EMBARGO HOURS JUNE 4 TH ADASS Budget Survey Report

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1 ADASS Budget Survey 2015 Report June

2 ADASS Trustees About Us The Association of Directors of Adult Social Services is a charity. Our objectives include; Furthering comprehensive, equitable, social policies and plans which reflect and shape the economic and social environment of the time Furthering the interests of those who need social care services regardless of their backgrounds and status and Promoting high standards of social care services Our members are current and former directors of adult care or social services and their senior staff. 2

3 Contents Foreword... 4 Methodology... 5 Key results... 6 Council budgets and savings... 6 Adult social care budgets and savings... 6 Breakdown adult social care savings... 8 Confidence in making savings Demographic Pressures Directors views of future savings Impacts of Savings Prevention Spend Activity Income 2014/15 and Planned Income 2015/ Provider Fees (inclusive of inflation) Key Drivers for home care and residential care costs in 2015/ Use of care cost calculators and paying home care costs Winter Pressures Conclusions

4 FOREWORD The annual ADASS Budget is an authoritative analysis of the state of adult social care finances and provides in-depth intelligence on how adult social care is responding to the twin challenges of meeting increased demand and managing reducing resources. The survey seeks to explore Directors views of how councils are reconciling the growing numbers of people, often with increasingly complex needs, requiring care and support with the significant and sustained reductions in the funding available. The survey data clearly sets out the concerns of councils in making increasingly difficult choices and the attempts to minimise impacts upon front line services. ADASS has set out its vision for Adult Social Care, in which the future system is protected, aligned and re-designed. This will require urgent action by Government to address the social care funding gap and by councils to continue their innovation to make the most of scarce resources to maximise outcomes for the citizens and communities they support. The survey is completed by almost 100% of councils each year and I am extremely grateful to all Directors of Adult Social Services across English Local Authorities for their support and contribution to this important work, and I would also like to express my thanks to the ADASS Resources Committee and the ADASS Staff Team for coordinating and producing this report. Ray James President Association of Directors of Adult Social Services 4

5 METHODOLOGY The ADASS Budget Survey is an annual survey conducted by the Association of Directors of Adult Social Services (ADASS), and is sent to every Director of Adult Social Services in 151 English local authorities. These Directors are full members of ADASS. There are 155 local authorities in England with adult social care responsibility, but due to their particular circumstances of jurisdiction, the following local authorities were excluded from the survey; Guernsey, Jersey, Isle of Man and Isle of Scilly. For this survey, there were 147 completed returns. This is a response rate of 97% and is line with similar response rates over the previous 4 years. The survey is issued around the same period each year and for 2015, the survey was conducted between March and April Directors completed their responses via an online link. Where possible, the survey questions have remained consistent over the last 5 years to provide a longitudinal narrative, specifically tracking budgets, levels of savings, demographic pressures and where savings have been made. Additional questions have been included over this period to strengthen the understanding of the financial position of adult social care and a number of specific topical questions are asked in each survey to reflect particular issues at that time. The analysis is validated internally by the ADASS Resources Committee which includes Directors, qualified Accountants, and financial specialists. The survey report is anonymised and aggregated to a national level. No individual council data is shared with 3 rd parties and the details of the report remain the property of ADASS. 5

6 KEY RESULTS COUNCIL BUDGETS AND SAVINGS Council Net Budget (excluding Schools) and Savings 2015/16 Council Net Budget 15/ bn Council Savings 15/16 3.6bn % Council savings 15/16 against 15/16 Council Net Budget 9.3% ADULT SOCIAL CARE BUDGETS AND SAVINGS Adult Social Care Net Budget 2014/15 Councils have delivered against their planned net Adult Social Care (ASC) budgets in 2014/15, with minimal overspend of 44m. This represents a 0.3% overspend. ASC Net Budget 14/ bn ASC Net Budget 14/15 Outturn 13.8bn Variation 0.3% Variation 44m ASC Net Budget 2015/16 Adult Social Care Net budgets have reduced by 0.5bn (3%) and have remained at the same proportion of spend against council budget as in 2014/15 (35%), illustrating the extent by which council have sought to protect front line Adult Social Care from cuts. ASC Net Budget 15/ bn % Variation ASC Net Budget between 14/15 and 15/16-4% Variation ASC Net Budget between 14/15 and 15/16 0.5bn % ASC Net Budget 15/16 against 15/16 Council Net Budget 35% 6

