Adult Social Care Activity and Finance Report, England - 2019-20

Local authorities received 1,930,560 requests for support from new clients in 2019-20, an increase of 6.6% since 2015-16. In 2014-15 this was the first year of the SALT data collection, and due to a number of data quality issues, councils were provided with the opportunity to revise their 2014-15 data; this was published alongside the 2015-16 collection however only some of the councils who would have liked to review the data had the technology and resources to do so. As such, when considering trends in the Activity data, we have used 2015-16 as our starting point.

The total number of completed episodes of short term care to maximise independence (ST-Max) for both new and existing clients, where an outcome had been determined within the reporting period was 261,605. 87.4% (228,665) of these completed episodes were for adults aged 65 and over. Short term support to maximise independence is terminology introduced in the EQ-CL framework to describe a range of services that are of short duration (typically being provided for a few weeks) and that have the explicit aim of trying to minimise the person’s use of ongoing social care services.

Overall, the number of clients receiving long term care has decreased each year since 2015-16, to 838,530 in 2019-20. This has been mainly driven by clients aged 65 and over receiving long term care, with numbers down 39,045 to 548,450 since 2015-16. However, the number of clients aged 18 to 64 receiving long term care has increased slightly over the period, increasing by 5,055 to 290,075 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 £19.7 billion. This represents an increase of £918 million from the previous year, a 4.9% increase in cash terms and a 2.4% increase in real terms.

Source: ASC-FR Collection, 2019-20, NHS Digital - See Table 4 in Reference Data Tables, and ONS deflators found here https://www.gov.uk/government/statistics/gdp-deflators-at-market-prices-and-money-gdp-september-2020-quarterly-national-accounts

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 2019-20 generated £200 million.
• 85 out of 151 local authorities with adult social care responsibilities utilised some or all of this 3% precept in 2019-20. It is important to note that a number of authorities had already reached their maximum level last year and so could not increase further; as such, comparisons with 2018-19 are not appropriate.

When considering year on year changes at a local authority level, the change in gross current expenditure was variable, with 26 local authorities reporting a decrease since the previous year.

Local authority level data showing the differences in expenditure levels between 2018-19 and 2019-20 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.

The table below shows total gross current expenditure and its constituent parts compared to last year. As a whole, gross current expenditure has risen by 4.9%, 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.

Table 2: Gross current expenditure, by care type, 2018-19 and 2019-20

Net current expenditure is total expenditure excluding capital charges and less all income. Full details of the sources of these data can be found in Appendix B.

For users specifically interested in this metric, an additional set of net current expenditure reference tables based on data collected in the ASC-FR are available.

Net current expenditure on Adult Social Care is also collected by the Ministry of Housing, Communities & Local Government as part of the Local Government Revenue Outturn returns, and published here: https://www.gov.uk/government/collections/local-authority-revenue-expenditure-and-financing

Of the £22.3 billion total expenditure in 2019-20, 71.9% (£16.7 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 4.4% increase (£712 million) from 2018-19.

One area of central funding is the improved Better Care Fund, which increased from £1.5 billion in 2018-19 to £1.8 billion in 2019-20. 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. As such, this collection cannot be used to consider the financial pressures on local authorities as it does not reflect the full picture on all income streams available to fund social care.

The remaining 28.1% (£6.5 billion) of total expenditure is funded by income from other sources, which has increased by 5.4% (£335 million) since 2018-19 (as seen in Figure 5 below). Other Income has decreased, while income from the NHS, client contributions and joint arrangements 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 63.8% 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 3.