Adult Social Care Activity and Finance Report, England - 2018-19 [PAS]

While expenditure has risen every year since 2015-16, three main activity measures report mixed trends, so the increase in expenditure may be linked to the increasing costs in the provision of care.

Local authorities received 1,914,535 requests for support from new clients in 2018-19, an increase of 3.8% (70,615 requests) since 2018-19, and an increase of 5.7% since 2015-16^[3]. At a local authority level, more than a half (85 of 152 local authorities) saw an increase in requests compared to last year.

The total number of completed episodes of short term care to maximise independence^{[4] [5]} (ST-Max) was 255,275. This is an increase of 3.8% (9,240 episodes) from 2017-18. Eighty-six per cent (219,390) of these completed episodes were for adults aged 65 and over. The number of completed episodes of ST-Max for new clients increased by 5.1% compared to the previous year, whereas for existing clients the number of episodes dropped by 4.6%.

Overall, the number of clients receiving long term care has decreased each year since 2015-16, to 841,850 in 2018-19. This has been mainly driven by clients aged 65 and over receiving long term care, with numbers down 39,060 to 548,435 since 2015-16. However, the number of clients aged 18 to 64 receiving long term care has increased slightly over the period, increasing by 8,390 to 293,415 since 2015-16. More detail can be found in the long term care section of this report.

Gross current expenditure on adult social care by local authorities was £18.7 billion. This represents an increase of £807 million from the previous year, a 4.5% increase in cash terms and a 2.6% increase in real terms. Some local authorities provided comments^[6] regarding the change in expenditure for their authority, citing factors including the improved Better Care Fund and an increase in those requiring support for complex needs, leading to much higher costs of providing care.

This effect can also be seen in the average costs of care per week for residential and nursing care (known as unit costs) which have risen in 2018-19.

The average cost of residential care for a person aged 65 and over per week was £604 in 2017-18, but has now risen to £636, while the cost of nursing care for the same age band has increased from £638 to £678 a week. For those aged 18 to 64, the number of clients in residential or nursing care are much smaller, but a similar effect can be seen with unit costs increasing, from £921 to £976 a week for nursing care and from £1,274 to £1,320 a week for residential care.

The csv files accompanying this report provide a full breakdown of all expenditure and activity figures provided by local authorities as part of the ASC-FR collection.

Figure 1: Overview of adult social care activity provided or organised by local authorities^[7], 2018-19

Total expenditure on adult social care by local authorities in 2018-19 was £22.2 billion (up £882 million since 2017-18, a 4.1% uplift), however this includes capital charges and some of this expenditure is offset by income from other sources such as the NHS^[8].

In 2018-19 gross current expenditure on adult social care (which accounts for spending by social care departments and also includes client contributions), was £18.7 billion, and this is the measure of expenditure used throughout this report (except where otherwise stated).

It is important to be aware of the constituent parts that contribute to calculating gross current expenditure, as shown in Figure 2, as any year on year changes to gross current expenditure will be driven by increases or decreases in one or more of these areas.

Figure 2: How gross current expenditure is calculated

Gross current expenditure has increased £0.8 billion since 2017-18, which is a 4.5% increase in cash terms and a 2.6% increase in real terms. As shown in Figure 3, this is the third consecutive year gross current expenditure in real terms has increased since 2009-10.

Figure 3: Gross Current Expenditure in cash and real terms, 2008-09 to 2018-19

In additional to the usual funding of adult social care through council tax and grants from central government (such as improved Better Care Fund), in the last three years, local authorities have been able to use an adult social care precept to raise additional funds.

• The additional adult social care precept in 2018-19 generated £538 million, down from £552 million in 2017-18.
• 148 out of 152 local authorities with adult social care responsibilities utilised some or all of this 3% precept in 2018-19^[9]

When considering year on year changes at a local authority level, the change in gross current expenditure was variable, with 25 local authorities reporting a decrease since the previous year.

Local authority level data showing the differences in expenditure levels between 2017-18 and 2018-19 can be found in Table 3 of the reference data tables which accompany this report.

Figure 4 below provides a summary of gross current expenditure on adult social care and how this expenditure is allocated.

Table 1 shows total gross current expenditure and its constituent parts compared to last year. As a whole, gross current expenditure has risen by 4.5%, with increases in all constituent parts. This is largely due to long term support which makes up the majority of the total gross current expenditure. Short term support, which makes up the smallest proportion of gross current expenditure, has seen a growth of 4.4% (£25 million) from the previous year.

Table 1: Gross current expenditure, by care type, 2017-18 and 2018-19

Figure 4: Overview of gross current expenditure on adult social care^[10], 2018-19

Users of this report may be interested in the overall estimate of public spending on adult social care, which consists of the net current expenditure (local authority spend) plus planned spending on the minimum Better Care Fund for social care or direct with social care providers, to give a total of £17.9 billion in 2018-19. A full time series of the estimated public spend on adult social care can be found in Table 2 below.

Table 2: Net current expenditure^[11] on adult social care services in cash terms, by source of funding^[12], 2009-10 to 2018-19

Of the £22.2 billion total expenditure in 2018-19, 72.0% (£16.0 billion) is funded directly by the local authority (this includes capital charges and is known as net total expenditure, as seen in Figure 6 below). This represents a 5.0% increase (£761 million) from 2017-18.

One area of central funding is the improved Better Care Fund, which increased from £1.1 billion in 2017-18 to £1.5 billion in 2018-19.^[13] Expenditure funded by Specific and Special Grants such as the improved Better Care Fund is captured in the data, but those grants are not reported as income in this collection.

The remaining 28.0% (£6.2 billion) of total expenditure is funded by income from other sources, which has increased by 2.0% (£122 million) since 2017-18 (as seen in Figure 5 below). Income from joint arrangements has decreased, while income from the NHS, client contributions (up for the fourth consecutive year) and other income have all increased.

In the 2017-18 adult social care finance return, recording of the income from the Better Care Fund became mandatory. This year local authorities stated they received a combined total of £1.8 billion income from Better Care Fund, which accounted for 66.1% of their Income from NHS. Please note that this relates to actual expenditure reported by local authorities in the ASC-FR return when considering it against the planned minimum Better Care Fund spend for social care or direct with social care providers, reported in Table 2.

Figure 5: Income, by income source, 2015-16 to 2018-19

Figure 6: Overview of total local authority expenditure and income on adult social care^[14], 2018-19