Balancing the budget between long and short term care

Savings on long-term adult social care services combined with investments in short-term services can have a positive impact on the overall spending performance of  a council.

Adult social care currently accounts for an average of 40% of a council’s budget. The majority of this spend (96.2%) is on long-term services - those that last more than six months.

Short-term care, on the other hand, looks to provide targeted, intensive support to individuals to help them quickly regain or maintain a level of independence they achieved prior to a hospital episode or illness.

By reducing the need for costly longer-term care, a shift to relying on short-term care in combination with other innovative approaches could reduce a council's spend significantly.

Reducing overall spend

We looked at the sixteen authorities with the lowest and highest proportional spend on long-term services between 2015/16 and 2017/18 to assess if changes in the proportional spend on long-term services make an impact on the total adult social care expenditure

Change in Adult Social Care spend, 2015/16 – 17/18 for the local authorities with the highest proportion of long-term spend


Source: NHS Digital

We found that those local authorities with the highest proportion of spend on long-term services also had the highest increase in spend on adult social care as a whole, with an average increase of 8.76%.

Of the councils with the lowest proportional spend on long-term services, there was only one authority with a significant increase in their total spend over the last three years. Except for that outlier, the authorities that relied on the increased provision of short-term services benefited from a lower increase in total spend on adult social care, with an average increase of just 1.24%.

Change in Adult Social Care spend, 2015/16 – 17/18 for the local authorities with the highest proportion of short-term spend


Source: NHS Digital

This comparison supports the idea that authorities that have made an intentional shift towards relying on the increased provision of short-term services and alternative approaches have made significant reductions in costs, demand for ongoing services and increased cost effectiveness in the adult social care sector.

Delivering to budget

But does this reduction in spend on long-term services translate into a council being better able to deliver to its overall adult social care budget?

For this analysis we looked at the sixteen authorities that experienced the greatest increase and decrease in their proportion of long-term spend between 2015/16 and 2017/18.

For those councils with the greatest increase in proportion of long term spend, in 2015/16 one local authority was under budget. In 2017/18, three of these authorities (42%) are now under budget.

In contrast, none of the authorities with the greatest decrease in proportion of long-term spend were under budget in 2015/16. However, in 2017/18, following a shift in spend to more short-term services, six of the eight councils (75%) are now under budget.

Delivery to budget for the sixteen authorities with the highest increase and decrease in proportional spend on long-term services


Source: Gov

Despite some good performance for those with increased long-term spend, this shows that the majority of council’s who have shifted more of their spending towards short-term services are characterised by a lower increase in their total spend and less likely to overspend their budgets.

Getting the right balance

This analysis highlights that a shift toward short-term services and innovative solutions can help local authorities better manage their adult social care budget, reducing demand and making significant savings.


  1. Adult Social Care Activity and Finance Report, England - 2017-18, NHS Digital, 2018
  2. Local authority revenue expenditure and financing England: 2017 to 2018 individual local authority data - outturn, Government, 2018

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