7 ASC Savings 2015/16 Adult Social Care savings for 2015/16 are 1.1bn (8% of Net Adult Social Care budget). In 2014/15 this was 850m. Savings in 2015/16 represents a 29% increase from planned savings in 2014/15. Since 2010, the ADASS Budget Survey has tracked a total of 4.6 billion budget reductions for Adult Social Care. This is equivalent of 31% of the 2010/11 Net Adult Social Care budget, and the 4.6 billion cumulative savings over 5 years equates to cash reductions of 1.6 billion, demographic increases of 1.75 billion and price pressures of 1.25 billion. Adult Social Care savings for 2015/16 make up 30% of the total council savings for 2015/16. ASC Savings 15/16 1.1bn % ASC Savings 15/16 against 15/16 ASC Net Budget 8% % ASC Savings 15/16 against 15/16 Council Savings 30% % ASC Savings 15/16 against 15/16 Council Net Budget 3% 2014/15 to 2015/ /11 to 2015/16 Cash Reduction ( bn) Demography ( bn) Price Pressure ( bn) Total ( bn)

8 BREAKDOWN ADULT SOCIAL CARE SAVINGS More people are living longer with more complex needs that require vital care, support and protection from adult social care in councils. But this year (2015/16) councils are running out of efficiencies and will make service reductions of 420 million to people needing that care and support and their carers. There have been 5 years of funding reductions totalling 4.6 billion and representing 31% of real terms net budgets. This year, adult social care budgets will reduce by a further 0.5 billion in cash terms. Taking the growth in numbers of older and disabled people into account, this means that an additional 1.1 billion would be needed to provide the same level of service as last year. There are more than 400,000 fewer people receiving social care services since i and of those who are still supported, a significant number will get less care. Most directors expect that still fewer people will get access to services over the next 2 years. The proportion of savings secured through efficiency has fallen from 80% of savings in 2014/15 to 75% in 2015/16 and at the same time savings from income has increased from 4% to 6%, and from service reductions from 16% to 18% over the same period, i.e. fewer savings are proportionately being made from efficiencies and more from charges and reducing frontline services % 15/16 Savings from Efficiencies %savings from Increased Income % savings from service reductions Savings from Efficiencies 807m % Savings from Efficiencies 75% Savings from Increased Income 66m % Savings from Increased Income 6% Savings from Reduced Services 192m % Savings from Reduced Services 18% 8

9 Breakdown of Efficiencies 2015/16 This is a new question for 2015 and picks out that 57% of the planned savings from efficiencies are to come from improved productivity that is doing more or the same with less. Only 4% is from managing provider fees which would suggest that councils are attempting to protect a fragile market already at low costs, and only 5% from reduced bureaucracy which might imply that councils are already very lean and efficient. 28% of the planned efficiencies is through reducing the amount of care being delivered. This covers both size of care packages and numbers being supported % efficiencies through reduced activity % efficiencies through provider fees % efficiencies through reduced bureacracy % efficiencies through productivity Efficiencies through reducing volumes of care packages 228m % Efficiencies through reduced volumes of care packages 28% Efficiencies through managing fees below inflation (0.5%) 32m % Efficiencies through managing fees below inflation (0.5%) 4% Efficiencies through reducing bureaucracy 42m % Efficiencies through reduced activity 5% Efficiencies through productivity (doing same or more for less) 463m % Efficiencies through productivity 57% 9

10 Breakdown of Service Reductions 2015/16 This is a new question for 2015, which shows that of the planned service reductions to achieve the saving targets, home care was targeted the most (54% of reported service reductions) and reductions to residential care accounted for 36% of the total reductions. The largest overall area of reductions was 30% for home care services for older people % reported service reductions OP Homecare % reported service reductions OP Residential % reported service reductions LD Homecare % reported service reductions LD Residential % reported service reductions PD Homecare % reported service reductions PD Residential % reported service reductions MH Service Reductions represented by home care for OP 40m % Service reductions represented by home care for OP 30% Service Reductions represented by residential care for OP 27m % Service reductions represented by residential care for OP 20% Service Reductions represented by home care for LD 23m % Service reductions represented by home care for LD 17% Service Reductions represented by residential care for LD 17m % Service reductions represented by residential care for LD 13% Service Reductions represented by home care for PD 9m % Service reductions represented by home care for PD 7% Service Reductions represented by residential care for PD 4m % Service reductions represented by residential care for PD 3% Service Reductions represented by MH services 14m % Service reductions represented by MH services 10% 10

