Health and social care reforms have placed high importance on the integration of services to improve the quality of care for people and bring about savings and efficiencies. The Government has allocated an additional £2 billion per annum by 2014/15 to social care through the NHS, with a dedicated re-ablement fund to support people recovering from hospital.
This report helps renew concentration on these aims by comparing the reality to-date against expectations. This report reveals the financial and personal costs of variations in social care provision:
- £115 million of Government expenditure earmarked as “additional” in 2011/12 for transfer from the NHS to local authorities in order to improve social care has actually been used by commissioners to prop-up eligibility criteria for existing services. Two of England’s largest cities (Sheffield and Manchester) spent all their “additional” funding (over £15 million) on maintaining existing services.
- The number of emergency re-admissions to hospital for over-75s within 28 days of discharge could be reduced by 227,400 in England if all councils could reduce their admissions to those of the best performing quarter of councils. Such improvements could result in potential national saving of £318.4 million per year for the NHS.
- There is a greater than seven-fold variation in the proportion of older people receiving homecare following a care assessment (defined as the person receiving more than ten hours per week of care in their own home).
- The Government wants to increase opportunities for people to be cared for at home to achieve efficiency savings and better outcomes. In practice, 1 in 5 people are able to access homecare following an assessment in some areas, but this applies to only 1 in 25 people in others. These variations are unexplained currently.
- The Government wants people with mental health problems to have access to services across public health, NHS and social care: this is central to the Government’s mental health strategy as outlined in No health without mental health. In practice, only 4% of the additional £648 million for social care in 2011/12 was spent on mental health services.
- There is a six-fold variation across local authorities regarding weekly expenditure on self-directed support, but this is central to the policy for personal budgets in future.
- There is a 20% difference between the best and worst performing local authorities in the proportion of people describing themselves as either “extremely” or “very satisfied” with their care and support services.
- Over 500,000 people will die in a place not of their choosing during the life of this parliament.
The authors of this report acknowledge that the social care system is inadequately funded, over-stretched and under-delivering, but this atlas shows why funding “”more of the same” will not deliver better care and outcomes automatically. They call for substantial reform to the legal and quality frameworks governing the delivery of social care services.
This report proposes 30 recommendations to improve services and update the social care quality framework, in order to make these comply with “the underlying drivers of NHS reform to provide a higher quality, tailored and more efficient, service for its users, their families and carers”.
Sloggett, R. (2012). An atlas of variations in social care: an analysis of the quality of social care services in England. London: MHP Health Mandate, June 2012.