The barriers to integration between health and social care have worsened in the last year, the president of the Association of Directors of Adult Social Services has said.

Peter Hay told NHS managers at the NHS Confederation conference that four of five key factors which limit integration had got worse.

He said while there had been some improvement from the removal of some performance management in local government, financial pressures, organisational complexity, changing leadership and financial complexity “all seem to have got worse, not better”.

Mr Hay said the impact of reductions in local government budgets would have on social care had been underestimated. He said: “Anyone who says that is not going to have any impact on social care denies the reality.”

He said there was a £1bn gap in social care funding this year and Adass members had warned it will be the same or more next year. “The gap is going to get worse before it gets better,” he said.

It was difficult for local authorities to reduce their social care spend as the only way they had of doing this was tightening eligibility for services, Mr Hay said. He revealed that attempts to reduce eligibility had resulted in 20 judicial reviews nationwide as service users challenged decisions to restrict access.

He said: “We’re now spending an awful lot on lawyers. It’s good news if you have got shares in those.”

Senior fellow at the King’s Fund Richard Humphries said: “The NHS will never work properly until social care is decently and properly funded.”

He also said that although performance on delayed transfers of care had improved, there was still a wide variation. He said there was a “30-fold difference” between the number of patients being delayed across primary care trusts .

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