Adult Social Care Activity and Finance Report, England, 2021-22

This is the sixth year in which the adult social care activity and finance data have been brought together into one annual official statistics report.

Adult Social Care Finance Return (ASC-FR) Data has a classification of National Statistics. National Statistics status means that official statistics have been assessed as meeting the highest standards of trustworthiness, quality and public value. Short and Long Term (SALT) Data is produced in the same way and has a classification of Official Statistics.

All official statistics should comply with the UK Statistics Authority’s Code of Practice for Statistics which promotes the production and dissemination of statistics that inform decision making. Find out more about the Code of Practice for Statistics.

Activity data is sourced from the SALT return, while finance data is taken from the ASC-FR. In previous years the report also included analysis of the Deferred Payments Agreement (DPA) collection. This is now a separate publication which can be found here: https://digital.nhs.uk/data-and-information/publications/statistical/deferred-payment-agreements

This report presents the main themes from the mandatory data at England level only. Regional and local analysis can be found in the publication Data Tables. The full data collected including voluntary elements of the data are available in both Excel and CSV format.

Further information around the data collections can also be found within the Data Collections and Guidance section of the Adult Social Care data hub.

Adult social care activity provided or arranged by local authorities covers a wide range of services including long term and short-term care, plus support to carers. Clients may take a variety of different pathways through the system, according to their needs.

This report looks at the breakdown of expenditure by local authorities on adult social care, and the activity that is provided or arranged by the local authorities. It does not cover adult social care activity and expenditure that is provided or funded elsewhere, for example, if the care is arranged and funded by the client without any involvement from the local authority.

While the two collections have been designed to be as complementary as possible, there are some differences in how data is categorised and so direct comparisons between the two sources should be made with care.

It is possible however, to consider broader similarities and differences in the trends shown in the data. For more information see the How can the data be used? section below.

Where there are differences in the definitions used between the collections these will be clearly stated. Further information is available in the Adult Social Care Data Dictionary which sets out the data definitions for each of the collections, alongside the guidance documents for each collection. If any further information is required about how the data used in this report can be compared, please contact us at [email protected].

The finance elements of this report focus primarily on gross current expenditure. This is defined as the total expenditure less capital charges, and less all income except for client contributions. Please see Figure 2 in the Trends in expenditure section.

This publication consists of the following outputs:

• Data Tables - providing activity and finance data at national, regional and local authority level.
• Net current expenditure Data Tables - providing net current expenditure finance data at national, regional and local authority level.
• Data quality summary - showing submissions made, validation reasons, general comments and COVID-19 insight.
• Data quality statement – assessing the quality of the SALT and ASC-FR data collection returns.
• CSV pack - Machine readable open data (csv files), data dictionary, UUID files.
• PowerBi interactive tool – showing comparable metrics at national, regional, CIPFA and local authority level.

The data is presented as follows:

• Finance data within the commentary of this report is rounded to the nearest £million. Figures in £billions are reported to one decimal place unless this does not sufficiently highlight the range in which case there may be exceptions to two decimal places.
• Activity data within the commentary of this report is rounded to the nearest five.
• Percentages are rounded to one decimal place.

This report may be of interest to members of the public, policy officials and other stakeholders to make local and national comparisons and to monitor the quality and effectiveness of services.

NHS Digital performed validation checks within the data templates and provided post-submission data quality reports for each local authority to identify both logical inconsistencies in the data, and where the data submitted is an outlier against either local and national data or against submissions from previous years. Local authorities could then review and resubmit data ahead of the deadline or provide explanations for any identified issues.

Both the SALT and ASC-FR data returns contain complex elements and this, combined with the aggregate nature of the collections, means that some data quality issues are not always immediately apparent. Furthermore, the annual nature of the collections means that any issues with the submitted data can sometimes take a while to be identified and worked through with local authorities. Please see the excel Data Quality Summary Tables for comments provided by the local authorities on the quality their data.

Through the respective collections’ Working Groups, NHS Digital work with local authorities and other stakeholders to continually develop the data template and the accompanying guidance documents to improve clarity and ease of completion.

