Spending on adult social care in England has fallen by 3% since 2009/10. The number of adults receiving publicly funded care packages has decreased, even though demographic change would suggest that demand is increasing. It is clear that local authorities, which are responsible for adult social care, initially drove down the price of care they commission from private and voluntary sector providers.
However, difficulties measuring exactly what care is being purchased and provided with public money mean that it is not possible to say whether adult social care is more efficient now than in 2009/10. What is clear, is that any efficiencies made have not been sufficient to meet demand, and unpaid care has partially filled the gap.
For full citations and further details, see . This analysis is drawn from Performance Tracker, produced by the Institute for Government in partnership with CIPFA.
1. Day-to-day spending on adult social care fell by nearly 10% in real terms between 2009/10 and 2014/15.
- This followed a period of increased spending. Before 2009/10, there had been an average real-terms annual funding increase since 2001/02 of 5.7%.
2. But spending has increased since then, and will continue to do so.
Four new grants and one policy change have led to a slight increase in spending:
- The Improved Better Care Fund announced in the 2015 Spending Review.
- A £2bn top up of the Improved Better Care Fund by 2019/20 in the March 2017 Budget.
- The 2017/18 and 2018/19 Adult Social Care Grants.
- A £240m grant for 2018/19 announced in October 2018.
- The adult social care precept.
- The increased spending is likely to continue. MHCLG estimated that these grants and the precept raised an additional £0.4bn in 2016/17 and £2.3bn in 2017/18, and will raise £3.3bn in 2018/19 and £3.7bn in 2019/20.
- Most analysis suggests there is still a funding gap. The IFS has estimated that the gap between forecast spending in 2019/20 and adult social care need is between £2.8bn and £4bn.
3. Most adult social care is provided outside the public sector.
- In 2018, the NAO estimated that informal and voluntary sector care accounted for most of the value of adult social care (£62bn to £102bn), followed by publicly funded care (£22bn) and self-funded care (£11bn).
- Local authorities have protected their adult social care spending. Adult social care spending made up 36.9% of council-controlled budgets in 2017/18, 34% in 2010/11, and is estimated to rise to 37.8% in 2018/19.
- Local authorities have consistently overspent against planned adult social care budgets. In aggregate, councils spent £132m more than they had budgeted for in 2014/15, rising to £526m in 2016/17. ADASS reported there was no aggregate overspend in 2017/18.
4. The number of people aged over 65 has increased by 19% since 2009/10.
- Older people are more likely to need help. In 2016/17, 43% of people aged over 80 needed help with daily activities, compared with 19% of people aged 65-69.
- The number of over 65s reporting that they need help has decreased. This figure decreased by 1% – just over 26,000 people – between 2011/12 and 2016/17.
- Not all adults in need will seek support. The number of people requesting support has remained broadly flat: rising 2% between 2009/10 and 2013/14, then falling 2% between 2014/15 and 2016/17. This does not mean that demand is flat.
- Yet overall demand has risen. This is because the number of working-age adults with a severe learning disability, mental health problem or physical disability rose by almost 10%. The needs of these groups are often very complex.
5. The number of adults receiving long-term, publicly-funded social care packages fell by 27% between 2009/10 and 2013/14.
- More intensive and expensive care has fallen by less. Community care packages fell by 32% over the period, but care provided in residential and nursing homes only fell by 6% and 4% respectively.
- This number had previously been increasing. Between 2000/01 and 2008/09, the number of people receiving this kind of care rose by 7.6% (although the data was collected and published differently).
- More people are receiving short-term care. The proportion of adult social care referrals resulting in any kind of short-term care increased from 15.9% in 2014/15 to 17.1% in 2016/17. The number of referrals resulting in re-ablement support rose 2.6% in the same period.
6. There was a 21% increase in the number of adult social care jobs between 2009/10 and 2017/18.
- The social care workforce in England is growing. However, some of these jobs are part-time, and multiple jobs may be held by a single person.
- The composition of those jobs has changed. The number of jobs in the independent sector increased by 28% between 2009/10 and 2017/18, while the number of jobs working directly for local authorities fell by 39% due to service closures and outsourcing.
7. In 2017/18, 8% of all social care jobs were vacant, and the turnover rate of social care staff was over 30%.
- The vacancy rate in direct care is higher. Here, the vacancy rate increased from 6.4% to 8.6% between 2012/13 and 2017/18. The largest vacancy rates were among social workers (10.8%), occupational therapists (9.8%) and care workers (7.7%).
- Turnover has increased too. Between 2012/13 and 2017/18, social worker turnover rose by 5.0%, care worker turnover by 9.1% and registered nurse turnover by 5.2%.
- Some of this turnover is internal. In 2017/18, 40% of leavers left for another job within the adult social care sector, and 67% of new starters were recruited from within the sector.
8. Between 2010/11 and 2013/14, the fees paid by local authorities to residential and nursing care providers fell by 9% in real terms.
- This put real pressure on providers. Since 2009/10, care homes with a greater share of local authority-funded clients have consistently made economic losses of between 2% and 8%. The CMA estimates that local authorities are paying approximately 10% below the total cost of care home places.
- The same is happening in home care. In 2016, the average hourly price that English councils paid for home care was £14.66; only 10% of all councils paid the estimated minimum sustainable price of £16.70.
- Local authorities are seeing home care contracts handed back. Between 2016 and 2018, 40% of councils had a home care contract handed back.
- This is not sustainable. Due to pressures from increased staff costs, two-thirds of councils increased provider fees between 2014/15 and 2015/16, and more than 60% of councils increased residential, nursing and home care fees by more than 3% in 2018.
9. Between 2016 and 2018, the share of all care providers that the CQC rated as 'outstanding' and 'good' increased by 19% respectively.
- Those receiving care have not seen a drop in quality (based on limited evidence). The proportion of care providers rated ‘requires improvement’ or ‘inadequate’ declined by 14% and 6% respectively.
- Satisfaction has remained high among users of social care services. The number of social care users who say they are ‘very’, ‘extremely’ or ‘quite satisfied’ has remained between 90% and 91% since 2009/10.
10. On an average day in 2017/18, 1,900 hospital beds in England were occupied by someone whose discharge was delayed due to social care.
- In 2016/17, it was even higher – almost 2,500.
- Since March 2017, delays due to social care have declined rapidly. But they still remain higher than in 2010.
- Most delayed transfers are due to patients waiting for a care package in their own home. This rose from 12,777 days in August 2010 to 33,520 days in March 2017 (an increase of over 160%).
- More people are receiving unpaid care. The ONS estimates that the number of people receiving continuous care in the UK (168 hours a week) grew 14.3% between 2009/10 and 2014/15. There was a 16.4% increase in hours of unpaid care between 2009/10 and 2013/14 from 7.3bn to 8.5bn. This has since declined to 7.9bn in 2016/17.
- The value of unpaid care has increased. The amount it would cost to purchase care currently provided informally increased consistently after 2009/10, but declined slightly from £68.7bn to £68.3bn between 2015/16 and 2016/17.