This Commons Library briefing paper examines the key funding pressures facing adult social care services in England and evidence of the impacts of these pressures on social care and health services. The paper explains the additional funding committed to adult social care between 2016/17 and 2020/21, and outlines concerns about a social care funding gap and future financial uncertainty.
Social care funding
The House of Commons Library has published a number of papers regarding social care funding.
For more information about the system as it currently stands, and how means tests are applied for those seeking financial support, see the paper on Social care: paying for care home places and domiciliary care (England).
The Library paper Adult Social Care Funding (England) outlines the pressures on the current care system and considers recent attempts by the Government to ameliorate the situation, including:
- A new Social Care Precept, under which local authorities are able to increase council tax levels by up to 2% (above the referendum threshold) for each year between 2016/17 and 2019/20. In December 2016, the Government announced increased flexibility which will enable local authorities to, if they wish, bring forward the Social Care Precept, by raising council tax by up to 3% in 2017/18 and 2018/19;
- An improved Better Care Fund –to include additional social care funds of around £4.4 billion between 2017/18 and 2019/20.
- A new Adult Social Care Support Grant which will provide £240 million to local authorities in 2017/18.
Funding for social care has been considered by many political parties and Governments. The Library paper on Government reviews and policy proposals for paying for care since 1997 (England) looks at various policies and proposals over the past 20 years.
In the 2017 Election, the Conservative Manifesto proposed a more generous means-test with a “single capital floor” of £100,000 (compared to the current limit of £23,250). The Manifesto also suggested that the means test for domiciliary care would include the value of an individual’s home; in the past, such assets were only considered for residential care; some have labelled this as a ‘dementia tax’. Further information can be found in the Library briefing paper, Social care: Conservative manifesto’s commitments on the means-test including the £100,000 limit (England).
The Government has said that its proposals for reforming how social care is funded would be set out in a Green Paper consultation, and earlier this month repeated its position that it would “provide further details on the next steps on social care in due course”.
Delayed Transfers of Care
‘Delayed transfers of care’ (DTOCs) are where a patient is ready for discharge from a hospital, but cannot do so, resulting in a prolonged stay in the hospital. In some cases, this is because the appropriate support outside of the hospital environment is not ready.
There are two financial sanctions on local authorities that aim to incentivise better rates of DTOC:
Delayed discharge payments
When the NHS is about to discharge a patient with care needs, the NHS must give the relevant local authorities 24 hours’ notice, alongside a description of the patient’s likely support requirements. This is known as a discharge notice. If a local authority fails to act upon this information, resulting in a delay to a patient’s discharge, the NHS body can claim reimbursement for each day of delay.
A survey carried out by Association of Directors of Adult Social Services in England (ADASS) reports that “16 councils were fined for delayed transfers of care in 2016/17, with individual fines as high as £280,540. Ten councils paid the fine. In 2017/18, eight councils have been fined, with fines as high as £99,970. Six councils have paid the fine.”
The Library has produced a paper on Delayed transfers of care in the NHS, which includes trends over time and efforts to reduce delays. The King’s Fund guide to delayed transfers of care may also be useful.
Better Care Fund
The Better Care Fund (BCF) is the Government’s primary funding mechanism specifically for the integration of health and social care. It is a pooled fund that local areas can use to provide better community care outside of a hospital environment.
In the 2017 Spring Budget, it was announced that targeted measures would be introduced to help the local areas with the highest delayed transfer of care rates. The Better Care Fund (BCF) 2017-19 planning requirements, published in July 2017, aimed to “reduce delayed transfers of care (DToC) to occupying no more than 3.5% of hospital bed days by September 2017.” For those areas not meeting this target, the Department of Health stated that 2018-19 allocations of the Better Care Fund might be ‘reconsidered’. Many councils have suggested that these target rates are unrealistic.
The Better Care Fund is explained in the Library paper on Health and Social Care Integration. Section 1.3 explains how the fund is being used to tackle delayed transfers of care.
Library paper, NHS Indicators: England, October 2017 – Section 3 in particular looks at Delayed Transfers of Care
House of Lords Debate on Care Homes: Hospital Discharges, cc.395-397, 16 October 2017
NHS trusts have fined councils up to £280,000 for delayed discharges, Community Care, 13 October 2017
Council and NHS in £19.5m funding row over patients staying in hospital too long, The Sentinel, 12 October 2017
Councils warn of ‘catastrophe’ if funding is withheld, Shropshire Star, 21 September 2017
Delayed transfers of care: county councils struggle as government targets loom, Community Care, 23 August 2017
Written statement: Delayed Transfers of Care, HCWS24, 03 July 2017
Opposition Day debate on Social Care, cc.304-354 16 November 2016
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This Commons Library Briefing paper provides an overview of changes to local authority duties around the provision of adult social care during the coronavirus outbreak.