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A short-term approach to reducing adult social care costs

Matt Custance Matt Custance

Long-term care continues to represent a significant proportion of total spend on adult social care in England.

We take a look at the benefits of increasing the focus on short-term care, to see how local authorities can better balance their adult social care budgets.

Regional variations in spend

Our research shows that between 2015 and 2018, all regions experienced an increase in their long-term services spend. Nationally, the average proportion of long-term services expenditure was 96.2% in 2017/18, and there was very little variation in this figure across the regions.

However, diving into each region unearths variation across local authorities. Of the 324 local authorities in England, only eight were found to have a considerably lower long-term services spend.

Of the eight councils with the lowest proportion of long-term services expenditure, with 9% or more of their expenses going towards short-term service provision, six were London boroughs . Only one local authority stood out as having almost a fifth of its total spend designated to short-term services (see graph below). 

Top eight local authorities with highest and lowest proportional spend on long-term services 2017/18

Graph to show top eight local authorities with highest and lowest proportional spend on long-term services 2017/18

Source: NHS Digital

The advantages of short-term care

While these figures show that the pressure in the system is still forcing spend up, they also suggest that there is an intentional shift towards the provision of short-term services among  several local authorities.

This could be seen as an antidote to long-term care costs. Short-term care looks to provide targeted, intensive support to individuals to help them regain independence or maintain the level of independence they achieved prior to a hospital episode or illness.

Increasingly, short-term interventions are commissioned collaboratively with NHS partners. This reflects a move towards more integrated services and an understanding of the mutual benefits that can be achieved for the two sectors, as well as the individual receiving services.

Alternative solutions to support patients

Investment in short-term care is not the only way local authorities are looking to address the costs of long-term care.

Following austerity and budget cuts, local councils have had to save money in all parts of the social care system, including home care. This has led to some councils substituting formal care for solutions that make better use of an individuals’ own networks and local community organisations.

Two such approaches are ‘social prescribing’ and ‘the three conversations’. Social prescribing is when health professionals refer patients to community groups and support services in order to improve their health and wellbeing. The three conversations model also makes use of personal, family and community connections, while taking into account any additional needs and how these might be addressed.

Alternative approaches can lead to a significant reduction in demand on the adult social care sector. A review of the impact of social prescribing showed that the scheme led to cost reductions of between £265 and £378 per patient over a 12-month pilot period in 2014. The Local Government Association also calculated that social prescribing could significantly increase the cost effectiveness of primary prevention, with up to £21 saving for every £1 invested on certain social projects.

Shifting spending patterns

By ensuring that users of social care remain at home and connected to their community for longer, local councils can reduce demand on the sector while advancing care outcomes for individuals. This shift in focus and spend is also likely to have a positive impact on the financial performance of local councils.


Adult Social Care Activity and Finance Report, England - 2017-18, NHS Digital, 2018

For more information, get in touch with Matt Custance.

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