Social care 360: access

This content relates to the following topics:

1. Requests for support

Requests for social care support continue to grow. 

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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 in 2019/20?
The number of people asking for social care support from their councils increased in 2019/20 from 1.91 million to 1.93 million. The rate of increase was 1.8 per cent for working-age adults and 0.4 per cent for older people. Year-on-year growth in 2019/20 was slower than the previous two years.

What is the long-term trend?
Overall, there has been a consistent increase in people seeking support since 2015/16 – an increase of 120,000 people since 2015/16. Proportionally, the increase in demand has been greater among working-age adults (from 500,000 to 560,000, a 12 per cent increase) than among older people (from 1,310,000 to 1,370,000, a 5 per cent increase). In fact, when population growth is taken into account, demand has increased since 2015/16 by 10 per cent among working-age adults but fallen 2 per cent among older people.

What explains this trend?
Some of the increase is driven by demographics. There are now more older people, partly as a result of the post-war ‘baby boom’ and partly because older people generally are living longer (though, sadly, Covid-19 may affect this). Social care needs, and conditions such as dementia, increase with age.

In addition, there are more working-age adults with disabilities. This is because more people with severe disability now survive childhood but often with complex support needs, and also because more working-age adults now report disabilities – 19 per cent in 2019/20 compared to 15 per cent in 2010/11. By contrast, the level of disability among older people is largely unchanged since 2010/11: it has been between 44 per cent and 46 per cent in every year of the past decade. These trends in reported disability among older people and working-age adults are mirrored by disability benefits take-up: rates have increased for working-age adults but stayed flat for older people.

What the impact of Covid-19 likely to be?
We don’t know yet. In the early stages of Covid-19, local authority directors of adult social care say fewer people made requests for support. This may be due to reluctance to use services and, perhaps, concern about adding to the huge existing pressure on the system. This led to more care being provided by families: Carers UK estimated that, since the start of the pandemic, 4.5 million people have started to provide informal caring. There may therefore be a backlog of demand for formal services building up.

Some people with Covid-19 will also have been left with care and support needs as a result of their condition: the government estimates that approximately 1 in 10 people with Covid-19 continue to experience symptoms beyond 12 weeks. This may add to requests on local authorities in 2020/21 and beyond. Other people’s condition may have worsened as a result of the pandemic and the measures taken to tackle it.

Against this, Covid-19 led to an increased death rate among older people and working-age disabled adults who might otherwise have had need for social care support. One major study estimated that there were 29,400 excess deaths of care home residents during the first 23 weeks of the pandemic, equivalent to 6.5 per cent of all care home places in England.

2. Service users

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

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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) is being met.  

What was the annual change in 2019/20? 
In 2019/20, there was a decrease in the number of people receiving long-term care, from 842,000 to 839,000. The fall was driven by a reduction in long-term care for 18–64 year-olds, with long-term care for older people essentially static. There was also a fall in the number of working-age adults receiving short-term care to maximise independence (ST-Max), though an increase for older people.  

What is the long-term trend? 
Despite the increase in the number of requests for support (see indicator 1), overall, the number of people receiving formal services has fallen since 2015/16. By far the biggest fall has been in older people receiving long-term care – down from 587,000 in 2015/16 to 548,000 in 2019/20. This is despite the older population increasing by 642,000 in that period. However, over the period, long-term support for working-age adults has increased slightly and short-term care to maximise independence (ST-Max) for both age groups has also increased slightly.

What is long-term care?

Long-term care is any ongoing service or support provided by a local authority to a person to maintain quality of life. It is provided after a formal assessment and is subject to regular review.

What is short-term care to maximise independence (ST-Max)?

Short-term care is an episode of time-limited support – for example, reablement – intended to reduce or eliminate the need for ongoing support. The numbers for ST-Max refer to the numbers of packages of support provided and there are an average of 1.2 completed episodes of ST-Max per person during the year.  

