Confidence among directors of adult social care that integration with health will deliver significant savings has plummeted while more than three quarters reported NHS partners were seeking to reduce contributions to social care or continuing health care, a major survey has found.
The Association of Directors of Adult Social Services annual budget survey found just 40% of respondents viewed health and social care integration as a very important savings priority in 2017-18, down from 82% last year.
Meanwhile 90% of directors do not expect sustainability and transformation plans to bring financial benefits for their council.
The survey received responses from directors at 138 of the 151 councils providing social care.
A quarter of respondents reported that their council had either been fined or warned of potential fines by hospital trusts over delayed transfers of care, in a sign of the pressure on health budgets as the NHS seeks to bring its spiralling deficit under control. There was no comparative data for last year, but Adass president Margaret Willcox said fines appear to be becoming more prevalent due to financial pressures on the health and social care system.
She added: ”Fines are legal under the Care Act 2014 but are counter-productive [to joint working] and some councils had declined to pay.”
HSJ reported last month that Birmingham City Council was is in dispute with Sandwell and West Birmingham Hopsitals Trust over unpaid fines for delayed transfers of care totalling £1.1m.
The report estimates that councils plan to agree a provisional better care fund total of £5.5bn in 2017-18, down from £5.36bn last year.
According to the survey £1.27bn of this was spent on protecting social care but the majority, 79%, was spent on avoiding cuts to services and therefore has not paid for any additional activity.
When directors were asked what their councils would specifically spend better care fund money on, including the extra £1bn that has been made available in 2017-18, just 32% of the 87 directors that responded to this question said it would be spent on reducing pressures on the NHS including delayed transfers of care.
Richard Humphries, senior fellow at The King’s Fund said: ”Given the huge pressures facing social care services, expecting this money to double up by coming to the aid of the NHS was always likely to prove to be a triumph of hope over expectation.”
Half of directors reported entering into risk sharing with clinical commissioning groups last year, with around the same proportion reporting that they planned to do so this year.
However, 78% of councils reported having discussions with health bodies on reductions in continuing healthcare or NHS contributions to social care, while 39% said talks had been held on better care fund reductions.
Three-quarters of directors said they were either very pessimistic or fairly pessimistic about the future financial state of the health and social care economy in their areas.