Birmingham City Council’s future plans to cut its Adult social care budget were today thrown into question by the Birmingham Independent Improvement Panel (BIIP). In what is expected to be its final report to the Department of Communities and Local Government the Improvement Panel noted the ability of the Council to achieve £30m in projected savings as a ‘cause for concern’.
The Panel noted the failure to make these savings through the integration of health and social care services has the potential to pull the Council’s Long term financial plan off course.
According to the BIIP “The Council’s four-year financial plan sets out the need for reductions of £251m in its annual revenue costs from 2016/17 to 2019/20. The Council is aware that achieving these reductions will be extremely difficult, but the task of achieving budget reductions in future years will continue to be challenging.” (1)
The Panel regards the Adult Social Care cost reductions of £30m for 2017-18 as challenging. It notes as a cause of concern the ability to make the planned savings based on redesigning and integrating services across the local health and social care economy.
These concerns follow those of the South and Central Birmingham Clinical Commissioning Group who in their response to City Council’s Budget Consultation for 2016+ challenged the proposed level of savings. According to the city’s CCGs it is likely that only £20m could be saved over a total of four years.
The Birmingham South Central Clinical Commissioning Group responded: ‘Initial work undertaken by the CCGs estimated a maximum potential net saving to NHS budgets of £20m over a 4 year period;’ and that as a result: ‘Without understanding proposals in far more detail the CCGs are sceptical about deliverability, and concerned regarding of lack of consultation regarding plans.’ (2)
The budget proposals for Adult social care represent the largest service area for cuts within Council with a £30m budget cut expected next year, rising to £90+m by 2019/20. The Council is proposing to close and outsource a number of care services it provides for older people and people with disabilities as part of its package of cuts.
The concern of the Improvement Panel is with the so-called savings to be achieved from integrating care and health services to reduce demand on NHS. The Government has been driving the integration of the NHS and local authority commissioned adult social care services as a means to make significant cost ‘savings’ by reducing demand on acute hospital beds.
The mechanism for making these savings is the Better Care Fund which is a pooled budget for NHS and Local Authority funds. It is top-sliced from existing budgets paid to CCG’s and local councils. The Better Care Fund operates on a ‘payment by results’ basis where the CCGs receive money back from Government for achieving NHS-based targets which can then be passed on and shared with Local Authorities.
Birmingham’s Better Care Fund strategy identifies a ‘costly’ target group of largely elderly people who place greatest demand upon NHS and Social Care services. There are around 138,000 people over 65 in Birmingham. 110,347 of these (75%) were identified in both NHS and council data, and we are together spending £456m per year on their services. The aim of the integration of services is primarily to prevent this group of people entering hospital. This is a resource and austerity led initiative where people’s needs and rights are being framed as a costly problem.
The Birmingham Independent Improvement Panel in identifying the short falling of the Council’s forward Budget plans fails to mention the context and impact of the ongoing cuts to Adult social care services in recent years and their likely consequences for the NHS. Between 2011 and 2014 there has been a £100m cut to funding to Adult social care in Birmingham, a cut of the order of 27%. Net expenditure on social care services was £379m in 2011 but four years later this had reduced to £276m.
The BIIP in criticising the Council’s failure to move beyond the early planning stage in integrating services fails to mention that the Government has delayed the allocation of new monies for the Better Care Fund until 2017/18 when it will receive a further £6.7m rising to £52.4m by 2019/20.
The implementation of the Better Care Fund has been a national failure with few ‘savings’ so far realised. The BIIP once again places the failures of the Government’s austerity policies at the door of Birmingham City Council and fails to identify the true dimensions and causes of the crisis in adult social care in the city.
(1) BIIP letter to Greg Clark MP 21st March 2016.
(2) p.35 BCC (2016) Final Report on Council Business Plan and Budget 2016+ Consultation: http://www.birmingham.gov.uk/brumbudget16