Social care 360

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This year’s Social Care 360 report uses the latest available data (2019/20) to describe the key trends in adult social care as the Covid-19 pandemic struck and to suggest what the impact of the pandemic might be. It paints quite a bleak picture of adult social care in England, with many key indicators already going in the wrong direction before the pandemic struck.

  • Demand was increasing but receipt of long-term care was falling. Between 2015/16 and 2019/20, 120,000 more people requested social care support but around 14,000 fewer people received either long- or short-term support.1 
  • The means test continued to get meaner because thresholds were not rising in line with inflation.
  • User satisfaction with publicly funded care was showing a small, long-term decline. 
  • Fewer people were using direct payments, suggesting a fall in personalisation of care.  

Even where indicators were going in the right direction, there were caveats.

  • Total expenditure had finally returned to a similar level to that of 2010/11 but not if population growth is taken into account – per person spending was still well below that seen a decade ago.
  • As a result of the National Living Wage, care worker pay was rising by more than inflation but was not keeping pace with other sectors.
  • Staff vacancies were falling but remained at a high level.
  • More carers were getting support but this was mainly in the form of advice.

To ensure that these indicators paint a more positive picture in future years, we've outlined six things that need to happen >> 

  • 1. These figures include people receiving long-term support and short-term care packages. Because some people receive more than one type of support or package of care in a year, these are not exact figures but are the best available estimates for the overall output of the care system.

Click through for the Social care 360 sections

This year’s Social Care 360 has a colour coding system for each of the indicators we describe. This should be interpreted as follows:

  • Red: a trend that's getting worse.
  • Green: a trend that's improving.
  • Amber: either a trend that’s small or not clear over the period we’re describing, or where the direction of travel itself is not obviously good or bad. For example, an increase in requests for support could be both an indicator of unmet need being identified (good) and an indicator of increasing need among the population (bad).



Requests for support >

Requests for social care support continue to grow.


Service users >

The number of people receiving long-term care continues to fall.


Financial eligibility >

Financial eligibility for social care continues to get tighter.

Expenditure and providers


Local authority spending >

Total spending by local authorities is slightly higher than at the start of the decade.


Costs >

The cost of commissioning care for local authorities continues to rise.


Care home beds >

There are fewer places in nursing and care homes.

Workforce and carers


Vacancies >

Staff vacancies have fallen but remain at a very high level. 


Pay >

Care worker pay is increasing but not as fast as other sectors. 


Carer support >

More carers are getting support but it is mainly advice.  



Care ratings >

More adult social care services are rated ‘outstanding’ or ‘good’.


Personalisation >

For the third year in a row, fewer people are using direct payments.   


Satisfaction >

There has been a small, long-term fall in user satisfaction. 

What needs to happen?

In many cases, we expect Covid-19 to make the situation worse. Demand will increase but receipt of care will, likely, not. Costs will go up but expenditure is unlikely to keep pace. If we are to avoid reporting on a further bleak round of indicators in future years, six things need to happen as part of a long-term wide-ranging reform programme for adult social care.

  • More money is needed to fund the current system. The Health Foundation estimates that an extra £1.9 billion will be needed simply to meet demand for adult social care by 2023/24, while funding is also needed to meet existing unmet need and improve the quality of services. Further funding will be necessary to cover the additional costs of Covid-19, support the provider market, fill vacancies and pay staff a fairer wage.
  • Eligibility needs to be improved, in the short term by easing the financial pressure on local authorities and allowing them to apply existing rules more fairly and in the longer term by changing those rules to make more people entitled to support.
  • Workforce reform is essential. While vacancies may fall in the short term due to unemployment in the wider economy, the sector needs better pay, training and development to compete with other sectors and deliver the care needed.
  • Personalisation needs re-invigoration. If the 2014 Care Act’s principle around self-directed support has meaning, government needs to establish clear oversight so that the number and quality of direct payments, and other routes to choice and control, increase rather than decline.
  • Prevention needs to take centre stage. Services such as reablement should be an even greater focus for local authorities and national government.
  • Carer support needs urgent attention. As formal services closed during Covid-19, carers took on much of the heavy lifting (sometimes literally) of support. A new settlement for them ought to be part of reform.

Read report as a PDF

You can read the 2021 Social care 360 review as a PDF here.

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.

Full methodology

Requests for supportNumber of requests for support received from new clients, by age group As reportedAdult 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 reportedAdult Social Care Activity and Finance Report, NHS Digital
Financial eligibilityUpper capital limitAdjusted to 2019/20 prices using December 2020 GDP deflators from HM Treasury

Local authority circulars


Total expenditure



Gross current expenditure

Adjusted to 2019/20 prices using December 2020 GDP deflators from HM Treasury and calculated difference from 2010/11 budget, calculated per person rate

Adjusted to 2019/20 prices using December 2020 GDP deflators from HM Treasury, calculated per person rate 

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 

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 2019/20 prices using December 2020 GDP deflators from HM Treasury Adult Social Care Activity and Finance Report, NHS Digital
Care home beds

Care home beds per 100 people 75+ 

Nursing home beds per 100 people 75+ 

As reportedPalliative and End of Life Care Profiles, Public Health England 

Nursing home beds, by region 

Residential home beds, by region 

Calculated percentage change between 2013 and 2020 Data provided directly by CQC 

Vacancy rate (adult social care) 

Unemployment rate (whole economy) 

As reportedThe state of the adult social care sector and workforce in England, Skills for Care 
PayMedian hourly pay for care workers and other low paid professions, 2012/13 and 2019/20 Calculated difference between median hourly care worker pay and median hourly pay for other professions The state of the adult social care sector and workforce in England, Skills for Care 
Carer supportSupport provided to carers during the year, by type of support provided Calculated as percentage of all carer support provided Adult Social Care Activity and Finance Report, NHS Digital 
QualityPercentage of care services by rating As reportedData provided directly by CQC 
PersonalisationNumber of service users receiving direct payments and part-direct payments at the year-end 31 March Calculated year-on-year change Measures from the Adult Social Care Outcomes Framework, NHS Digital 
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 


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.  

  • Will Fenton, Skills for Care  
  • Matt Hibberd, Local Government Association  
  • Sarah Liley, NHS Digital 
  • Ann Mackay, Care England  
  • Vic Rayner, National Care Forum  
  • Duncan Stacey, Care Quality Commission  
  • Robyn Wilson, NHS Digital 

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