Social care spending dropped 8% under coalition

Original post from Community Care


Credit: Monkey Business Images/Rex Features
Credit: Monkey Business Images/Rex Features

Spending on adult social care dropped 8% in real-terms under the coalition government, official figures reveal.

A total of £17.2bn was spent on adult social care on 2014-15,  the health and social care information centre data shows. This marks a reduction of 1 per cent in real terms from the previous year and an 8 per cent drop from 2009-10, the year before the coalition entered government.

The figures include local authority spending and the income councils received from people that self-fund their social care. They also include funding transfers from the NHS to boost social care budgets. The amount of health service cash transferred to social care rose from £620m in 2011-12 to £1.1bn in 2014-15.

The figures mark the latest evidence of the financial pressure on adult social care that has prompted directors to warn that the system is unsustainable and left providers fearing that some services could collapse.

Research by the Association of Directors of Adult Social Services (ADASS) found that a £4.6bn social care funding gap opened up between 2010 and 2015. ADASS’s estimate is based on:

  • A £1.6bn reduction in local authority social care budgets;
  • The need for councils to save an additional £1.75bn to ensure services can meet demographic pressures and;
  • An extra £1.25bn in costs incurred through price inflation.

Local authority leaders have appealed to the Conservative government to address the funding shortfall. The government will set out its spending priorities in the Autumn spending review.  ……..’


Hard Evidence: has the coalition made pensioners better off?

Original post from The Conversation


Pull the other one. Carl Court/PA Wire

As a reader might infer from my photograph, I am a pensioner. I mention this with the purpose of full disclosure, because I shall discuss how the likes of me have fared compared to all of you out there who must work for a living.

We find in both media and research reports many reasons why those who live to pension-receiving age represent a serious burden to society in the UK and elsewhere. Prominent among these reasons are the proclivity of the elderly to use the NHS more (I plead guilty) and the indisputable fact that the retired seem content not to engage in paid work (guilty again).

To these transgressions has been added an additional charged – the alarming growth of “intergenerational wealth inequality”, according to the FT. The Conservatives have also been accused of wooing older voters with a range of benefits denied to the hard working, doing-the-right-thing households.

The poor suffer more

Faced with these allegations, a look at the numbers is warranted. The Office for National Statistics provides quite detailed information on the income of the taxpayer categories “non-retired” and “retired”. It is unfortunate that the latest statistics are two years old, referring to tax year 2012-2013. Nonetheless, this allows a comparison of the pre-coalition result to outcomes three years later.

One of the most important aspects of earnings and pensions is their unequal distribution. The chart below demonstrates the pattern of inequality, reporting the percentage change in “final income” for those retired (blue) and not retired (red), between 2009-2010 and 2012-2013, adjusted for inflation.

“Final income” comes as close as statistics can to measuring material welfare. It includes all income payments, plus cash benefits, minus income tax, minus indirect taxes, and finally, plus all benefits in kind.

Inflation adjusted percentage change in real final income by decile. The retired (blue) and not retired (red), tax years 2009-10 to 2012-13. John Weeks|Data: Office for National Statistics, CC BY
Click to enlarge

Once we wade through all the categories and numbers, we discover that the average non-retired earner suffered a decline in final income of 8%, while the pensioner almost broke even at -0.7%. For those not retired the losses were quite similar across the board. For example, the poorest 10% of earners suffered a 10% decline, the same as for the seventh worst off, with the fifth worst off suffering a 13% decline. The smallest decline occurred for the top earners – continuing the much noted tendency towards greater inequality over the last three decades.

For the retired the story is quite different. The poorest 40% of pensioners endured a real income contraction of more than 8%. Every other earning category enjoyed an increase with the exception of a tiny decline of 0.1% in the eighth.

A clear message comes from statistics for retired and not retired households – gains and losses have a distributional dimension. Declines were much the same for the employed. In contrast, the bottom 40% of pensioners suffered serious decline, while the top 60% did not.

Private v state pensions

A second chart reiterates the importance of the distribution of pension income. It shows the inflation adjusted change in wages and salaries for the non-retired, private pensions and the state pension over the same years. The wages and salaries of non-retired households declined for the poorest 40% at about the average for all earners.

The private pension story proves quite different. The average private pension rose by inflation adjusted 12%, while the outcome for the bottom 40% was a decline of 1.3%. The state pension increased by almost 4% for the poorest 40% – by far their main source of income – and even this was less than the overall increase (5.3%). Though all state pensioners receive the same cost of living increase, earlier retirement by the more unemployment-prone explains the smaller gain for the poorest 40%.

Inflation adjusted percentage change in wages and salaries, and pension income, average and for the bottom 40%, tax years 2009-10 to 2012-13. John Weeks | Data: Office for National Statistics, CC BY
Click to enlarge

The statistics convey a lesson in caution about generalisations. Yes, on average pension incomes rose more (or fell less) than non-pension incomes under the coalition government through the tax year 2012-2013. But differences over the income distribution are dramatic – those at the top gained and those at the bottom lost out.

David Cameron and chancellor George Osborne are not attempting to “woo older voters”. Among the retired they woo the same constituency they woo in the country as a whole – the rich.  ……..’