11 DIRECTORS CONFIDENCE IN MAKING FURTHER SAVINGS Whilst 45% of Directors were fully confident that planned savings for 2015/16 would be met, this confidence falls sharply away beyond 2015/16 to only 5% being fully confident that savings will be met in 2017/ % 90% 80% 70% % 50% 40% 30% 20% % no confidence % partial confidence % fully confident 10% 0% 2015/ / /18 Fully confident Partial confidence No confidence 2015/16 45% 54% 1% 2016/17 7% 82% 11% 2017/18 5% 79% 16% 11

12 DEMOGRAPHIC PRESSURES Cost pressures relating to the increased numbers of older and disabled people needing care and support continue to run at 3% per year. This equates to 350m additional costs in 2015/16, of which 76% was funded by councils ( 270m). In 2014/15 councils managed to fund 83% of demographic pressures. Breakdown of Demographic Cost Pressures Cost pressures from adults with Learning Disabilities and older people living longer both the same at 42% each of the total demographic cost pressure for 2015/16. are % OP Demog pressures % PD Demog pressures % LD Demog Pressures % MH Demog pressures Total Demographic Pressures 350m Demography pressure as % ASC Net Budget 15/16 3% Demography pressures funded 270m Demography Pressures funded 77% Demography pressures funded as % ASC Net Budget 15/16 2% Demographic pressures Older People 148m % Demography pressures OP against total demography pressure 42% % OP Demography Pressures funded 78% OP Demography Pressures Funded 115m Demographic pressures Adults with Physical Disability 34m % Demography pressures PD against total demography pressure 9.5% % PD Demography Pressures funded 68% PD Demography Pressures Funded 23m Demographic pressures Adults with Learning Disability 147m % Demography pressures LD against total demography pressure 42% % LD Demography Pressures funded 79% LD Demography Pressures Funded 116m Demographic pressures Adults with Mental Health issues 24m % Demography pressures MH against total demography pressure 7% % MH Demography Pressures funded 64% MH Demography Pressures Funded 15m 12

13 DIRECTORS VIEWS OF HOW FUTURE SAVINGS WILL BE MADE Directors were asked how they would make savings, for both 2015/16 and for 2016/17 onwards. Directors report increasing reliance upon integration in making savings going forward (71% as from 2016/17 onwards), and a continued focus upon early intervention and prevention (73% as from 2016/17 onwards). There is also an increasing emphasis upon what was described as stopping unnecessary services and shifting activity to cheaper settings, along with better procurement. The majority of Directors do not see controlling wages or increasing charges as areas of importance in making future savings. This can be explained by firstly that most of adult social care budgets are spent with external providers, many of whom pay staff at or close to the minimum wage and therefore decisions about the level of the minimum are not within the control of local authorities nor providers; and secondly, the survey analysis illustrates that there is limit to how much further councils can increase charges. On the contrary, the majority of Directors have reported that wage pressures are key drivers for increased costs of residential & nursing care and home care services in 2015/16. 13

14 2015/16: Areas of savings Not % Areas of Savings relevant Low Medium High Reduced bureaucracy Better procurement Increased personalisation Control wage increases Expand independent sector provision Shift activity to cheaper settings Reduce level of personal budget Stop unnecessary services Reduce number of people in receipt of care Increase prevention / early intervention Increase user charges Integration Assistive Technology /16: Areas of Savings High Medium Low Not relevant 14

15 2016/17 onwards: Areas for Savings % Areas of savings for 2016/17 and Not beyond relevant Low Medium High Reduced bureaucracy Better procurement Increased personalisation Control wage increases Expand independent sector provision Shift activity to cheaper settings Reduce level of personal budget Stop unnecessary services Reduce number of people in receipt of care Increase prevention / early intervention Increase user charges Integration Assistive Technology /17 onwards: Areas for Savings 100% 80% 60% 40% 20% 0% High Medium Low not relevant 15

