Social care 360

This content relates to the following topics:

The key trends in adult social care in England outlined in this report are:

  1. Requests: More people, particularly working-age adults, are requesting support
  2. Receipt of care: The number of people receiving long-term care has fallen again 
  3. Eligibility: Financial eligibility is tighter and reform has been put back 
  4. Spending: Total expenditure has increased due to the Covid-19 pandemic and is now higher than in 2010/11  
  5. Costs: Local authorities are paying more for care home places and home care. 
  6. Capacity: The total number of care home places has declined slightly 
  7. Vacancies: The staff vacancy rate is the highest since records began 
  8. Pay: Care-worker pay continues to rise but struggles to compete with other sectors 
  9. Carers: Fewer unpaid carers now receive paid support and respite care has also fallen 
  10. Quality: Quality is largely stable but fewer ratings were published during Covid-19 
  11. Personalisation: Fewer people receive direct payments 
  12. Satisfaction: Satisfaction of people using services is edging downward 

Click through for the Social care 360 sections

Access

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Requests for support >

More people, particularly working-age adults, are requesting support.

2. Service delivery

Service delivery >

The number of people receiving long-term care has fallen again.

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Financial eligibility >

Financial eligibility is tighter and reform has been put back.

Expenditure and providers

4. Expenditure

Expenditure >

Total expenditure has increased due to the Covid-19 pandemic and is now higher than in 2010/11.

5. Cost of commissioning

Cost of commissioning >

Local authorities are paying more for care home places and home care.

6 - Care home places

Care home places >

The total number of care home places has declined slightly.

Workforce and carers

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Vacancies >

The staff vacancy rate is the highest since records began.

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Pay >

Care-worker pay continues to rise but struggles to compete with other sectors.

Carers

Carers >

Fewer unpaid carers now receive paid support and respite care has also fallen.

Quality

10. Quality ratings

Quality ratings >

Quality is largely stable but fewer ratings were published during Covid-19.

11. Direct payments

Direct payments >

Fewer people receive direct payments.

12. User satisfaction

User satisfaction >

Satisfaction of people using services is edging downward.

Introduction

Key social care trends in England in 2021/22 showed signs of a return to the situation before Covid-19. 

Most importantly, the number of new requests to local authorities for support (indicator 1, requests for support) increased, but the number of people receiving publicly funded care fell (indicator 2, service delivery). This had been the case until 2020/21 but then, due to Covid-19, the number of new requests from older people fell sharply. Requests have now returned to pre-Covid levels. 

The most likely reason for this long-term trend of falling receipt of long-term care, despite increasing demand, is the fall in local authority spending power. We explore this further in section 4 (indicator 4, expenditure). 

A graph showing that compared to 2015/16, more people in England are requesting social care support but fewer people are receiving it

* This chart combines the number of people receiving long-term care services with the number of packages of short-term care support to maximise independence (ST-Max) provided. There may be some overlap between these figures: some people who receive long-term care may also receive ST-Max in a year and some people may receive more than one episode of ST-Max.

There are, however, other noticeable effects of Covid-19 that have not yet stabilised. 

The most dramatic effect is in workforce vacancies (indicator 7, vacancies). Before the Covid-19 pandemic, the vacancy rate in adult social care was a reverse mirror of the rate of unemployment in the wider economy. When unemployment was low, social care vacancies were high, and vice versa. Though the trend was in the same direction in 2021/22, social care vacancies increased by far more than the overall unemployment rate declined. 

This change explains the current workforce crisis in adult social care. 

Another continuing effect is in local authority expenditure on social care (indicator 4, expenditure). The long-term trend was a fall in real-terms spending between 2010/11 and 2014/15, followed by consistently above-inflation increases to 2019/20. Here again the trend remained the same but the increase in spending accelerated sharply in both 2020/21 and 2021/22. However, some local authority expenditure in these years was on support for the social care sector to deal with Covid-19 rather than on individuals’ care so the years are not directly comparable. 

One other change is the ‘dog that did not bark’. In last year’s Social care 360 we described the government’s announcement of a programme of reform for social care that would have meant more people were eligible for publicly funded social care (indicators 1, requests for support, and 2, service users) as well as introducing a cap on lifetime social care costs. 

In this year’s Social Care 360 we report on the postponement of those reforms.

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 2021 and 2022 there were approximately 126,000 people self-funding (34.9 per cent) their care in care homes in England, compared with 235,000 (65.1 per cent) state-funded care home residents. There is no similar data available for people who use home care.

 DefinitionMethodologySource
Introduction

Requests for support

Long-term care recipients and number of episodes of short-term support to maximise care (ST-Max)

Calculated year-on-year change 
1. Requests for supportNumber of requests for support received from new clients, by age group As reportedAdult Social Care Activity and Finance Report, NHS Digital 
2. Service users

New clients with an episode of ST-Max care and a known sequel, by age group

Long-term support during the year, by age group

Voluntary sector grants

Carers receiving financial support

As reportedAdult Social Care Activity and Finance Report, NHS Digital
3. Financial eligibilityUpper capital limitAdjusted to 2021/22 prices using September 2022 GDP deflators from HM Treasury

Local authority circulars

4. Expenditure

Total expenditure

Gross current expenditure


 

Expenditure by type of care


Adjusted to 2021/22 prices using September 2021 GDP deflators from HM Treasury

 



Calculated year-on-year change

Adult Social Care Activity and Finance Report, NHS Digital 
5. 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 2021/22 prices using September 2022 GDP deflators from HM Treasury Adult Social Care Activity and Finance Report, NHS Digital
6. Care home beds


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

Care home (residential/nursing home) beds by region 

As reported


Calculated year-on-year change

Data provided directly by CQC 
7. 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 reportedThe state of the adult social care sector and workforce in England, Skills for Care 
8. PayMedian hourly pay for care workers and other low-paid jobsAdjusted to 2021/22 prices using September 2022 GDP deflators from HM Treasury The state of the adult social care sector and workforce in England, Skills for Care 
9. Carer support

Support provided to carers during the year, by type of support provided 

Number receiving respite care

As reportedAdult Social Care Activity and Finance Report, NHS Digital 
10. QualityOverall ratings for all active adult social care locations as at 1 April of each year As reportedData provided directly by CQC 
11. PersonalisationNumber of service users receiving direct payments and part-direct payments at the year-end 31 March As reportedAdult Social Care Outcomes Framework, NHS Digital 
12. 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 
Methodology sources

GDP deflator

Population estimates

75+ population estimates

As reported

HMT GDP deflator

ONS Census

Palliative and End of Life Care Profiles, Public Health England 

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.  

  • Stuart Hoddinott, Institute for Government
  • Will Fenton, Skills for Care  
  • Matt Hibberd, Local Government Association  
  • Michael Chard, ADASS
  • Sarah Liley, Jane Winter, Robyn Wilson, Data and Analytics, NHS England 
  • Vic Rayner, National Care Forum  
  • Staff at the Care Quality Commission
  • Natasha Curry, Nuffield Trust
  • Lucinda Allen, Health Foundation 
     

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