Publishing a report called Papering over the cracks, the NHS Confederation analyses the demographic and financial trends in social care, assesses the impact on the NHS, and proposes a way forward.

It calls for a cross-party political consensus that addresses both the immediate cash shortfall and the need for a long-term funding solution. Without further action on funding, even the basic social care that we currently expect for the very old may not be available in the future, it says.

While the NHS Confederation has previously backed some short-term use of NHS funds as “a necessary sticking plaster”, it says that continuing to dip in to the healthcare coffers would be “a shorted-sighted policy of robbing Peter to pay Paul”.   

It warns that the NHS is already labouring to find unprecedented efficiency savings of up to £5 billion a year. It would be impossible to save an additional £2 billion a year without potentially seriously affecting the care of patients.

The report says:

The health and social care system must respond to the needs of a population that is living longer, often with a range of long-term conditions.

• The number of people aged over 65 is projected to grow by 50 per cent over the next 20 years;

• The number of people aged over 90 has risen 21 per cent in the decade from 2001 to 2011;

• The number of people with dementia is set to more than double to 1.7 million by 2050;

• Demand for local authority-funded social care is rising as a result of the economic situation but local authorities face major funding shortfalls.

As cuts in social care bite, more and more people are turning to the NHS, which has a human and financial cost.

• 66 per cent of NHS chairs and chief executives highlight shortfalls in local authority funding have impacted on their services in the past year;

• Of these, 92 per cent highlighted more delayed hospital discharges, 87 per cent more demand for community services, 57 per cent more acute admissions;

• NHS Confederation analysis shows that delayed transfers of care alone cost the NHS £545,000 a day, approximately £200 million a year;

• Figures suggest that people who need social care are more likely to use the NHS and that those receiving intensive care in residential settings have fewer hospital admissions than those cared for at home.

Funds temporarily allocated to transform services have in many areas needed to be used to paper over cracks in the social care system.

• In 2010, the Government allocated an additional £2 billion a year to social care by 2014/15, with £1 billion coming from the NHS;

• In 2012, the Government announced that an extra £300 million over two years would be found from NHS efficiency savings to support social care;

• On average 64 per cent of funds have clearly been used for transforming care while 18 per cent has been used to maintain the current level of service;

• These averages mask significant regional variation;

• Local authorities are understandably planning on the basis that this money will continue to be available as any reduction will make it harder to meet need.

The Government must implement long- and nearer-term funding solutions and recognise it will not be sustainable to fund this from the NHS

• The Treasury should find funds for the Dilnot Commission’s “practical and credible” proposals for a long-term solution, estimated to at up to £2.2 billion;

• Politicians, the Government, the NHS and local authorities should be frank about the scale of contributions the public will be liable for in future;

• In addition, a nearer-term funding package is needed that enables investment in services that save money, not just the bailing out of areas in crisis;

• The Government has said the NHS will receive a broadly flat budget settlement until 2014/15 

• But this does not account for rising demand and costs which mean the NHS must make unprecedented savings of £4 to £5 billion a year just to stand still;

• It is impossible for the NHS to save an additional £2 billion a year to plug the social care funding gap without severely affecting patient care.

Jo Webber, NHS Confederation deputy director of policy, said: “The NHS and local government are facing immense pressures.  We share the problems and we must share the solutions.

“Necessity is the mother of all invention, and the NHS and our local authority colleagues need to look at how we can radically redesign care and be more innovative in the way we integrate services for people with care needs.

“We cannot solve this problem on our own. Increased funding is a key part of this solution. Without the involvement of the Treasury, including a clear outline of how we will address long-term social care funding in the next Spending Review, we will see a decline in services and greater pressure building on the NHS.

"We support the short term transfer of NHS funds to support local social care shortfalls in funding. But the health service cannot keep on picking up the pieces of a broken social care system. If it continues to do so it will buckle under the pressure. A policy of robbing Peter to pay Paul would be very short sighted. We need to address this issue now and transform models of care, or risk paying the price further down the line."

The Confederation’s report features case studies from around the country.

Matthew Winn, chief executive of Cambridgeshire Community Services NHS Trust, says: “We are planning for worsening scenarios. On top of the 4 per cent efficiency savings we have to make annually, we have to plan to save another 3 to 5 per cent for the next two years just to keep up with demand for older people’s services. The demographic evidence about increasing demand is clear – this is not an issue for the future it is happening now.”

Ed Macalister-Smith, chief executive of Bath and North East Somerset and Wiltshire primary care trust cluster, says: “The pressures on social care will continue and indeed worsen. In the areas where joint working is the norm, these pressures are not being felt so severely within the NHS.  However where joint working isn’t so well established, the pressures are being felt more acutely.”

Michael Scott, chief executive of Norfolk Community Health and Care Trust, says: “The funding from the NHS has enabled my local authority to just keep up with demand. However if a sustainable funding solution isn’t found for social care, this will result in more older people ending up in more expensive care in hospital.”