16 IMPACT OF SAVINGS 83% of Directors report that over the next 2 years there will be impacts as the result of savings being made; up from 54% of Directors reporting that the savings they are making to date will have an impact. It is noted that a number of Directors (45%) are reporting that there have been no or minimal impacts to date, but this falls to only 7% believing this over the next 2 years. ADASS carried out some further testing of the numbers of Directors reporting no or minimal impacts to date, and the emerging view is that Directors think that the savings to date will not affect their ability to meet their essential statutory duties, but this almost completely dissipates over the next 2 years, as they becoming increasingly sceptical that savings can be made (down from 81% to date to 39% believing planned savings can be made in the next 2 years). This view is further confirmed with 50% Directors reporting that they believe fewer people will get access to services, and 58% directors believing personal budgets will get smaller over the next 2 years. Directors think that there will be more legal challenges and 17% think that quality of care will worsen also over this period. The view of Directors correlates with a recent report by Carers UK (State of Caring- May 2015) which noted of the 4,500 carers responding to survey by Carers UK, 55% of carers say that they are worried about the impact of cuts to care and support services over the next year. In a report by AgeUK last year, it estimated that 900,000 people in England between the age of 65 and 89 have unmet social care needs, and experts at the charity now believe the figure is closer to one million. 16

17 Impact of savings to date % agree % disagree % don't know There are no or minimal impacts Fewer people can access ASC services People are getting smaller personal budgets Quality of life for care users is worse There is increased pressure on the NHS Quality of care is lower Planned savings will be met Providers are facing financial difficulty There are more legal challenges don't know - to date disagree - to date agree - to date 17

18 Impact of savings in next 2 years % agree % disagree % don't know There are no or minimal impacts Fewer people can access ASC services People are getting smaller personal budgets Quality of life for care users is worse There is increased pressure on the NHS Quality of care is lower Planned savings will be met Providers are facing financial difficulty There are more legal challenges don't know - next 2 years disagree- next 2 years agree -next 2 years 18

19 PREVENTION SPEND Prevention activity to increase independence and limit the need for more expensive ongoing care and support is core to national and local policy and is intrinsic within the Care Act. However the Survey shows that whilst councils are planning to spend 880m on prevention in 2015/16 and see it as a source of savings for the future, current expenditure represents only 6.6% of the budget and has fallen by 6% in cash terms since 2014/15. Spend on prevention forms 6.6% of budgets this year, a reduction in cash terms of 6% from the previous year. Yet directors see increased prevention and integration as their top two areas for savings for this year, next and beyond. 6.80% 6.75% 6.70% 6.65% 6.60% 6.55% 6.50% 6.80% 6.60% % preventative spend against ASC net ouuturn budget 14/15 % preventative spend against ASC net ouuturn budget 15/16 Spend on prevention 2014/15 937m % spend on prevention 2014/15 compared to 2014/5 budget 6.8% Spend on prevention 2015/16 880m % spend on prevention 2015/16 compared to 2015/16 budget 6.6% Difference in spend from 2014/15 to 2015/16-6% 19

20 The ADASS Budget Survey defines prevention as the services that can be accessed by people that did not cross the councils FACs Eligibility threshold; Telecare Day Services Transport Information and Advice Crisis Response Carers Services Reablement Intermediate Care Dementia Services Falls Services Meals, Laundry, Shopping and Handyman Services Stroke Recovery Employment Services Asylum Seekers Housing Related Support Voluntary & 3rd Sector Preventative Services & Support 20

21 ACTIVITY The survey asked respondents to detail numbers receiving particular services at 1 st April 2014 and at 31 st March 2015, to track changes on activity over the course of 2014/15. Extrapolating the survey responses to 100% (151 councils), there are 16,000 1 fewer individuals receiving either home care or nursing and residential care home services over the course of 2014/15. This is a projected reduction of 2.0%. Based upon the same level of extrapolation, there are 5,500 fewer older people in residential & nursing care homes, and 10,275 fewer older people receiving home care services in 2014/15 However the fall in the numbers of individuals receiving home care services in 2014/15 may be compensated for by the changes in how councils report activity in the national data collections to the Health and Social Care Information Centre, which now does not include certain types of activity such as reablement. 1 88% councils provided a full response to questions on activity (q24-27), recording a total reduction in numbers of 14,076 receiving either commissioned home care or residential / nursing home care over the course of 2014/15 21

