What is social care? How many people deliver social care? How much does social care cost individuals and the state?
Our press and public affairs team, library service and policy experts deal with hundreds of enquiries every year. Below are our answers to some key questions that have been frequently or recently posed to us. If you’ve got a question, get in touch with us.
What...?
What is adult social care?
Adult social care covers a wide range of activities to help people who are older or living with disability or physical or mental illness live independently and stay well and safe. It can include ‘personal care’, such as support for washing, dressing and getting out of bed in the morning, as well as wider support to help people stay active and engaged in their communities. Social care includes support in people’s own homes (home care or ‘domiciliary care’); support in day centres; care provided by care homes and nursing homes (‘residential care’); ‘reablement’ services to help people regain independence; providing aids and adaptations for people’s homes; providing information and advice; and providing support for family carers.
Social care is often broken down into two broad categories of ‘short-term care’ and ‘long-term care’. Short-term care refers to a care package that is time limited with the intention of maximising the independence of the individual using the care service and eliminating their need for ongoing support. Long-term services are provided on an ongoing basis and range from high-intensity services like nursing care to lower-intensity community support. Both long and short-term care would be arranged by a local authority and could be described as ‘formal’ care.
Who...?
Who is eligible for publicly funded adult social care in England?
Though some services, such as advice and information, are available to anyone, most publicly funded social care in England is only available to people with the highest needs and lowest assets. People with assets worth more than £23,250 are normally not eligible (for residential care, this figure includes the value of their property, if they have one). People are usually expected to contribute towards the cost of publicly funded services from their income.
Who provides adult social care in England?
Local authorities are responsible for assessing people’s needs and, if individuals are eligible, funding their care. However, most social care services are delivered by independent sector home care and residential care providers, which are mainly for-profit companies but also include some voluntary sector organisations. Many people will also have this care organised and purchased by their local authority, though many people with disabilities directly employ individuals (‘personal assistants’) to provide their care and support.
How much...?
How much does the government spend on social care?
In England, local authorities individually decide what they will spend on social care – there is no ‘national’ government budget (though some of the amount local authorities have available to spend comes from grant funding they receive from central government to spend on social care). In 2021/22, the total expenditure on adult social care by local authorities was £26.9 billion, up £2.6 billion compared to 2010/11. However, as a result of Covid-19, some expenditure in 2020/21 and 2021/22 was on support for the social care sector rather than individuals’ care and so totals are not comparable with previous years.
Around half of this expenditure is on working-age adults, with the other half on people aged 65 years or over. For older people, the majority of spending (65 per cent) is for those who need physical support, while for working-age adults the majority (68 per cent) is for those with learning disabilities.
What is the cost of receiving adult social care?
In 2021/22, the average cost of a local authority-funded care home place for someone aged over 65 was £767 a week. For working-age adults, the cost was £1,428 a week. In 2021/22, local authorities, on average, paid £18.88 an hour to commission externally provided home care services.
There are no precise figures on spending for people who fund their own care, though the Competition and Markets Authority estimated that care home fees paid by ‘self-funders’ are, on average, 41 per cent higher than those paid by local authorities for places in the same care homes.
How much does social care cost and how many people will have to spend more than £100,000?
The lifetime costs of adult social care for older people varies considerably according to the level of their need. In 2010 the Dilnot Commission estimated 50 per cent of people aged 65 and over will spend up to £20,000 on care costs. The Department of Health and Social Care estimates that 1 in 7 will face costs of more than £100,000. However, it is very difficult to predict which individuals will have the greatest needs (for example, those who will develop dementia) so costs are very hard to prepare for.
How much do individuals spend on social care?
The National Audit Office cites an estimate from industry experts Laing Buisson that £8.3bn is spent on privately purchased social care.
Many people who receive publicly funded social care are also expected to contribute towards it from their income. In 2021/22 a total of £3.2 billion was spent on these fees and charges.
How many...?
How many people receive adult social care in England?
In 2021/22, 818,000 people received publicly funded long-term social care, primarily in care/nursing homes or in their own homes. In addition, there were 224,000 episodes of short-term care provided.
How many people work in social care in England?
In 2021/22 the adult social care sector was comprised of around 17,900 organisations across 39,000 care-providing locations with 1.79 million posts (1.62 million filled posts and 165,000 vacancies). The number of full-time equivalent filled posts was estimated at 1.17 million and the number of people working in adult social care was estimated at 1.50 million in 2021/22; more than in the NHS (headcount of 1.4 million).
How many people who request social care actually get it?
In 2021/22, local authorities received 1.98 million requests for support from new clients – 612,000 from working age adults and 1.37 million were from older people.
In total, 818,000 people received long-term care (529,000 older people and 289,000 working-age adults). There were also 224,000 episodes of short-term care.
Overall, around 43 per cent of requests for support result in some form of service, a further 26 per cent receive advice or signposting, and 30 per cent receive nothing.
Are people happy with the quality of care they receive?
In 2021/22, 64 per cent of users of publicly funded social services said they were extremely or very satisfied with the services they received and a further 24 per cent said they were quite satisfied. These numbers are slightly down from 2014/15. There are no figures about satisfaction levels of people who pay for their own care.
Why...?
Why is the cost of social care rising and how much is it forecast to rise in the future?
The rising cost of social care is driven by two main factors: increasing demand for services and increasing costs of providing them.
The number of people who need social care has risen over recent years, though this has not always been reflected in the number of people using care services. 1.98 million people requested support from their council last year, an increase of 9 per cent since 2015/16. This rate of increase has in part been driven by demographic trends. People are living longer with multiple or complex needs and therefore might require short or long-term social care.
This trend is sent to continue. Forecasting from the Personal Social Services Research Unit (PSSRU) highlights the rate at which the number of older people will grow over the next two decades.
However, demand for social care is not driven exclusively by an ageing population, the prevalence of disability among working-age adults has increased over recent years. The most recent data shows that the prevalence of disability among working-age adults is 23 per cent, up from 15 per cent in 2010/11. The same figure for older adults has remained fairly static over the same period.
As well as increasing demand, the unit cost of providing care services is also going up, driven mainly by workforce costs. Care workers, who make up the majority of the workforce, have benefited from the introduction of the National Living Wage: average care worker pay has increased from an average of £6.75 an hour in September 2012 to £9.50 in March 2022. However, it has now fallen below the average pay of shopworkers.
