Social care 360

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People often complain about the lack of data about social care; there is, in fact, a significant amount but it is often held in fragmented databases that are rarely explored.

This review outlines and analyses 20 key trends in adult social care in England over recent years. It draws on data that is:

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

It takes a broad perspective, including indicators that relate closely to health, housing, benefits and carers, as well as to the services provided by local authorities, and in doing so provides a uniquely rounded – a '360 degree' – view of the sector. The review is structured into six sections, which you can access below.

Click through for the Social care 360 sections

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Access >

Who is accessing care and how has this changed over time?

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Expenditure >

How much is spent on social care and what's it costing councils?

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Providers >

Have nursing and residential home places decreased?

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Workforce and carers >

Who's working in care and what's the role for carers?

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Quality >

What do quality and satisfaction ratings say about care?

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Integration with other services >

How well does social care work with other related services?

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

Emerging themes

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.  

Our approach

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.

Full methodology

 DefinitionMethodologySource
DemandNumber of requests for support received from new clientsData calculated as a per 100,000 population rate and indexed to 2015/16Adult 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

Long-term support during the year

Data calculated as a per 100,000 population rate and indexed to 2015/16Adult Social Care Activity and Finance Report, NHS Digital
Financial eligibilityMeans test threshold upper limitAdjusted to 2017/18 prices using December 2018 GDP deflatorsApproaches to social care funding, Health Foundation and The King’s Fund
NeedDisability prevalence by age groupAs reportedFamily Resources Survey
 

Mid-year population estimate

Population projections

As reportedOffice for National Statistics
Disability benefits

Attendance Allowance: cases in payment

Disability Living Allowance: cases in payment

Personal Independence Payments: claims in payment

Data calculated as a per 100,000 18+ population rateDepartment for Work and Pensions (DWP Stats-Xplore)
Local authority expenditureExpenditure (including capital) – totalAdjusted to 2017/18 prices using December 2018 GDP deflatorsAdult Social Care Activity and Finance Report, NHS Digital
 Income – client contributions, joint arrangements, income from NHS, other incomeAdjusted to 2017/18 prices using December 2018 GDP deflatorsAdult Social Care Activity and Finance Report, NHS Digital
Cost of buying careUnit costs for clients accessing long-term support – residential and nursingAdjusted to 2017/18 prices using December 2018 GDP deflators and calculated year-on-year changeAdult Social Care Activity and Finance Report, NHS Digital
 Unit costs, average weighted standard hourly rate for the provision of home care by activity provisionAdjusted to 2017/18 prices using December 2018 GDP deflatorsAdult Social Care Activity and Finance Report, NHS Digital
Number of nursing and care home beds

Care home beds per 100 people 75+

Nursing home beds per 100 people 75+

As reportedPublic Health England Fingertips Tool – End of Life Profile
JobsEstimated number of full-time equivalent (FTE) adult social care jobsCalculated year-on-year changeThe size and structure of the adult social care workforce, Skills for Care
VacanciesVacancy rate – all job rolesAs reportedThe state of the adult social care sector and workforce in England, Skills for Care
CarersSupport provided to carers during the year, by type of support providedAs reportedAdult Social Care Activity and Finance Report, NHS Digital
 Carer’s Allowance: cases in paymentNumber in payment as at Q4Department for Work and Pensions (DWP Stats-Xplore)
Care qualityThe percentage of care services rated outstanding or goodAs reportedChart published in State of Care, numbers provided directly by CQC
User 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
Public satisfaction

How satisfied or dissatisfied are you with social care provided by local authorities for people who cannot look after themselves because of illness, disability or old age?

All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?

As reportedBritish Social Attitudes Survey, King’s Fund analysis of NatCen Social Research’s BSA survey data
Direct paymentsNumber of service users receiving direct payments and part-direct payments at the year-end 31 MarchAs reportedAdult Social Care Outcomes Framework, NHS Digital
Care home admissionsThe number of council-supported younger/older adults whose long-term support needs were met by a change of setting to residential and nursing care during the year (excluding transfers between residential and nursing care)Data calculated as a per 100,000 population rateAdult Social Care Outcomes Framework, NHS Digital
Delayed transfers of careNumber of delayed days during the reporting period, acute and non-acute, for NHS organisations in England by the responsible organisationData calculated as 12-month rolling averageNHS England
ReablementNumber/proportion of older people (aged 65 and over) discharged from acute or community hospitals to their own home or to a residential or nursing care home or extra care housing for rehabilitation, with a clear intention that they will move on/back to their own home (including a place in extra care housing or an adult placement scheme setting)As reportedAdult Social Care Outcomes Framework, NHS Digital
CQCNHS Continuing Healthcare cumulative activity year to date from 1 April, EnglandAs reportedTime series data provided directly by NHS England, most recent years available publicly
Disabled facilities grantAverage number of disabled facilities grants completed per authorityAs reportedDisabled facilities grant (DFG) and other adaptations – external review
 Funding for disabled facilities grants – central government fundingAs reportedDisabled facilities grants for home adaptations, House of Commons Library

With thanks to

With help at The King's Fund from Richard Humphries, Ruth Robertson, Dan Wellings, Siva Anandaciva, David Maguire, Dave Buck.

Many people in many other organisations provided support for this work by discussing the indicators and the trends behind them and by reviewing copy, often more than once. Their help was invaluable, though the final text, the analysis behind it and any errors or omissions remain the responsibility of the authors. Thank you to:  

  • Sue Adams, Care and Repair England
  • Sharon Allen, Skills for Care
  • Phillip Anderson, MS Society
  • Laura Arrowsmith, NatCen Social Research
  • Graham Atkins, Institute for Government
  • Tim Atkins, Care Quality Commission
  • Fredi Cavander-Atwood, MS Society
  • Clenton Farquarson, Think Local Act Personal
  • Dave Griffiths, Skills for Care
  • Dan Harbour, Beacon CHC
  • Chris Hatton, University of Lancaster
  • Matt Hibberd, Local Government Association
  • Liz Hodgkinson, NHS England
  • David James, Care Quality Commission
  • John Jackson, Local Government Association and Association of Directors of Adult Social Services
  • Jim Ledwidge, Independent Continuing Healthcare advisor to Association of Directors of Adult Social Services
  • Sarah Liley, NHS Digital
  • Sheila Mackintosh, University of Western England
  • Brian O’Shea, Spinal Injuries Association
  • Tim Parkin, Think Local Act Personal
  • Caroline Speirs, Think Local Act Personal
  • Duncan Stacey, Care Quality Commission
  • Andy Tookey, NHS England
  • Michael Varrow, consultant, Health Foundation
  • Martin Walker, Think Local Act Personal
  • Elizabeth Webb, Age UK
  • Sally West, Age UK
  • Robyn Wilson, NHS Digital
  • Members of the Association of Directors of Adult Social NHS Continuing Healthcare National Reference Group