22 INCOME 2014/15 AND PLANNED INCOME 2015/16 Unlike the NHS, Adult Social Care charges for services and this income is important to help ensure scare resources can be prioritised to those in most need and eligible for a service. Actual income in 2014/15 and planned income for 2015/16 remains similar at 2.38bn. Total Income 2014/ /16 Diff % Diff Non-residential 661m 659m Residential 1.734bn 1.722bn Total 2.384bn 2.381bn 3m -0.1% Income Non-residential % Change 2014/15 to 2015/ OP PD LD MH Older People 2.6% Physical Disability 0.2% Learning Disability -0.9% Mental Health -7.2% Income residential % change 2014/15 to 2015/ OP PD LD MH Older People -0.3% Physical Disability -2.7% Learning Disability -3.5% Mental Health 0.1% 22

23 PROVIDER FEES (INCLUSIVE OF INFLATION) Councils have kept provider fees frozen for a number of years. This year directors report that only 32 million of efficiencies will be found through this route (just 3% of overall savings). In the context of providers selling up, staff turnover, quality, wages, and the need for a million more care workers in the future, maintaining a caring, compassionate and trained workforce in a sustainable provider market is now a key concern. 56% of directors report that providers are facing financial difficulties now. Additionally there are concerns about the quality of care: in CQC s published data in April 2015, 8.7% of adult social care providers inspected were rated as inadequate and a further 31.9% as requiring improvement. Most local authorities are not going to be able to make further savings by squeezing the prices that providers are paid. Indeed it is likely that many are going to have to pay more if providers are to be able to attract workers as unemployment falls. The survey asked Directors to detail any % increase, % decrease or no change to independent sector provider fees inclusive of inflation in 2015/16 compared to 2014/15. In total 67% of councils increased provider fees, 31% councils made no changes and 2% decreased provider fees in 2015/ % Increase % decrease % no change 30% of councils increased fees between 1% and 1.9%, and 12% of councils increased fees by over 3% in 2015/16. Independent sector provider fees for older people residential & nursing care were increased by between 1% and 1.9% by approximately 38% of councils, whereas 37% councils made no change to fees for older people home care services and 21% increased older people home care fees between 1% and 1.9% in 2015/16 (inclusive of inflation). 23

24 KEY DRIVERS FOR HOME CARE AND RESIDENTIAL CARE COSTS IN 2015/16 Drivers for home care costs 83% of Directors believe pay pressures will drive unit costs in 2015/16 compounded by travel time pressures (45% of Directors) and local market issues such as lack of capacity and competition (48 % of Directors). However only 6% Directors believe overheads and 4% Directors believe that a reduction in cross subsidisation will be key drivers for home care unit costs Low % Medium % High % 24

25 Drivers for residential /nursing care unit costs in 2015/16 70% directors believe pay pressures will drive up residential / nursing care unit costs in 2015/16 and 39% believe that local market issues (lack of capacity, competition) will be a major driver. About 50% of Directors do not think that overheads and a premium to cover winter pressures and quality are key drivers for unit costs, and only 14% of directors believe that a reduction in cross-subsidisation (differences between council and self-funder rates) will be a key driver for residential / nursing care unit costs in 2015/ % 4 90% 80% 70% % 39 50% 40% 30% 20% Low % Medium % 10% 0% High % 25

26 USE OF CARE COST CALCULATORS AND PAYING HOME CARE COSTS Use of Care Calculators: home care contracts 18% of councils currently apply care calculators in setting their home care contracts and a further 9% are planning to introduce their use in the next 12 months. Home Care contracts 9 18 Yes % No % 73 Planning to introduce next 12 months % Use of Care Calculators: residential / nursing home contracts 44% of councils currently apply care calculators in setting their residential / nursing home contracts and a further 7% are planning to introduce care calculators in the next 12 months. Residential / Nursing Home contracts 7 Yes % 44 No % 49 Planning to introduce next 12 months % Paying the target United Kingdom Home Care Association (UKHCA) target rate for home care services Councils report that it would cost them an additional 278m were they to pay the UKHCA target rate of 15.74ph for contracted home care services in 2015/16. In March 2015 UKHCA calculated a minimum rate for home care services to take into account paying the National Minimum Wage and travel time. This is a guide rate set at a national level. ADASS welcomes greater transparency in reaching a fair price for care, but notes the UKHCA does not take into account local market circumstances and conditions. 26

27 WINTER PRESSURES Councils received only 5.9% ( 41m) of the 700m allocated to the NHS to respond to winter pressures in 2014/15. 26% of councils are planning for inclusion of system resilience funding in their budget plans for 2015/16 and 23% of councils were fined for delayed transfers of care in 2014/5 to a total of 2m. 2 2 Figure corrected as of 8 th June

