The implementation of the first phase of the 2014 Care Act by the Department of Health (DH) has gone well, but its cost estimates and funding mechanisms have put local authorities at increased financial risk due to uncertain levels of demand for social care, a report has found.
The National Audit Office (NAO) report found that 99% of local authorities were confident that they would able to carry out the Act reforms from April 2015.
But the NAO also warned that local authorities may not have enough resources to respond if demand for care exceeds expectations. The Care Act, which aims to reduce reliance on formal care, promote people’s independence and wellbeing and give people more control of their own care and support, will increase demand for assessments and services at a time when local authority provision has been falling and the number of people in need is rising. The NAO estimates that phase 1 of the Act will cost £2.5 billion to carry out from 2013-14 to 2019-20, more than half of which is for carers’ assessments and services – a new entitlement and the largest single cost.
The NAO says DH may have underestimated the demand for assessments and services for carers. DH based its estimate of take-up on the number receiving Carer’s Allowance, which it compared with other sources. The NAO repeated DH’s calculation concluding that it was as reasonable to assume that those carers who have applied for Carer’s Allowance and are eligible, but do not receive it because they receive other allowances, are as likely to seek an assessment. This equates to a risk of £27 million (26%) in extra assessments and services if these people also come forward.
“The first phase of the Department of Health’s new approach to adult social care has been implemented well,” said Amyas Morse, head of the NAO. “But this places new responsibilities on local authorities whose core funding is being significantly reduced. They may not have enough resources to respond if, as could be the case, demand for care exceeds expectation. This could result in their having to delay or reduce services in the short-term. This risk to value for money needs to be managed. The Department for Communities and Local Government has taken steps since November 2014 to improve its understanding of new burdens on local authorities. But it needs to use intelligence from the new burdens regime to improve its understanding of the pressures affecting authorities’ financial sustainability.”
More money for social care
In response, calls have been made for more money to be put into social care. Sarah Lambert, head of policy at the National Autistic Society (NAS), said: "While [the] NAO report says that the first phase of the Act’s implementation has gone well, it also highlights serious concerns about local authorities’ ability to meet demand at a time of tightening resources. The NAS believes that this could lead to delays in people accessing vital support and raises the prospect of the reforms failing to live up to their potential.
"All too often adults with autism miss out on vital support. NAS research indicates that 7 in 10 adults with autism aren’t getting the help they need from social services and that 1 in 3 develop severe and often avoidable mental health problems due to insufficient support.
"George Osborne has a chance to address these issues before it’s too late, as he prepares next month’s Emergency Budget. He must ensure that the DH has got its sums right and make the necessary investments so that people with autism get the care and support they need.
“Supporting the most vulnerable members of society by investing in social care isn’t just the right thing to do; evidence shows that it also saves local councils and the NHS money by giving people the care and support they need before they fall into crisis and need expensive specialist care.”
Sue Brown, vice chair of the Care & Support Alliance, also voiced concern over funding: “The Care & Support Alliance has previously warned that the Care Act reforms will prove to be ‘built on sand’ unless more funding is put into the social care system.
“Chronic underfunding of adult social care has seen dramatic year-on-year rationing of support, excluding hundreds of thousands of older and disabled people from the care they desperately need to get up, get dressed and get out of the house. This is also putting unbearable pressure on family carers. The scale of the crisis in social care funding is clear – the [Local Government Association] and the Association of Directors of Adult Social Services estimate a £4.3 billion funding gap by 2020.
"The Care Act is a bold reform of the system, but the Government needs to provide adequate funding so that local authorities can actually implement the reforms. Last year, 9 out of 10 councils signalled concern that lack of funding could jeopardise vital reforms to the care system with the implementation of the Care Act 2014. Last week, ADASS found 83% of directors report there will be an impact on services over the next two years due to funding cuts.
"The Government needs to urgently address the crisis in care funding to prevent the care system from total collapse in the next decade. Anything else is a false economy."