Intended for healthcare professionals


Bankrupt: a council in crisis and the impact on health and social care

BMJ 2019; 364 doi: (Published 05 February 2019) Cite this as: BMJ 2019;364:l172
  1. Richard Vize, freelance journalist
  1. London, UK
  1. richard.vize{at}

Northamptonshire county has a plan to stave off insolvency but health leaders are concerned that cuts will slash already rickety support for those in need, finds Richard Vize, as councils across England are increasingly driven towards offering the legal minimum of services

As the NHS in England begins implementing its plan for spending its additional £20bn (€22.2bn; $25.5bn) over the next 10 years,1 a growing number of local authorities facing financial crisis are slashing adult social care budgets.

The long term impact on health services will be profound, affecting everything from hospital discharge to falls prevention and rehabilitation. According to the Association of Directors of Adult Social Services, councils in England are taking out £700m from their adult spending this financial year, 4.7% of that budget.2

East Sussex County Council is planning to strip its services back to a “core offer,”3 which includes reducing services for vulnerable children and adults. Worcestershire County Council is looking to shed around 200 staff—which will have a serious impact on child and adult social care which accounts for almost 70% of its budget.4 Other councils facing serious financial pressures include Cornwall, Lincolnshire, Somerset, Surrey, and Torbay.

Northamptonshire County Council—whose problems have been exacerbated by mismanagement5—is in the deepest trouble. Last autumn, it adopted a financial stabilisation plan: targets include saving £700 000 by reducing long term care placements from hospital and £1.8m from “new ways of delivering care and independence.”

Local health service leaders are concerned about the impact of the cuts on the wider health and care system; many important but non-statutory services are being badly hit, such as support for welfare rights advice and a home …

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