• This briefing offers an analysis of the size of the gap in adult social care funding in England – at least £2bn in 2017/18.
  • This estimate is based on information provided on the position of social care funding in 25 of the 44 Sustainability and Transformation Plans (STPs).
  • The briefing draws on interviews with a range of STP leaders and argues that the social care funding gap has significant implications for STPs. Insufficient funding risks their ability to improve care and put services on a more sustainable footing.

Download The social care funding gap – implications for local health care reform.

Key points

  • The visible squeeze on NHS funding has added a powerful urgency to local plans to reform health and care services, known as STPs.
  • The 44 STPs across England bring together a coalition of local hospital, primary care and social care bodies to think collectively about how to respond to the challenges of a growing and ageing population. The plans contain ambitious proposals to close the gap between demand and available funding by improving the prevention of ill health; making more efficient use of hospital and specialist care; and by delivering care, when possible, closer to people’s homes. 
  • Successful implementation of these plans will require a robust social care sector. Six years of real terms reductions in social care budgets have left 400,000 fewer people receiving essential help, as well as destabilising the providers of care, leading to some going out of business. Social care is essential for people to lead as independent a life as possible, and to ensure they can be moved out of hospital safely and quickly. 
  • Our analysis of STPs suggests that the funding gap for adult social care is at least £2bn in 2017/18. This figure is in line with other estimates.
  • Many of the STPs include proposals to improve the care of older people, often requiring effective and accessible social care. 
  • We interviewed local STP leaders and found that the size of the social care funding gap identified in the STPs may be an underestimate. They also reported that, while health and social care were working well together in some areas, in others the social care funding situation was creating strain in the relationships between sectors.
  • So far, the government has allowed local authorities to raise additional funding through a new council tax precept and committed an additional £1.5bn of central funding for social care by 2019/20. However, this is insufficient to meet the rising needs on the social care system, and the benefits will not be fully realised until the end of the parliament. 
  • The 2017 budgets need to provide significant additional funding for social care to ensure proper support for those people and their families who are struggling to manage, and to protect the NHS from inefficiency.


Dr Umesh Prabhu

Very well written paper and brilliant analysis. As Simon Stevens said 'We will not transform NHS without transforming social care. It is important to fund both social care and NHS properly, But simply giving more money without transforming acute sector, Primary care, community care, we will not be able to transform NHS or social care.

NHS and social care are two jewels in the crown of our great nation and we must be very proud of these two Institutions. Both of them need to be transformed together but without good leadership, good governance and accountability for leaders and good investment in IT with common Electronic Paper Record (EPR)and common Radiology and Pathology EPR, we will not be able to transform anything.

Devomanc is supposed to be pilot for the nation and this paper is timely. But none of the reforms or transformation will work unless we get the basics right and that is good leadership, good governance and good accountability for all leaders to deliver. NHS will not be successful if same old leaders are appointed to do transformation, Same old leaders do the same old things in same old way. Of course, NHS does have some fantastic leaders and must retain these excellent leaders who have been successful and appoint some new leaders, new blood and new vision and there has to be excellent staff, patient and public engagement and then only NHS and social care can be successful.

With 45% doctors and 25% of staff working in NHS being Black and Minority Ethnic (BME) unless we get Work Force Race Equality right, I very much doubt if we can transform or make NHS and social care safer and better.

90% of the Trusts and CCGs BME staff are 3 to 15 times more unhappy. Unhappy staff - unhappy patients. I sincerely urge all senior NHS leaders to look at this important issue and appoint some good BME leaders who are values based in to various leadership positions in the NHS. When any one community is not involved or engaged then we are not a community and we create a culture of 'Them and Us' and in such a culture everyone suffers.

Equality and inclusion says a lot about is as a society and hence it is important to get this right.

Jeanette Lodge

Isolation is now recognised as being a cause of ill health. Many small local charities address this issue within communities with evidence to show that their interventions are effective. Despite this, most of the third sector would express disappointment that, despite occasional funding from CCGs, via Local Authorities, very few referrals are received from health professional. The charities often have difficulties in identifying those who they could support because of their isolation and so need the help of those 'in the know' to pass on information about services and activities within the 3rd sector which would be beneficial to health and wellbeing. Increased numbers within community groups makes them more viable and so the referrals not necessarily money are of importance to the sector.
I am sure that more use of these local organisations would lead to savings within the Health and Social services by keeping individuals involved with their communities, making new friends and becoming more active.
Most local authorities have a fairly comprehensive list of groups in their area.

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