Social care 360: access

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

Why is this indicator important?  
New requests for support to local authorities are our best available marker of demand for adult social care services.

What was the annual change?
The total number of new requests for support increased from 1.92 million in 2020/21 to 1.98 million in 2021/22. Requests from both older people and – particularly – working-age adults increased. The number of new requests from working-age adults increased 5.8 per cent from 578,000 in 2020/21 to 612,000 in 2021/22. Requests from older people increased 2.2 per dent from 1.34 million in 2020/21 to 1.37 million in 2021/22.  

Overall, requests for support were equivalent to 5,420 requests every day of the year. There were 1.5 requests per person, meaning that 1.36 million people asked for help during the year. 

What is the longer-term trend?
Requests for support are 9 per cent higher than they were in 2015/16 but there is a significant age difference in the rates of growth. Among working-age adults requests have increased 22 per cent, from 501,000 to 612,000 in 2021/22. Among older people, they have increased 4 per cent, from 1.31 million to 1.37 million. Overall, the increase is 9 per cent, from 1.81 million to 1.98 million. At this rate of growth, requests for support will exceed 2 million for the first time in 2022/23. 

The source of requests for support has not changed significantly since 2015/16: around 4 in 5 requests originate from the community and – despite intense government and media focus on this aspect of social care – only 1 in 5 from hospital discharge. 

What explains the trends?
2021/22 appears to mark a return to the general trend since 2015/16 of increasing demand for social care services, driven particularly by working-age adults.  

This, in turn, is likely to reflect increasing disability among working-age adults: 21 per cent of 18–64-year-olds reported disability in 2020/21 compared with 18 per cent in 2015/16 (and 15 per cent in 2010/11). Among older people, prevalence of disability has, if anything, fallen but balancing this has been an increasing number of older people in the population. Additionally, until Covid-19 life expectancy had been increasing and need for social care tends to increase with age.

This longer-term trend of increasing requests was interrupted in 2020/21 with a fall in requests among older people, which is likely to reflect a reluctance to come forward for services during the Covid-19 pandemic. 

What has happened in 2022/23?
A survey by the Association of Directors of Adult Social Services estimated that in August 2022 246,000 people were waiting for assessments of social care needs, an increase from 204,000 in November 2021 (though a fall from 294,000 in April 2022). It is not clear, however, whether this represents an increase in new requests for support or difficulties in clearing a backlog of existing requests, or both. 

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

Why is this indicator important?
Receipt of long- and short-term care are the key measures available to assess the extent to which demand for social care (see indicator 1, requests for support) is being met. 

What was the annual change?
The number of people receiving long-term care fell from 841,000 in 2020/21 to 818,000 in 2021/22. This decrease was made up of a very small fall in the number of 18–64-year-olds receiving long-term care, from 290,000 to 289,000, and a much larger fall in the number of older people receiving long-term care, from 552,000 to 529,000.  

In short-term care to maximise independence (ST-Max), there was an overall small increase from 219,000 to 224,000, split fairly evenly between older people and working-age adults. 
 
What is the long-term trend?
Since 2015/16, there has been a small increase in the number of working-age adults receiving long-term care, from 285,000 to 289,000 (1.4 per cent) but a much larger fall in the number of older people receiving long-term care – down from 587,000 to 529,000 (10 per cent). Overall, 818,000 people received long-term care in 2021/22 compared to 873,000 in 2015/16.  

When increases in population size is taken into account, the fall is even starker. In 2015/16, slightly more than 6 per cent of people aged over 65 were receiving long-term care but by 2021/22 this had fallen to slightly more than 5 per cent. The percentage of the working-age population receiving long-term care was largely unchanged at around 0.8 per cent in both years.  

With ST-Max, there has been an increase in new provision for both working-age adults up from 21,000 to 28,000 (32 per cent) since 2015/16, and older people, up from 190,000 to 196,000 (3.2 per cent). When population size is taken into account, this represents an increase in provision for working-age adults but a decrease in provision for older people.   

