user had decreased (moderately or substantially), had stayed about the same, or had increased (moderately or substantially) for three categories: residential care; community care; and reablement services.

11.  Respondents reported that the level of residential care in most local authorities (80%) had stayed the same, while in 5% of local authorities it had increased (moderately or substantially) and in 15% of local authorities it had decreased moderately (see graph below). No local authorities reported a substantial decrease in the level of care provided. A similar pattern was reported for community care: in 72% of local authorities the level of care had stayed the same, while in 15% of local authorities it had increased (moderately or substantially) and in 13% of local authorities it had decreased moderately.


12.  For reablement services, 59% of local authorities stated that provision had increased (moderately or substantially). This is likely to be due, in part, to the government providing extra one-off funding of £70 million specifically for reablement services during the last six months of 2010-11. In 39% of local authorities provision stayed about the same, and in 2% of local authorities it decreased moderately.

13.  Some respondents also provided details about changes to levels of care in telecare, transport services, personal budgets and other care areas such as prevention services, as shown in the graph below.

Efficiency savings

14.  We asked local authorities to provide their planned and actual efficiency savings. The results are tabulated below. These show that local authorities are making less efficiency savings in social care than in other areas and that proposed increases in efficiency saving between 2010-11 and 2011-12 are less for social care (84% increase) than for local authorities as a whole (120%). However this should be interpreted with caution as there was some evidence that local authorities interpreted the 'total local authority budget' differently.
(n=44)Average social care efficiency saving per local authority Social care efficiency savings as a percentage of social care budget Total local authority efficiency savings as a percentage of total budget
2010-11 Planned£4.5 million 3.8%4.1%
2010-11 Actual£4.5 million 3.7%4.2%
2011-12 Planned£8.6 million 7.3%9.1%

15.  We asked local authorities to rank from 1 to 5 (1 for the biggest saving, 5 for the smallest) the 5 approaches which achieved the biggest adult social care efficiency savings in 2010/11. We provided a list of five approaches (back-office efficiencies, estate rationalisation, reduced payments to private sector providers, more efficient use of staff time and increased reablement) and gave respondents space to write in up to 5 additional approaches.

16.  The graph below shows that in 2010/11 the biggest areas where efficiency savings were achieved were reduced payments per unit activity to private sector providers (29.5% of first-place rankings and 24.1% of second-place rankings) and back-office efficiencies (18.0% of first-place rankings and 13.8% of second-place rankings).

First and second place rankings for 2010/11


17.  We also asked local authorities to rank from 1 to 5 the five approaches that they have planned for 2011/12 which they think will deliver the biggest social care efficiency savings. The graph below shows that the main areas where efficiency savings are planned are reduced payments per unit of activity to private sector care providers (27.9% of first-place rankings and 21.3% of second-place rankings) and increasing reablement to reduce dependence on care (19.7% of first-place rankings and 13.1% of second-place rankings).

First and second place rankings 2011/12


Other observations

18.  We asked local authorities if they had any other observations about the effects on adult social care of changes in government funding for health and social care. The main responses were:

  • Concerns over rising demand for services caused by demographic changes to their populations (13 local authorities).
  • Issues related to the interaction of, and joint working between, health and social care (8 local authorities). For example, that cuts to the NHS would mean increasing social care costs for local authorities, the level of bureaucracy involved in accessing NHS funding, and the opportunity for better joint working between health and social care.
  • Concerns about their independent sector providers (7 local authorities). For example, the consequences of provider collapse, the quality of the care they provided, and that legal issues would make it difficult for them to economise by cutting independent care home fees.





 
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Prepared 24 January 2012