Social care 360

This content relates to the following topics:

This year’s Social care 360 includes data from 1 April 2020 to 31 March 2021, encompassing both the first and second waves of the Covid-19 pandemic. 

Several of the trends show marked changes from previous years. One of these is clearly related to the pandemic.  

  • Public expenditure on social care increased sharply, as the government channeled money into the sector to help fund the additional costs of Covid-19. 

In others, Covid-19 is likely to have been involved but other factors might also have played a role. 

  • New requests for support from older people to local authorities went down, most likely as people avoided contact with formal care services, but requests for support from working-age adults increased.  
  • Overall, the number receiving formal long-term care services in fact went up.   

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Requests for support >

Requests for social care support continued to grow from working-age adults but fell for older people.

2. Service delivery

Service delivery >

The number of people receiving long-term care rose slightly.


Financial eligibility >

Financial eligibility for social care continues to get tighter.

Expenditure and providers

4. Expenditure

Expenditure >

Total spending by local authorities rose sharply due to Covid-19.

5. Cost of commissioning

Cost of commissioning >

The cost of commissioning care for local authorities rose in cash terms, but not in real terms. 

6 - Care home places

Care home places >

There are fewer places in nursing and care homes.

Workforce and carers


Vacancies >

Staff vacancies fell in 2020/21 but have increased again since.


Pay >

Care worker pay has increased but not as fast as other sectors. 


Carers >

More carers are getting support but it is mainly advice.  


10. Quality ratings

Quality ratings >

More adult social care services are rated ‘outstanding’ or ‘good’, though fewer ratings were published. 

11. Direct payments

Direct payments >

The number of people using direct payments continues to fall. 

12. User satisfaction

User satisfaction >

User satisfaction is high but no data is available for 2020/21.

The Covid-19 pandemic

The Covid-19 pandemic prompted action from government. In addition to extra money, Covid-19 brought about belated recognition by central government about the need for greater oversight of adult social care. As a result, important legislation has been introduced that will improve data collection and analysis in the sector and give the Care Quality Commission an assurance function with local government commissioning of social care.

However, the government’s reform agenda has focused on areas not really affected by Covid-19, with reforms to address the ‘catastrophic’ care costs that some individuals face in their lifetimes and reform of the means test announced in a White Paper published in December 2021. Even planned reforms to the provider market, aimed at ensuring that local authorities pay providers a ‘fair cost of care’ are primarily driven by the requirements of introducing a cap on care costs. While these reforms are welcome, they do little to tackle the other fundamental problems in adult social care, including unmet need, underfunding and workforce, which were highlighted by the pandemic. These remain in urgent need of a response, which the government’s social care White Paper largely failed to provide.

The pandemic caused major changes to local authority social care activity in 2020/21 and this may also have affected the data in this report. NHS Digital notes several limitations associated with the data, including those outlined below. 

  • Changes to the way in which people who were discharged from hospital were funded may have meant more people were counted as receiving support than in previous years (see Indicator 2 for more details). 
  • Local authorities reallocated resources in response to the pandemic and some activities would not necessarily have been counted in these statistics. Equally, some services, such as day centres, closed while Covid-19 restrictions and social distancing were in force, but people who had been using them might still have been counted as receiving support, even if they did not use alternative services, such as online support.  
  • Expenditure totals may not be directly comparable because some expenditure by local authorities was spent to support care providers (funding, for example, personal protective equipment costs, infection control measures and compensating for extra staffing costs due to Covid-19) rather than directly on users of services.  
  • Some weekly cost-of-care statistics may be distorted because some local authorities supported care homes through block bookings rather than for actual weeks of care delivered.  

In addition, Covid-19 had significant effect on GDP and measures of inflation. In this review, we have therefore presented some financial information in both cash and real terms.     

Read report as a PDF

Read the 2022 Social care 360 review as a PDF. 

You can explore previous editions here:

Data and methodology

This review draws on data that is:  

  • publicly available  
  • published at least annually  
  • comprehensive (or, at the very least, a representative sample)  
  • from a reliable source.  

This approach gives a broad perspective on adult social care, and especially the large part of it that is publicly funded. It does, however, have gaps, notably around people who fund their own care (sometimes referred to as ‘self-funders’), for whom there is relatively little data.  

According to the Office for National Statistics, between 2019 and 2020 there were approximately 144,000 people self-funding (36.7 per cent) their care in care homes in England, compared with 248,000 (63.3 per cent) state-funded care home residents. There is no similar data available for people who use home care. 

Requests for supportNumber of requests for support received from new clients, by age group As reportedAdult Social Care Activity and Finance Report, NHS Digital 
Service users

New clients with an episode of short-term support to maximise care (ST-Max) care and a known sequel, by age group

Long-term support during the year, by age group

As reportedAdult Social Care Activity and Finance Report, NHS Digital
Financial eligibilityUpper capital limitAdjusted to 2020/21 prices using September 2021 GDP deflators from HM Treasury

Local authority circulars


Total expenditure



Gross current expenditure

Adjusted to 2020/21 prices using September 2021 GDP deflators from HM Treasury and difference calculated from 2010/11 budget, per person rate calculated using mid-year population estimates


Adjusted to 2020/21 prices using September 2021 GDP deflators from HM Treasury, per person rate calculated using mid-year population estimates 

Adult Social Care Activity and Finance Report, NHS Digital 

Mid-year population estimate

Aggregated data for all people aged over 18 ONS Custom Age Tool 

Unit costs for clients accessing long term support – residential and nursing, by age group 

Unit costs, average weighted standard hourly rate for the provision of home care – external 

Adjusted to 2020/21 prices using September 2021 GDP deflators from HM Treasury Adult Social Care Activity and Finance Report, NHS Digital
Care home beds

Care home (residential/nursing home) beds per 100 people 75+   

As reportedPalliative and End of Life Care Profiles, Public Health England 

Care home (residential/nursing home) beds by region 

Calculated year-on-year changeData provided directly by CQC 

Vacancy rate (adult social care) 

Unemployment rate (whole economy) 

Number of adult social care jobs. Full-time equivalent jobs. Number of people working in adult social care. 

As reportedThe state of the adult social care sector and workforce in England, Skills for Care 
PayMedian hourly pay for care workers and other low-paid jobsAs reportedThe state of the adult social care sector and workforce in England, Skills for Care 
Carer supportSupport provided to carers during the year, by type of support provided As reportedAdult Social Care Activity and Finance Report, NHS Digital 
QualityOverall ratings for all active adult social care locations as at 1 April of each year As reportedData provided directly by CQC 
PersonalisationNumber of service users receiving direct payments and part-direct payments at the year-end 31 March Year-on-year change calculatedMeasures from the Adult Social Care Outcomes Framework, NHS Digital 
SatisfactionQuestion 1 combined – Overall, how satisfied or dissatisfied are you with the care and support services you receive? As reportedPersonal Social Services Adult Social Care Survey, NHS Digital 


With thanks to

Thank you to the following people and their organisations for reviewing a draft of this report, though the final text, the analysis behind it and any errors or omissions remain the responsibility of the authors.  

  • Graham Atkins, Institute for Government
  • Sarah Duggan, Care Quality Commission
  • Will Fenton, Skills for Care  
  • Matt Hibberd, Local Government Association  
  • Sarah Liley, NHS Digital 
  • Vic Rayner, National Care Forum  
  • Robyn Wilson, NHS Digital 

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