What explains this?
Local authorities say that the reduction in the number of people in long-term care in 2021/22 was in part due to the impact of the Covid-19 pandemic, which has led to a reduction in service availability and capacity, in turn due to staff shortages (see indicator 7, vacancies). The year 2021/22 also began with 14,000 fewer people in long-term care at the end of 2020/21 compared to the previous year. This was in part due to a Covid-related increase in deaths. 

These year-on-year changes are likely to have compounded a longer-term trend for older people, which has seen the number of people receiving long-term care fall from 587,000 in 2015/16 to 529,000 in 2021/22. We have previously explained this trend as being largely due to local authority financial pressures. Government funding for local authorities fell by 55 per cent between 2010/11 and 2019/20, resulting in a 29 per cent real-terms reduction in spending power. This, in effect, has led local authorities to ‘ration’ social care to those in the greatest need. In October 2022, the Local Government and Social Care Ombudsman said it was seeing ‘more cases where councils are failing to provide care, or are limiting care, while using cost as the justification’. It ascribed this to ‘under-resourced system unable to consistently meet the needs of those it is designed to serve’.

A further possible explanation is an increasing uptake by local authorities of ‘strengths-based’ and/or enabling approaches, which seek to focus on support that might be available from an individual’s wider support network and community, rather than through the provision of formal long-term care and support. However, it is noticeable that there has been no significant change in indicators that might suggest such an approach has been taken, such as support for carers (which has fallen since 2015/16), investment by local authorities in the voluntary sector (which has also fallen) and use of short-term care to maximise independence (ST-Max) (which has seen relatively modest increases in packages provided).  

What has happened in 2022/23?   
In November 2022, the Association of Directors of Adult Social Services reported that more than 9 in 10 adult social services directors in England did not believe there was the ‘funding’ or ‘workforce’ to meet care needs of older and disabled people in their area.  

In the 2022 Autumn Statement, the government announced a funding package for adult social care of up to £7.5 billion in 2023/24 and 2024/25. The Chancellor said this would allow delivery of an extra 200,000 social care packages, albeit providing no details on how this number was calculated. 

However, as part of the Autumn Statement, the government also announced it was postponing reforms that would have seen more people become eligible to receive publicly funded social care from November 2023 onwards.  

Financial eligibility is tighter and reform has been put back    
 

Why is this indicator important?  
Unlike the NHS, social care operates a financial assessment (a ‘means test’) to decide who is eligible for publicly funded care. The levels of this are set nationally and announced each year. The ‘upper threshold’ decides the level of savings and other assets people can have and still qualify to receive publicly funded care. The lower that figure is, the fewer the people who qualify.      

What was the annual change?
The upper threshold remained at £23,250 in 2021/22.

What is the longer-term trend?
The upper threshold has not changed since 2010/11. If it had increased in line with inflation, in 2021/22 it would have been £5,485 higher at £28,735, so more people would qualify for support. 

What explains this?
By not increasing the threshold in line with inflation, successive governments have made the means test even meaner: it has become harder for people to get publicly funded social care, reducing its cost to the taxpayer. Another key measure, the Minimum Income Guarantee, which defines the lowest amount of income an individual needing care at home must be left with after care charges, has also not increased in line with inflation. This effectively means that adults with disabilities can be charged more for care at home.

What has happened in 2022/23?
The upper threshold remained at the same level for 2022/23 and will be the same in 2023/24. In October 2023, as part of wider reforms of adult social care, which were to include the introduction of an £86,000 cap on care costs, the upper threshold was due to rise to £100,000 and the lower threshold was due to rise to £20,000. However, in November 2022, the government announced that these charging reforms would be delayed until October 2025.  

However, from April 2022, the Minimum Income Guarantee rose. This was in line with government projections of inflation at the time, though has subsequently proved to be an under-estimate. 
          

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