Social care 360: access

This content relates to the following topics:

1. Requests for support

There were more requests from working-age adults but fewer from older people 
 

Figure 1: a chart showing how in 2020/21, the number of new requests to local authorities from working-age adults rose, while the number from older adults fell. The data shows the total number of requests from new clients, by age group. Those from clients aged 18 - 64 are in dark blue, those from clients aged 65+ are in light blue.

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 number of new requests for adult social care support to local authorities increased among working-age adults, from 560,000 in 2019/20 to 578,000 in 2020/21. However, requests for support by older people fell, from 1.37 million to 1.34 million.   

Overall, requests for support fell slightly from 1.93 million to 1.92 million, which is still equivalent to 5,250 requests every day of the year. 1.3 million people asked for help during the year, making an average of 1.5 requests each.   

What is the longer-term trend?  
Despite the fall in 2020/21, requests for support are still 6 per cent higher than they were in 2015/16 (1.81 million). Among working-age adults they have increased 15 per cent, from 501,00 to 578,000 over the same period. Among older people, they have increased 2 per cent, from 1.31 million to 1.34 million.  

The source of requests for support has not changed significantly since 2015/16: around 4 in 5 requests originate from the community and 1 in 5 from hospital discharge.   

What explains the trends?   
The fall in new requests among older people in 2020/21 is likely to reflect a reluctance to come forward for services during the Covid-19 pandemic. The Institute for Fiscal Studies found that almost three-quarters of over-50s needing community or social care services in the first stage of the pandemic said they had not accessed them and almost half of these said they did not even attempt to contact services.   

This exceptional annual change may therefore have temporarily masked the broader general trend, evident since 2015/16, of increasing demand from older people. This trend has been caused by an increasing number of older people who have been living longer – need for social care tends to increase with age. However, this may have been counterbalanced by a fall in the proportion of older people with disabilities that affect their independence: the Health Foundation estimates that there were 200,000 fewer older people living in the community with high social care need in 2018 than would have been the case if disability prevalence had stayed the same as in 2006.   

Given the fall in new requests from older people in 2020/21, it is surprising that new requests for support from working-age adults in fact went up: it is not obvious why they would have been less concerned about the risk of Covid-19 transmission than older people. It may be that there is no single, clear reason for this change but it warrants further investigation. 

What has happened since?  
A snap survey in November 2021 by the Association of Directors of Adult Social Services estimated that more than 200,000 people were waiting for assessments related to adult social care. It is not clear, however, whether this is a consequence of new requests for support or difficulties in clearing a backlog of existing requests, or both.  

2. Service delivery

The number of people receiving publicly funded long-term care rose slightly  
 

Chart showing that in 2020/21 the total number of older adults receiving publicly funded long-term care rose, but the number of people receiving short-term care fell

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

What was the annual change?  
The number of people receiving publicly funded long-term care in 2020/21 increased by 3,000 (0.3 per cent) to 841,000. This overall increase was made up of a very small decrease in the number of 18–64-year-old adults receiving long-term care, outweighed by a slightly larger increase in the number of older people receiving long-term care. However, when increases in population size is taken into account, there was a small decrease in the number of people per 100,000 population receiving long-term care.   

In short-term care to maximise independence (ST-Max), there was an overall fall from 231,000 to 219,000 (5 per cent). This was made up of 2,000 (8 per cent) fewer working-age adults receiving ST-Max and 10,000 (5 per cent) fewer older people.   

What is the long-term trend?  
Since 2015/16, there has been a small increase in the number of working-age adults accessing publicly funded long-term care, from 285,000 to 290,000 (2 per cent) but a much larger decrease in the number of older people receiving long-term care – down from 587,00 to 552,000 (6 per cent). When population size is taken into account, there has been a small fall in working-age adults receiving long-term care and a much larger fall in older people.   

With ST-Max, there has been an increase in provision for both working-age adults, up from 21,000 to 26,000 (22 per cent) since 2015/16, and older people, up from 190,000 to 193,000 (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?  
It is surprising that the number of older people receiving publicly funded long-term care increased in 2020/21 even though the number of requests for support (see Requests for support) fell. This is contrary to the general long-term trend between 2015/16 and 2019/20, which saw receipt of long-term care by older people fall to 548,000 people. We have previously explained this fall as being, at least in part, a consequence of the financial pressures facing local authorities. National Audit Office analysis finds that government funding for local authorities fell by 55 per cent in 2019/20 compared with 2010/11, resulting in a 29 per cent real-terms reduction in local government spending power. However, the fall in spending power largely plateaued from 2016/17 onwards and reversed in 2020/21.  

It is possible that this overall trend was beginning to change by 2019/20: receipt of long-term care by older people stayed flat in that year rather than fell still further. However, it is also likely that the increase in 2020/21 was – at least in part – a consequence of changes to the health and care system due to the onset of Covid-19. In particular, the government introduced a hospital discharge fund under which the NHS paid for six weeks of care for those needing it when leaving hospital. As a result, people who would otherwise have been self-funding their own care after discharge from hospital were included in the long-term care figures for the first time. There are other possible explanations.   

What has happened since?   
In December 2021, the Association of Directors of Adult Social Services warned that workforce challenges caused by long-term recruitment problems and by illness and self-isolation due to Covid-19 were forcing local authorities to ration the support provided to people with social care needs

3. Financial eligibility

Financial eligibility has continued to get tighter    
 

Figure 3: Chart showing that financial eligibility has continued to get tighter by showing the actual rate and what it would be if it had kept pace with inflation

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 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 longer-term trend?  
The upper threshold has not changed since 2010/11. If it had increased in line with inflation, it would be £5,781 higher at £29,031, so more people would qualify for support.   

What explains this?  
By not increasing the upper 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, as ministers have sought to limit 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 means that adults with disabilities can be left with less income to live on after care costs have been charged and so, in effect, they might be charged more for their care.    

What has happened since?  
The upper threshold, and all other thresholds, remained at the same level for 2021/22. However, in September 2021, the government announced that from October 2023, as part of wider reforms of adult social care, which include the introduction of an £86,000 cap on care costs, the upper threshold will rise to £100,000 and the lower threshold – the point below which people pay nothing towards their care from their assets – will increase to £20,000. And from April 2022, the Minimum Income Guarantee will rise in line with inflation.   

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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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