Social care 360

The data shows us that the social care sector had been fragile for several years and that the unprecedented challenges for the sector in responding to Covid-19 started from this unsteady foundation. 

The data shows that spending by councils on social care has risen since the low of 2014/15 (though in real terms it remains below the 2010/11 level). Much of that money has been spent on trying to shore up a fragile provider market, with a consistent, above-inflation increase in the fees paid for residential, nursing and home care. While overall expenditure by councils on social care is now £942 million more in real terms than in 2015/16 (see indicator 6), spending on commissioned services from external providers has risen by £1.4 billion. 

However, this spending has had only limited impact: local authorities continue to report companies handing back contracts or going out of business, and service users report difficulties in finding the care they need. And while some of the extra money has been used to provide a welcome boost to care workers’ pay, this has not stopped vacancies from rising. Tackling these problems will be at least as important a challenge after the coronavirus epidemic as it was before.

As well as shining a harsh light on the fragility of the sector, the epidemic is already causing changes to the delivery of social care and its connections to other services, most obviously the NHS. It will certainly have effects – even if short term – on some of the key indicators in this report, such as requests for support, receipt of care, expenditure, and on specific measures such as delayed transfer of care from hospital. Some of next year’s indicators may therefore look quite different from this year’s.

However, alongside understanding these, it will also be important to remember some of the key longer-term trends in social care that reform will need to address. These may not have been as obvious during the Covid-19 crisis. They are described below. 

Fewer people are receiving publicly funded care...

A key trend in adult social care continues to be an increase in demand for care (see indicator 1) but a fall in the numbers of people accessing it (see indicator 2). Since 2015/16, local authorities have received over 100,000 more requests for social care support (a 5.7 per cent increase) but more than 18,000 fewer people1 have received it (a 1.7 per cent decrease).

...but there is a big difference between age groups

The overall picture obscures a big difference between the numbers of under-65s and over-65s receiving care. More working-age adults (under-65s) are getting support, but that increase is wiped out by a much larger fall in the number of older people (over-65s) getting support. Increasing demand for care from working-age adults does not just raise questions about meeting need but also challenges many people’s assumptions that the pressures on adult social care are simply the result of an ageing population. It also raises questions about the models of care we want, the type of system we may need in future, and how we should fund it. 

There is a shift from long-term to short-term support

The type of care being received is also changing, in that more people are receiving short-term care and fewer are receiving long-term care. This is seen most obviously in long-term care packages for older people, which have fallen by 7 per cent since 2015/16, while short-term care packages designed to maximise independence (ST-Max) have increased by 2 per cent. This trend can also be seen in provision of NHS Continuing Healthcare, where the numbers receiving short-term ‘fast track’ care have increased by 40 per cent but the numbers receiving standard, long-term care have fallen by 16 per cent. Short-term care can be the most appropriate form: in social care, it may involve helping people get back on their feet rather than going into long-term care. But it is not clear whether this is really what is driving the shift or whether other factors – including service availability and funding – are playing more of a role.

There remain too many knowledge gaps to explain all these trends 

There are too many gaps in our knowledge to paint a full picture of trends in adult social care. We can identify those gaps even if we cannot yet fill them. A critical gap concerns data about self-funders, where in most cases we are reliant on estimates of service use, expenditure and satisfaction. An even more fundamental gap, however, concerns the outcomes of receiving care; we know far too little about the impact of using adult social care services on the lives of those accessing care, their families, and on the wider health and care system. A further issue is local variation: here, we have the data but remain largely in the dark about the reasons for the differences it reveals. Addressing these gaps should be a fundamental part of the wider reform of social care.

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• 1. This figure combines the number of people receiving long-term support and the number of packages of short-term support to maximise independence (ST-Max). There will be some overlap between these two numbers because some people receive both types of support in a year and some people receive more than one package of short-term support. Nonetheless, it is the best available figure of overall care system output. have received it (a 1.7 per cent decrease).

You can read the 2020 Social care 360 review as a PDF here.

You can read the 2019 Social care 360 review as a PDF here.