Please note the 2011 English census is the most current ONS population data available at the disaggregation required for this report.

We can now confirm that the DHSC commissioned project to convert the current aggregate return for social care activity to client level will be mandatory from 1 April 2023, with the first quarter submission in July 2023. The envisaged benefits include increased value from the data collected, both through wider and more flexible availability of social care data together with the health links; a simpler return leading to reduced burden; and greater flexibility for future developments than aggregate returns such as SALT allow. DHSC and NHS Digital have engaged with all parts of the system, including all system suppliers, LGA, ADASS, NHS England and a range of individual LAs. Further information is available at Adult Social Care Client Level Data - NHS Arden & GEM CSU (ardengemcsu.nhs.uk)

For any queries on how this change may affect the contents of future reports, please contact [email protected] with the subject heading Client Level Data.

Year on year trends continue to be influenced by factors relating to the pandemic into 2021-22, such as increased funding being made available. Data for 2021-22 is also likely to be subject to more local variation than in previous years. NHS Digital have worked closely with local authorities throughout, gathering extra context on how the pandemic has impacted both provision and reporting.

The known strengths and limitations associated with this year’s data (some of which continue to be linked to COVID-19), are listed below so these can be considered when reviewing the key findings and analysis. Further details are provided alongside the relevant analysis. Where local authorities have made us aware of specific issues affecting their provision/data, these can be found in the accompanying excel Data Quality Summary Tables.

In 2020-21 the government (via the NHS) paid for new or extensions of existing packages of care and support for patients discharged from hospital or who would otherwise have been admitted to hospital. Although the SALT collection does not typically capture clients supported by the NHS, it includes activity funded under these COVID-19 hospital discharge arrangements, so long as it met the definition of care provided under the Care Act and was commissioned by the LA. These arrangements have continued into 2021-22.

This may mean that more clients were included in the collection over the reporting period; local authorities also advised that some of these clients would have been supported by the local authority anyway so the impact of this may vary from authority to authority.

Local authorities reported that resource was reallocated to focus on the most appropriate support. As the SALT collection does not cover a complete picture of activity, this means that reductions against one service line would not necessarily be offset by an increase elsewhere in the collection.

The continued impacts of the COVID-19 pandemic reported by local authorities has contributed to the reduced number of clients in long term care during the year and include:

• a reduction in availability or capacity of services
• services paused or closed
• staff shortages over the reporting period

COVID-19 funding continues to be provided and captured in 2021-22. All adult social care COVID-19 related costs should be captured in ASC-FR. Whilst separate lines have been added to the RO return for new COVID-19 associated categories, these could not be added to the ASC-FR data collection at short notice. This was due to the associated timescales required by the change process without impacting the timeliness of this published data. It is acknowledged that some of the spending (for example, on activity funded under COVID-19 hospital discharge arrangements, or where grant funding is passported directly to a care provider) may not directly relate to clients whose care is supported by the local authority however these costs are included for completeness, reported under Commissioning and Service Delivery, as this is Adult Social Care sector support, through local authorities. This means that year on year overall totals are not directly comparable.

The ability to capture activity and expenditure funded under COVID-19 hospital discharge arrangements in the ASC-FR collection varied by local authority. This has affected the unit costs accordingly.

Due to a serious cyber-attack, Hackney Council has been unable to submit SALT and ASC-FR 2020-21 and 2021-22 data to NHS Digital. There was also missing ASC-FR 2021-22 data for Swindon due to resourcing issues.

In order to present England level statistics that can be compared to previous years, NHS Digital have calculated estimates based on adding missing local authority data to 2021-22 regional and national totals.

These can be summarised as:

• adding 2019-20 Hackney SALT and ASC-FR data to 2020-21 and 2021-22 totals
• adding 2020-21 Swindon ASC-FR data to 2021-22 totals

We investigated other options for estimating England level statistics, such as uplifting previous years’ data for the missing local authorities by a factor equal to either the latest national, regional or nearest neighbour percentage increase. Because these ranges of estimates are fairly narrow, we have therefore we have chosen the option described above.

The detailed Data Tables display Hackney and Swindon local authority data as [x], denoting missing data.