A Technical Annex (pdf) to go with CQC’s State of Care 2012/13 report, you say? How could I possibly resist?!
Below are some highlights from the annex looking specifically at the funding of adult social care. (These figures will be familiar to folks who pore over the HSCIC releases every quarter, but I take the view you can never get enough of info like this.)
Total and type of spend on adult social care:
- Spend on adult social care has risen in cash terms – from £16.8bn in 2009/10 to £17.2bn in 2012/13, but there has been a real terms decline. Adults under 65 with a learning disability where the only major user group to see a real terms rise in expenditure from 2009/10 to 2011/12.
- The following proportions were spent on the following client groups in 2011/12(figures include Supporting People monies, which was presumably found down the back of the sofa in the last year or so
- 53% of spend was on older people
- 31% on adults under 65 with learning disabilities
- 9% on adults under 65 with physical/sensory impairments
- 7% on adults under 65 with mental health problems
Direct Payments expenditure:
- Expenditure on direct payments for adults increased in both cash and real terms. £360m was spend on Direct Payments in 2006/07 and reached £1.1bn in 2011/12
- This is a real terms increase of 175% and is 6% of all gross adult social care spend.
Unit costs of different types of social care are fascinating. Really.
- The average cost per adult supported in residential care, nursing care or intensively in their own home was £608 per person per week in 2011/12 – a 5% real terms cut
- The average cost of providing day care for adults (including older people) was £213 per person per week
- The cost of home care per person per week for all adults was £206.
- This one surprised me: the overall proportion of people who indicated that they (or their family) ‘top up’ their care has increased from 38.1% in 2010/11 to 38.8% in 2012/13. This probably isn’t as much as I thought it would be.
To summarise, there’s less money in real terms, no matter what anyone else tells you.
For those folks who want extra geek points – and, frankly, who doesn’t? – it’s well worth reading CQC’s technical funding annex in conjunction with the King’s Fund’s submission (pdf) to the Health Select Committee’s Inquiry into public expenditure on health on social care. In social care, it notes:
The number of older people receiving publicly funded services has fallen by 26 per cent since 2009/10, with an equivalent reduction of 21 per cent among working age adults over the same period. Given the overriding imperative to provide care closer to home and reduce the need for residential care and hospital admissions, it is particularly worrying that the largest reduction has been in the use of community-based services such as home care (down 25 per cent) compared to nursing home care (down 4 per cent) and residential care (down 1.7 per cent).
Their numbers on the NHS are just as frightening.
So, to summarise again:
- There’s less money in adult social care
- There are less people getting adult social care
- The number of people getting fewer services is rising quicker than the rate at which money is being taken out of the social care system
- Money is being cut from services which cost less and people prefer quicker than it is being cut from services which cost more and people prefer less
- The NHS is fairly buggered, or at least faces the biggest financial challenge it has ever faced.
What could possibly go wrong?
As a self-confessed social care geek, my second favourite publication of the year is CQC’s State of Care report. My favourite is, of course, the NHS Information Centre’s final Personal Social Services Expenditure and Activity report.
Here are some of the findings that stood out for me from this year’s report, roughly themed by some (hopefully useful) headings. Comments in (brackets) are my own observations on the preceding point.
- There are 53.1m people in England, of which 8.7m were 65+ and 1.2m were 85+
- There are estimated to be 800,000 living with dementia across the UK, and it is forecast that one in three people over 65 will develop dementia. (The current number seemed very low to me, especially since the latter figure suggests nearly 3 million people living with dementia in the future – a huge leap. This is further exacerbated by the statement on p39 that “over the next 30 years the number of people with dementia is expected to double”, which would still only get us to 1.6m people. Can anyone shed any light on these stats?)
- 1.35m people work in the NHS workforce in England. This compares to 1.63m who work in social care
- The majority of the increase in social care jobs came from Direct Payments (i.e. Direct Payments are good for the economy!)
- In September 2011, there were 8,316 GP practices in England, with 35,319 FTE GPs. The number of patients per practice has grown and stands at 6,651 per practice
- Only one third of men (33%) and one in six women (33%) will never need social care
- 83% of councils set their FACS eligibility as “substantial” in 2011/12 (this is a rise from 78% in 2010/11 and from 70% in 2009/10)
- 45% of care home places are occupied by self funders. A further quarter are topped-up by people or their families to make up for the gap between what the local council will pay and what the residential care costs
- Around 220,000 of the 1.1m people who receive domiciliary care are self funders (this is likely to be a significant under-representation of people who pay for their own care, since it will only include those who have made contact with their local council)
- The number of people with a Personal Budgets in 2011/12 was 527,000 – a growth of 40% from 2010/11. Of these, 139,000 receive a Direct Payment – a growth of 11% from 2010/11
- Expenditure on Direct Payments has increased 15% in real terms, to £960m
- 25% of people referred themselves to social care
- 22% were referred from secondary health source (e.g. hospital)
- 14% were referred from primary health sources (e.g. GP)
- 14% were referred by family, friends of neighbours
- It was interesting to note from the table on p.29 that social care providers are much less geographically dispersed than health providers
Poor care and user involvement
- There are three considerable factors which underpin poor quality care: cultures where unacceptable care becomes the norm, an attitude to care that is “task-based” and not person-centre, and managing high staff vacancy or turnover rates
- A recurring issue, particularly for people in learning disability or mental health services, is a lack of involvement in their care plans or having the chance to share their views on how their care is delivered
- More work is felt to be required by commissioners and providers to ensure person-centred planning is embedded into all care for people who use services
- In hospital wards that performed well on people’s quality of care there was strong consistency in the involvement of people in decisions about their care. In those hospital wards that performed poorly on quality of care, a common complaint was that people received little or no information about their care and what to expect
- In social care, problems often arose in people’s quality of care where there had been a lack of person-centred planning, with little information about people’s individual preferences