2. Impact of the level of contributions or health funding on expenditure Evidence suggests that, at a national level, the amount of additional funding contributions towards individual support packages has only changed to a minor extent over the last four years. As illustrated in Figure 5, the overall relationship between gross and net expenditure has stayed close to an average of 91.2%, and the scale of Continuing Healthcare (CHC) and Section 117 contributions (NHS funded care after a hospital discharge for support or services linked to an individual’s mental health condition) as a proportion of expenditure have stayed at approximately 6%. From the data shared by the 16 local authorities who participated in this research programme, the number of individuals in receipt of Section 117 aftercare services has changed minimally, with the proportion of individuals in receipt of support in 2022/23 (6.43% of packages) being the same as 2019/20 (6.44% of packages). Similarly, at a national level, data from NHS England indicates that the proportion of individuals eligible for NHS CHC has not changed substantially, as illustrated in Figure 5. There is, however, significant variation in how healthcare contributions are applied regionally. The BBC highlighted earlier in 2024 that “NHS data shows that in some parts of England more than 50% of adults who apply get support. In other areas, it’s fewer than 10%, according to data obtained from 33 of 42 NHS Integrated Care Boards (ICBs), who run the schemes” lxvii .
With the increasing strain on budgets for ICBs – NHS Confederation’s 2024 survey found that 90% of ICBs are planning to reduce non-clinical staff costs and redesign their services to meet cost pressure lxviii – it is expected that this will feature more as a national pressure on adult social care budgets, if health partners seek to adjust this balance nationally. The ADASS Spring Survey 2024 showed that almost 74% of Directors of Adult Social Care reported an increase in disputes on CHC fundings escalated to local resolution, an increase from 64% in 2023 lxix . Through the engagement carried out for this programme, many Directors of Adult Social Care raised this issue directly, and described how they are seeing NHS partners ‘pulling back’ as their budgets tighten, resulting in increased financial pressure on local authorities. Unmitigated, this would likely apply additional increases on expenditure for working age and lifelong disabled adults by adult social care.
3. Impact of changes in inflation or by minimum wage on expenditure Analysis for this programme indicates that both these factors have had a substantial impact on increasing costs for support for working age adults and individuals with lifelong disabled conditions. As shown in Figure 2, the Consumer Price Index increased by 21.25% from March 2020 to March 2024 lxxi , and the minimum wage in the UK increased at a similar rate of 21.79% lxxii . This growth rate has been mirrored in the increasing respective cost of older adults and dementia support.
Whilst inflation over this period has been significant, the increase in costs to support working age adults and individuals with lifelong disabilities has remained above inflation. Figure 2 shows that growth in spend has always been above inflation – an average of 4.7% greater. This would mean that even in a zero-inflation forecast, or a stable 2% every year level, growth in weekly cost would still be expected.
Figure 5: CHC and S117 contributions as a proportion of expenditure lxx
2019/20
2020/21
2021/22
2022/23
Net spend as a proportion of gross commissioned spend for working age adults (England) Size of CHC and S117 contributions as a proportion of gross commissioned spend for working age adults (England) Growth in percentage of packages with S117 contributions
90.90% 91.40% 91.20% 91.40%
6.30%
6.30%
5.90%
5.80%
100%
103%
103%
100%
36 HOME
HOME
37
Made with FlippingBook - Online catalogs