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Three surprising trends in adult social care

The latest Social care 360 report highlighted key trends across the sector, from supply and demand for social care, to pay and vacancies in the workforce, to user satisfaction. I worked on this year’s report for the first time, and here are three trends that shocked me, but could easily be overlooked:

1. Ten times more working-age adults are requesting support than receiving it

Since 2015/16, the number of 18–64-year-olds requesting social care support has increased by 22 per cent, compared to a 4 per cent increase from the 65+ population. This equates to 110,000 more requests in 2021/22 than 2015/16.

Why is this? One reason is the increasing disability rate among working-age adults. In 2021/22, 23 per cent of 18–64-year-olds stated they had a disability, up from 18 per cent in 2015/16. It is safe to assume that a higher proportion of disabled people will lead to an increased need for social care support.

You might expect this increase in demand to lead to an increase in social care support, but this is not the case; while 110,000 more 18–64-year-olds requested support in 2021/22 compared with 2015/16, there was only an 11,000 increase in those receiving support. So the number of working-age adults requesting support is ten times higher than the number receiving it, revealing the pressure facing the sector.

Bar graph showing The number of working-age adults requesting support has increased ten times more than the number receiving support

2. Spending on community and nursing care has increased, but the people receiving care has fallen

Local authority spending on residential care has fallen in real terms, while other areas of spending have increased. The largest increase is spending on community-based care, which has gone up by 20 per cent since 2015/16.

But an increase in expenditure on care does not necessarily mean more people are receiving it. To my surprise, between 2015/16 and 2021/22 the number receiving community-based care actually fell by 22,000. And the same thing happened in nursing care – spending went up while the number of people receiving care went down. The exception was residential care, where both spending and number receiving care fell.

Bar chart showing Spending on nursing and community care has increased, but fewer people are receiving care

Why is this? One reason is that the price local authorities have to pay for care has increased. Home care went up by 14 per cent (after adjusting for inflation), and residential and nursing care 17 per cent between 2015/16 and 2021/22. While these increases were necessary due to past prices being too low, this does mean that the same amount of money buys fewer units of care than it used to, and even if expenditure increases, it may not be enough to afford the same amount of care as before.

3. Fewer people are receiving respite care

With 5 million unpaid carers in England and Wales, 1.5 million of whom provide more than 50 hours of care a week, respite care is vital for these carers to have a break, both for their own wellbeing and for of the amount of money they save – in 2020 Carers UK estimated the value of unpaid care at £193 billion per year.

It is therefore worrying that one of the starkest falls in social care support is the number of people receiving respite care. Between 2015/16 and 2021/22 the number of people drawing on respite care fell by 42 per cent – from 57,000 to 33,000. Fewer carers are getting a rest, increasing the risk of exhaustion and burnout, and the likelihood that they will be unable to continue their caring responsibilities, which would in turn increase demand for local authority care.

Bar chart showing The number of people receiving respite care has fallen substantially since 2015/16


All of these trends are alarming and point to fundamental problems in adult social care. The issue with working-age adult demand is part of a wider problem in which 168,000 more adults requested support in 2021/22 compared to 2015/16; the fall in receipt of nursing and community care is part of a wider fall in receipt that has seen 42,000 fewer people receive care; and the fall in respite care receipt is part of a picture for carer support that has seen no increase in the number of carers supported since 2015/16 and fewer receiving paid support rather than advice and information.

These highlight a major problem in the sector – that it is not currently able to provide the volume and quality of care that is needed.

A health care working and a senior citizen in front of a home
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Social care 360

Our latest 360 review outlines and analyses 12 key trends in adult social care in England over recent years.

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