The NHS under the Coalition Government Part 2, NHS Performance

Original post from The King’s Fund

‘….26 March 2015

This report, the second part of ‘The NHS under the coalition government’, looks at how well the NHS has performed under the coalition government. The report acknowledges that assessing the performance of any health service is an inexact science for many reasons, but using routinely available data, the report creates a conventional ‘production path’ – describing the financial inputs to the NHS before detailing its outputs, such as hospital admissions, or A&E attendances.

It draws on surveys of patient and staff experience; access to care as measured by waiting times; and data on outcomes, safety and quality of care. The report concludes with an analysis of NHS productivity and financial performance between 2010 and 2015, and an assessment of its prospects in the next parliament and beyond.

Key findings

  • NHS performance held up well for the first three years of the 2010–2015 parliament but has since come under increasing strain.
  • Patient experience of the NHS generally remains positive, and public confidence is close to an all-time high and the very limited data on outcomes, safety and quality of care indicates some improvement.
  • There are growing concerns about the quality of mental health services and challenges in achieving parity of esteem between mental and physical health.
  • A substantial NHS deficit in the final year of this parliament seems certain, despite extra funds during 2014/15 and with funding boosted more in real terms since 2010 than planned.
  • Most of the NHS is working close to its limits, and staff morale is a growing concern – making prospects for NHS performance in the next parliament extremely challenging.

Policy implications

  • The next government must commit to additional resources while avoiding grand reforming gestures. Without more funding, there is a real prospect of accelerating decline in NHS performance.
  • The NHS must renew its commitment to productivity improvements. This will involve finding time and ways to equip staff at all levels with skills in quality improvement.
  • A transformation fund is needed to pump-prime investment in new models of care on a scale commensurate with the challenges facing the health and social care system.
  • A greater priority must be given to reforming the NHS ‘from within’ – including developing leadership (especially clinical leadership) and nurturing cultures focused on safe and high-quality care.
The NHS under the coalition government front cover

Print copy: £10.00 | Buy

No. of pages: 70

ISBN: 978 1 909029 48 4

The coalition government’s record on social care

Original post from The King’s Fund

‘…..12 March 2015


Social care wasn’t a big issue in the 2010 election campaign; cross-party talks about how to pay for it ended in an acrimonious political row about the Conservative’s ‘death tax’ poster. But the sense that something had to be done about social care returned after the election with some specific pledges in the coalition’s programme of government. The centrepiece was a commitment to establish an independent commission to consider how to pay for care.

Nearly five years on, how has social care fared? Arguably, the coalition has made more progress in five years than the previous government did in thirteen. The independent commission, chaired by Andrew Dilnot, reported within a year. To the surprise of many, his central recommendations were not only accepted but also embodied in legislation that will be implemented from April 2016.

To make any headway at all on an issue that has eluded all previous attempts at reform – and in the toughest fiscal climate in living memory – is a big achievement. It establishes a symbolic milestone in social care policy – that the state places a limit on how much the individual should pay for care and extends to care and support needs the protection from catastrophic costs that we have always enjoyed for health care needs.

The coalition should receive credit too for the most comprehensive and ambitious overhaul of social care legislation since 1948. The way that the government has engaged with the sector and its stakeholders to ensure the passage of the new Care Act is a model of good practice in policy development that contrasts sharply with the experience of the Health and Social Care Act. To consign the 1948 National Assistance Act to the history books is an achievement of which any modern government could be proud.

But the coalition has undermined much of the good it has done by deciding in the 2010 Spending Review to protect NHS spending from real-terms cuts but leave social care exposed to the impact of a 40 per cent real-terms fall in financial support to local government. The transfer of some NHS funds has helped a bit, but not enough to prevent a 17 per cent fall in spending on social care for older people (see figure 1).

Figure 1: growth in population and changes in spending on adult social care, 1997-98 – 2012/13

Growth in population and changes in spending on adult social care, 1997-98 – 2012/13

Growth in population and changes in spending on adult social care, 1997-98 – 2012/13

The sharpest service reductions have been in community-based services like home care that are vital to supporting people at home and avoiding admissions to hospital and long-term care. Since 2009 25 per cent fewer people are getting publicly funded social care.

Cuts on this scale to most other public services would elicit political and public outrage. It seems ironic that although the government has given priority to protecting universal benefits for older people (such as winter fuel allowances) irrespective of need or wealth, it is older people who arguably are least well served by the sharp deterioration in access to essential care and support. Public spending on older people is not coherent.

As the financial ratchet on local government tightens, doubts grow that the Care Act will be adequately funded. The funding reforms will be complex to administer and hard for people to understand. In the absence of accompanying action to address the underlying funding position, relatively few people will benefit from the changes. As the gap between demography and resources continues to widen – to an estimated £4.3 billion by 2020 – the National Audit Office is right to warn that no one knows how much longer services can carry on absorbing these pressures.

In the meantime, the deepening fault-line between universal NHS care that is free at the point of need and social care that is rationed to people with the highest needs and lowest means is not sustainable. That is why we endorse the recommendations of the Commission on the Future of Health and Social Care in England for a new settlement in which there is a single ring-fenced budget for social care as well as health.

As the election draws closer, the NHS may attract the loudest political noise but recent pressures in emergency care have highlighted the crucial inter-dependency of social care and the NHS. The coalition has done well to pass the Care Act, but bigger change is now needed. In an ageing society social care has become too important to play second fiddle to the NHS.