Adult Social Care Activity and Finance Report, England - 2020-21

Following a request for support, clients may be provided with a period of short term care.

Short term care falls into two categories;

Short Term Support to Maximise Independence (ST-Max) - This includes all episodes of support provided that are intended to be time limited, with the intention of maximising the independence of the individual and reducing / eliminating their need for ongoing support by the local authorities.

Other Short Term Support - All other short term services, for example, emergency support not otherwise included in short term to maximise independence.

Please Note: There are a number of differences in how information on short term care is collected between the ASC-FR and SALT returns.

For example, activity data includes those receiving short term care to maximise independence with a Primary Support Reason (PSR) of Social Support, whereas this PSR is not included in short term expenditure (instead being recorded elsewhere).

Therefore, care must be taken when comparing the two returns; some comparisons of general trends can be made, but more direct comparisons, such as a cost per episode of care, are not recommended.

Expenditure data combines ST-Max (£368 million) and other short term care spending (£313 million) to give an overall gross current expenditure on short term care of £681 million (up 11.8% or £72 million since last year). Expenditure on short term care accounts for 3.2% of the total gross current expenditure.

Adults aged 65 and over accounted for 74.4% (£507 million) of the total short term spend. This age group has seen a 12.5% increase since last year whereas expenditure for those 18-64 years old has seen a 9.8% increase.

Expenditure on ST-Max is up 5.5% or £19 million, whereas activity on ST-Max has decreased by 5.7% or 15,005 completed episodes since 2019-20. At local authority level, this was mixed with some local authorities advising that provision was reduced as part of their response to the pandemic, whilst others reported that provision had increased. Full details are available in the COVID-19 insight within the data quality outputs.

ST-Max is a time limited period of short term support intended to maximise the independence of clients and reduce, or prevent, longer-term reliance on social care. In 2020-21 there were a total of 246,600 completed episodes of ST-Max where the outcome was known within the reporting period, down 15,005 (5.7%) since last year. Of these completed episodes of ST-Max 87.9% (216,750) were delivered for adults aged 65 and over.

It is important to note that one person may have multiple episodes of ST-Max within the year. As such, the 246,600 episodes of ST-Max related to 206,370 clients, which equates to an average of 1.2 completed episodes of ST-Max per client during the year.

The Primary Support Reason describes why the individual requires social care support. ST-Max is typically provided to those clients with a primary support reason of physical support. This is where an individual requires help because they find physical things difficult to do by themselves. Physical support was stated as the primary support reason for 89.2% (220,000) of completed ST-Max episodes in the period.

The same can be seen when considering the £368 million (up £19 million since 2019-20) gross current expenditure on ST-Max, where 83.2% (£306 million) was allocated to services for clients with a primary support reason of physical support.

ST-Max is not only offered to new clients. Many (though not all) local authorities offer this to existing clients, who account for 11.0% (27,135) of the total completed episodes of ST-Max in the period. Given that existing clients already have long term needs, the outcomes are very different.

The following section will only discuss the outcomes for new clients (those not already in receipt of long term care). Data on outcomes for existing clients can be found in Table 27 of the reference tables and data files accompanying this report.

A primary aim of ST-Max is to provide short term rehabilitative support allowing a client to avoid ongoing long term support needs.

Around a third of all completed episodes (32.8%) resulted in the client having no identified needs (down from 35.3% in 2019-20), therefore they had no further ongoing requirement for adult social care support.

As Figure 11 below shows, this was the most frequent outcome for both those aged 18 to 64 and aged 65 over. After this, the second most frequent outcome for both age groups is long term support being offered.

Source: SALT Collection, 2020-21, NHS Digital - See Table 21 in Reference Data Tables