Demand for adult social care hits record high while support from local authorities drops

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There are more requests for publicly funded social care in England than ever before, yet the number of people receiving it continues to fall, finds a new report from The King’s Fund. 

The latest figures show that requests for support from both older people, and particularly working age adults, have increased significantly to around 1.98 million. Yet the number of people receiving long-term care has fallen to 818,000 in 2021/22, a 55,000 drop from 2015/16. Older people have been worst affected, with numbers receiving long-term care down to 529,000 in 2021/22– a fall of 23,000 in just one year. 

The authors of Social care 360 say the most likely reason for this long-term trend of falling receipt of care, despite increasing demand, is the financial challenges facing local authorities, who pay for publicly-funded social care. The cost of commissioning care is also rising. 

The review shows that requests for adult social care had been steadily rising since 2015 but then sharply fell in 2020/21, most likely reflecting a reluctance for people to come forward for services during the Covid-19 pandemic. Requests have now bounced back to reach an all-time high.

The total number of new requests for support increased from 1.92 million adults in 2020/21 to 1.98 million in 2021/22. The number of new requests from working-age adults increased from 578,000 in 2020/21 to 612,000 in 2021/22 (5.8 per cent). Requests from people aged 65 and over increased from 1.34 million in 2020/21 to 1.37 million in 2021/22 (2.2 per cent).   

The authors say the increase in requests from working age adults is likely to reflect increasing disability among adults aged 18–64. In 2020/21, 21 per cent of people in this age range who requested support reported living with a disability, compared with 18 per cent in 2015/16 and 15 per cent in 2010/11. Among older people, prevalence of disability has, if anything, fallen but balancing this has been an increasing number of older people in the population. 

Simon Bottery, Senior Fellow at The King’s Fund and lead author of the review said: ‘It’s likely that local authorities will see the number of new requests for adult social care pass the 2 million mark for the first time this year but, on current trends, fewer people will end up receiving long-term support. That means that more people will have to pay themselves, rely on family and friends – or go without care entirely.’

The review also shows that staff vacancies in the social care sector are now the highest since records began. Between 2020/21 and 2021/22, the number of vacancies in adult social care rose from 110,000 to 165,000. However, while care-worker pay continues to rise due to increases in the statutory minimum wage, it struggles to compete with other sectors. Most services are commissioned by the local authority but provided by private sector or charitable organisations and average care-worker pay in these organisations in 2021/22 was £9.66 an hour, an increase of 3.5 per cent in real terms since 2020/21. 

Simon Bottery explained: ‘Social care providers continue to face a crisis in recruitment. Vacancy rates in adult social care are higher than in the NHS and much higher than in other areas of the economy such as retail, education, and manufacturing. A critical factor in recruitment is pay: around half of all care workers would be better off in entry level roles in England’s supermarkets.’

The review identifies a number of other key trends:

  • Local authorities are paying more for care home places and home care. In real terms, the average weekly fee paid by local authorities in England for care homes places for working-age adults rose by 2.5 per cent, to £1,428 in 2021/22. The average weekly fee for older people’s care home places increased 2.6 per cent to £767. The average hourly rate for externally commissioned home care rose 2.9 per cent to £18.88.  
  • Total expenditure in 2021/22 was £2.6 billion more in real terms than in 2010/11 but this reflects short-term, Covid-related funding – some expenditure in 2020/21 and 2021/22 was on support for the social care sector rather than individuals’ care and totals are not comparable with previous years.  
  • The number of unpaid carers receiving direct support from local authorities fell from 338,000 in 2020/21 to 314,000 in 2021/22. The number of carers receiving support has not increased since 2015/16 and fewer of them now receive paid support such as cash payments. The number of people provided with respite care has also fallen, from 57,000 in 2015/16 to 33,000 in 2021/22. 

Simon Bottery added: ‘The review shows that many of the critical indicators for adult social care are going in the wrong direction yet the government’s main reforms, such as the introduction of a cap on lifetime care costs, have now been postponed until 2025 and there is little action so far on critical issues such as workforce and carers. The government has an opportunity to move from words to action in its reform plan, promised for the Spring. 

‘There is an urgent need for more funding and fundamental reform of a publicly funded social care system from which so many people are shut out.’

Notes to editors

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The King's Fund is an independent charity working to improve health and care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible health and care is available to all.