Social care 360: access

1. Requests for support

More people, particularly older people, are requesting support

Why is this indicator important?

New requests for support to local authorities are the best available marker of demand for adult social care services.

What was the annual change?

The number of new requests for support increased from 1.98 million in 2021/22 to 2.0 million in 2022/23. The main reason for this was an increase in requests from older people, which went up by more than 23,000, from 1.37 million in 2021/22 to 1.39 million in 2022/23. The number of requests from working-age adults was essentially unchanged at 612,000.

Overall, requests for support were equivalent to nearly 5,500 requests every day of the year. There were 1.46 requests per person, meaning that 1.37 million people asked for help during the year.

What is the longer-term trend?

In 2022/23, requests for support exceeded 2 million for the first time, but there is still a significant difference between the different age bands. Among working-age adults, requests for support have increased 22%, from 501,000 in 2015/16 to 612,000 in 2022/23. Among older people, they have increased 6%, from 1.31 million to 1.39 million. Overall, the increase is 11%, from 1.81 million to 2 million.

The source of requests for support has not changed significantly since 2015/16: around 4 in 5 requests originate from the community and 1 in 5 from hospital discharge.

What explains the trends?

After a fall in 2020/21 during Covid-19, when requests from older people fell sharply, requests have returned to the general trend seen since 2015/16 of increasing demand for social care services. 

This is likely to reflect both an increasing older population and increasing disability among working-age adults: 14.8 million working-age adults in the UK reported a long-term health condition in 2022/23, compared to 11.7 million in 2013/14, and 4.0 million people reported a severe disability, up from 2.9 million in 2013/14. 

What happened in 2023/24?

There were continued delays in responding to requests for support. A survey by the Association of Directors of Adult Social Services in autumn 2023 reported that nearly 250,000 people were still waiting for adult social care assessments at the end of August 2023. While this was a fall from the peak of 294,000 in April 2022, it was up from 225,000 at the end of March 2023.

2. Receipt of social care

There was an upturn in people receiving publicly funded support in 2022/23

Why is this indicator important?

Receipt of publicly funded long- and short-term care are the key measures available to assess the extent to which demand for social care is being met (see indicator 1, requests for support).

What was the annual change?

The number of people receiving publicly funded long-term care rose from 818,000 in 2021/22 to 835,000 in 2022/23. This was made up of a small increase in the number of 18–64-year-olds receiving long-term care, from 289,000 to 293,000, and a larger increase in the number of older people receiving long-term care, from 529,000 to 543,000.

In short-term care to maximise independence (ST-Max), there was a very small overall increase from 224,000 to 225,000, made up of a 4,000 increase among older people and a 3,000 decrease among working-age adults.

What is the long-term trend?

Since 2015/16, there has been a small increase in the number of working-age adults accessing long-term care, from 285,000 to 293,000 (2.7%), but a larger fall in the number of older people receiving long-term care – down from 587,000 to 543,000 (-7.7%). Overall, 835,000 people received publicly funded long-term care in 2022/23 compared to 873,000 in 2015/16.

When increases in population size are taken into account, the fall is even starker. In 2015/16, 6.0% of people aged 65 and over were receiving long-term care but by 2022/23 this had fallen to 5.2%. The percentage of the working-age population receiving long-term care was largely unchanged, at 0.9% in both years.

With ST-Max, there has been an increase in provision for both working-age adults, up from 21,000 to 25,000 (18.5%) since 2015/16, and older people, up from 190,000 to 200,000 (5.3%).

What explains this?

The year-on-year upturn in the numbers receiving long-term care is best accounted for by:

• the reducing impact of the Covid-19 epidemic, with greater service availability, reduced staff vacancies compared to the previous year and, perhaps, increased willingness to come forward for services

• a reduction in the number of people who had been on waiting lists for assessment or services, again due to the reducing impact of Covid-19. The Association of Directors of Adult Social Services said that a ‘huge effort’ by social care teams had reduced care waiting lists from 542,000 in April 2022 to 430,000 at the end of March 2023.

An alternative – or possibly additional – explanation for the increase in receipt could be that increased funding for local authorities had an impact on adult social care service delivery in 2022/23. The local government financial settlement increased spending power of local authorities by up to 6.9% in cash terms, while plans to introduce social care charging reform were shelved in the 2022 Autumn Budget and the funding redirected to ongoing expenditure.

However, this explanation seems inadequate. Local authorities said that the increase in spending power would not be sufficient to meet the pressures on them in 2022/23, including from adult social care. Outside observers agreed: in August 2022, the cross-party Levelling Up, Housing and Communities Committee said that the government ‘urgently needs to come forward with additional funding this year to help the ravaged adult social care sector meet immediate pressures’. Nor could postponement of social care charging reform have been a significant factor because the additional funding for social care announced in November 2022 only came into force in 2023/24.

A further possible explanation is local authorities increasing uptake of more preventive approaches to care and/or the wider adoption of ‘strengths-based’ approaches, which seek to focus on support that might be available from an individual’s wider support network and community, rather than through the provision of formal care and support. However, it is noticeable that there has been no significant change in indicators that might suggest such an approach has been taken, such as support for carers (which has fallen since 2015/16, see indicator 9, unpaid carers), investment by local authorities in the voluntary sector (which has also fallen: see Social Care 360 2021/22) and use of short-term care to maximise independence (which has seen relatively modest increases in packages provided).

3. Financial eligibility

Financial eligibility continues to tighten and reform has been postponed

Why is this indicator important? 

Unlike the NHS, social care operates a financial assessment (a ‘means test’) to decide who is eligible for publicly funded care. The levels of this are set nationally and announced each year. The ‘upper threshold’ decides the level of savings and other assets people can have and still qualify to receive publicly funded care. The lower that figure is, the fewer the people who qualify.

What was the annual change?

In 2022/23, the upper threshold remained at £23,250.

What is the longer-term trend?

The upper threshold has not changed since 2010/11. If it had increased in line with inflation,* in 2022/23 it would have been £7,080 higher at £30,330, so more people would qualify for support.

What explains this?

By not increasing the threshold in line with inflation, successive governments have made the means test even meaner: it has become harder for people to get publicly funded social care, reducing its cost to the taxpayer. However, another key measure, the Minimum Income Guarantee, which defines the lowest amount of income an individual needing care at home must be left with after care charges, has increased in line with inflation since 2021/22 – after several years of being frozen.

What has happened in 2023/24?

The upper threshold remained at the same level for 2023/24 and will be the same in 2024/25. However, the Minimum Income Guarantee rose in line with inflation and is due to increase again in 2024/25.

In October 2025 (as part of wider reforms of adult social care originally intended to be introduced in October 2023 and which include the introduction of an £86,000 cap on care costs), the upper threshold is due to rise to £100,000 and the lower threshold is due to rise to £20,000. This would require preparatory action in 2023/24.