What explains this trend? 
Local authority financial pressures are a key driver of this. 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. As a result, local authorities, though they have protected social care budgets compared to other services, are having to restrict the number of people to whom they provide support. While it is true that their overall spending on adult social care has been increasing (see indicator 4), much of that extra spend has been channeled towards paying providers more (see indicator 5), which, in turn, has been to compensate for an increase in costs, particularly wage costs driven by the National Living Wage (see indicator 8). 

However, other factors may be at work. Local authorities may be increasingly using effective short-term approaches that aim to help people regain independence rather than rely on long-term support. However, it is by no means clear the extent to which this is happening. It is also possible that the adoption of asset-based and self-help approaches, is leading to less uptake of formal services. However, it is currently impossible to measure how extensive – or indeed effective – such approaches are in practice, and there are concerns about the capacity of the voluntary and community sector and family carers to support them.   

Asset-based approaches aim to signpost people to less formal types of support, often provided by the voluntary and community sector, while strength-based approaches aim to support an individual’s independence, resilience and ability to make choices. The two terms are often used interchangeably.

What is the impact of Covid-19 likely to be? 
Even if Covid-19 were to increase demand still further (see indicator 1), pressure on local authority budgets means it is doubtful there will be a corresponding increase in service delivery: the long-term trend has been for increasing demand to outstrip service delivery because local authority budgets cannot afford it. This seems likely to continue in 2021/22: 41 per cent of local authorities with social care responsibility expect to make ‘substantial’ service savings to balance budgets and a further 53 per cent expect ‘some’ service savings.  

In the initial stages of Covid-19, service use fell due to staffing disruptions, reduced demand from people using services because of fears about infection and closure of some services such as day centres due to social distancing measures. Admissions to care homes were particularly affected, with a one-third fall in people arriving with public funding (and a much larger fall in self-funders). However, the picture is less clear since then and more data will not be available until October 2021. Though local authorities were given temporary powers under certain circumstances to ‘ease’ their duties under the Care Act 2014, only eight did so. Local authorities do, however, say the pandemic has uncovered unmet need in some areas.

3. Financial eligibility

Financial eligibility for social care continues to get tighter

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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 threshold is, the fewer the people who qualify.    

Financial assets are typically people's savings and – if a person is moving into a care home – their property. The means test sets two important cut-off points ('thresholds') for these assets.

The lower threshold – currently £14,250 – is the point below which an individual does not have to contribute anything towards their care from their assets (though will most likely still have to contribute to the costs of their care from their income).

The upper threshold – currently £23,250 – is the point above which an individual will have to fund all their social care costs.

Between these two thresholds, individuals have to contribute on a sliding scale using a formula which assumes that individuals have £1 of income for every £250 of assets.

For more information on the financial assessment, see the Age UK website.

What was the annual change? 
The upper threshold remained at £23,250 in 2020/21. This means that, when inflation is taken into account, the threshold in fact went down, so fewer people were eligible for publicly funded care.  

What is the long-term trend? 
The upper threshold has not changed since 2010/11. If it had increased in line with inflation, it would be £5,995 higher at nearly £30,000, so more people would qualify for support. And we know already that the threshold will stay at the same level in 2021/22. 

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, has also not increased in line with inflation, and this effectively means that adults with disabilities can be charged more for care at home. Letting these thresholds drift downwards in real terms is consistent with a failure to tackle the longstanding issues in adult social care and introduce proper reform.  

What is the impact of Covid-19 likely to be? 
The pandemic will have had no impact on financial eligibility.

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Comments

Mark Brooke

Position
EMC Consultant,
Organisation
Private
Comment date
16 June 2021

I have been reading various aspects of Adult care funding and I am dismayed by the complete lack of care.
Why are the top up fees not tax deductible.
Why are the thresholds not increasing in line with inflation.
The care homes are increasingly charging more and more so it becomes almost impossible to avoid having to pay top up fees, this would seem to be extortion.
It would seem that successive governments are ignoring the plight of its people especially the old an infirm.

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