28 CONCLUSIONS A call to government to protect essential care and support services to the most vulnerable members of our community. Service reductions: cuts are deepening More people are living longer with more complex needs that require vital care, support and protection from adult social care in councils. But this year (2015/16) councils are running out of efficiencies and will make service reductions of 420 million to people needing that care and support and their carers. There have been 5 years of funding reductions totalling 4.6 billion and representing 31% of real terms net budgets. This year, adult social care budgets will reduce by a further 0.5 billion in cash terms. Taking the growth in numbers of older and disabled people into account, this means that an additional 1.1 billion would be needed to provide the same level of service as last year. There are more than 400,000 fewer people receiving social care services since ii and of those who are still supported, a significant number will get less care. Most directors expect that still fewer people will get access to services over the next 2 years. Only 7% of directors are fully confident that planned savings can be met in and 5% in 2017/18. More Fragile Markets Councils have kept provider fees frozen for a number of years. This year directors report that only 32 million of efficiencies will be found through this route (just 3% of overall savings). In the context of providers selling up, staff turnover, quality, wages, and the need for a million more care workers in the future, maintaining a caring, compassionate and trained workforce in a sustainable provider market is now a key concern. 56% of directors report that providers are facing financial difficulties now. Additionally there are concerns about the quality of care: in CQC s published data in April 2015, 8.7% of adult social care providers inspected were rated as inadequate and a further 31.9% as requiring improvement. Most local authorities are not going to be able to make further savings by squeezing the prices that providers are paid. Indeed it is likely that many are going to have to pay more if providers are to be able to attract workers as unemployment falls. Spend on Prevention is Squeezed Spend on prevention forms 6.6% of budgets this year, a reduction in cash terms of 6% from the previous year. Yet directors see increased prevention and integration as their top two 28

29 areas for savings for this year, next and beyond. Many are struggling to balance investment in reducing future demand and costs at a time when budgets to meet existing statutory duties to provide care and support to those most in need are under such pressure. The NHS and Councils In the context of local government, councils have prioritised adult social care in the context of ongoing and significant reductions to their budgets. The survey shows that this year, as last, 35% of council budgets relate to adult social care: adult social care is 30% of total council savings. Councils have tried to protect social care spending at the cost of other services but are running out of ability to do this in the future. In the context of the NHS iii, health funding has increased from 97.5billion in to 116.4billion in , an increase of 19.3%. Over the same period, social care funding has decreased from 14.9billion to 13.3billion, a reduction of 10.7% and more in real terms when demography is taken into account. The money being transferred from the NHS is not enough to mitigate these spending reductions. Senior NHS leaders have already publically shared concerns about the funding for social care services to support people in greatest need. When the much-heralded 8 billion [NHS funding gap] figure that people have inferred from the Forward View is talked about, one of the important provisos for that was that there was not a further substantial offset in the availability of social care across the country. And to the extent that is the case that will, of course, produce more demand in the NHS. We have a shared agenda for ensuring that health and social care is contemplated in the round as we go into the next five years and the next Parliament. Simon Stephens, Chief Executive NHS England, May 2015 Our deep concern over social care funding must be addressed if we are to meet people s needs, never mind the impact that social care has on the ability of the NHS to provide safe, quality and timely treatment to those who need it. Open Letter to Prime Minister from NHS Confed, 15 th May 2015 Future Funding ADASS wants to see a social care system that is protected, aligned and re-designed. To achieve this, ADASS is calling upon the Government to urgently ensure that social care funding is protected and aligned with the NHS, including making provision for the social care funding gap alongside the funding gap for the NHS. This is paramount to securing adequate health and wellbeing outcomes for individuals and their carers and to ensuring that councils do not run out of money. Councils are doing what they can to protect adult social care funding: the government now needs to protect people needing care and support in the forthcoming budget and spending review. 29

30 Appendix 1 Further Reading Distinctive, Valued, Personal- Why Social Care Matters: The Next Five Years ADASS March i ii NHS Information Centre Community Care Statistics, Social Services Activity, England 2013/14 NHS Information Centre Community Care Statistics, Social Services Activity, England 2013/14 iii Department of Health Accounts and Departmental Expenditure Limits through to