Social care 360

Despite – or possibly because of – the breadth of this review, some clear themes emerge. 

The growth in support required by working-age adults is perhaps the single biggest trend. The Family Resources Survey (indicator 4) shows a consistent rise over the last decade in the number of working-age adults identifying themselves as having a disability. More working-age people are approaching local authorities for support, and more are getting it. And more working-age adults are claiming disability benefits (indicator 5). 

The trend in the level of need for older people is less straightforward. The indicators suggest that need for social care measured as the proportion of the population is stable, or even falling. However, the numbers of older people have grown significantly (and are projected to increase more sharply in the coming decades). There is also evidence that a significant amount of need among older people is not currently being met.  

Together these three factors – rising disability among the working age population, growing numbers of older people and existing unmet need – suggest there are significant challenges for our care and support system now and in the future.

Evidence from the NHS suggests this too, with sharp rises in the number of emergency admissions for patients aged 85 years or older and in admissions for patients with multiple health conditions. That in turn identifies a second theme: the underinvestment in preventive services. The investment is not decreasing, but began from a low point. For example, the number of people receiving Disabled Facilities Grants increased significantly in 2016/17, but from a very low level. Similarly, the number of people receiving reablement services has increased in 2017/18 but, despite the strong evidence for its effectiveness, to nowhere near the potential number that might benefit. 

A third, related, theme – perhaps a more contentious one – is the tendency for indicators that relate to local authority spending to remain the same or decline while those driven by central government are more likely to increase. The most obvious example is that the number of carers supported by local government has fallen over the past four years while the number receiving Carer’s Allowance, a national benefit, has nearly doubled. Since 2015/16, the take-up of disability benefits by under-65s has also risen more than the take-up of long-term care provided by local authorities, and take-up of disability benefits among over-65s has fallen less. 

There are some complicating factors. For example, there is wide local variation that we were not able to explore. We also note that the rate of take-up of NHS Continuing Healthcare (as well as NHS Funded Nursing Care) is declining but the reason is heavily disputed. Similarly, there has been a small increase in the number of young people going into residential care but the reasons, or whether we should be concerned about them, are not clear.

It is also important to point out that we are generally reporting measures of output rather than outcome. In terms of service delivery, this means we are reporting on the numbers receiving social care services at a time when – as we show – many local authorities are moving towards a model which tries to limit receipt of formal services. 

In the section on quality, some of our indicators can be seen as 'outcomes'; however, there are other gaps in this section. We report the Care Quality Commision’s (CQC) ratings of care providers but not indicators of concern about quality, such as safeguarding alerts or complaints to the ombudsman. This is mainly because both are likely to be significantly affected by awareness of how to complain and who to complain to (we do not use complaints to the Local Government and Social Care Ombudsman as an indicator, for the same reason).

There is also a gap around the volume and type of services provided to self-funders. There are very few, if any, indicators that meet our criteria of being publicly available, annual and representative. This is a particular concern in relation to the 400,000 fewer people who receive publicly-funded social care now compared to 2009/10. These people are now outside the system and, if they are receiving formal care, are paying for it themselves, yet we know very little about them.  

Taking a broad approach does limit our ability to explore issues in depth: our analysis can often only scratch the surface, raising rather than answering questions about the trends the data shows. 

To provide as much insight as possible, however, we have used two basic principles in reporting and analysing the indicators, we use:

• real-terms financial amounts – ie, adjusting for inflation
• activity and other measures in relation to the size of the population – typically per 50,000 or 100,000 people (though we do report actual numbers where useful). 

We intend to update – and explore – the indicators periodically to explore future trends.