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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.
- How the Covid-19 pandemic may have affected the statistics in this report
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.
Data and methodology
- How is Social care 360 put together?
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.
- Our methodology outlined
Definition Methodology Source Requests for support Number of requests for support received from new clients, by age group As reported Adult 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 reported Adult Social Care Activity and Finance Report, NHS Digital Financial eligibility Upper capital limit Adjusted to 2020/21 prices using September 2021 GDP deflators from HM Treasury 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 Costs
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 reported Palliative and End of Life Care Profiles, Public Health England
Care home (residential/nursing home) beds by region
Calculated year-on-year change Data provided directly by CQC Vacancies
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 reported The state of the adult social care sector and workforce in England, Skills for Care Pay Median hourly pay for care workers and other low-paid jobs As reported The state of the adult social care sector and workforce in England, Skills for Care Carer support Support provided to carers during the year, by type of support provided As reported Adult Social Care Activity and Finance Report, NHS Digital Quality Overall ratings for all active adult social care locations as at 1 April of each year As reported Data provided directly by CQC Personalisation Number of service users receiving direct payments and part-direct payments at the year-end 31 March Year-on-year change calculated Measures from the Adult Social Care Outcomes Framework, NHS Digital Satisfaction Question 1 combined – Overall, how satisfied or dissatisfied are you with the care and support services you receive? As reported Personal 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