Adult Social Care Activity and Finance Report, England, 2022-23

This appendix constitutes a background data quality report. For more specific information about the quality of the latest year’s data see the Data Quality Summary file which is available at https://digital.nhs.uk/data-and-information/publications/statistical/adult-social-care-activity-and-finance-report/2022-23

This data quality statement aims to provide users with an evidence-based assessment of the quality of the statistical output from the Short and Long Term (SALT) activity collection and the Adult Social Care Finance Return (ASC-FR), which local authorities in England submit to NHS England. It reports against the nine European Statistical System (ESS) quality dimensions and will allow the reader and users of the data to understand any limitations of the data.

The SALT and ASC-FR collections are concerned with adults, defined as those aged 18 or over, and relate to adult social care services. Children’s social services are not covered in these returns, nor are services provided to adults on behalf of children (e.g. Section 17 payments). Some local authorities are known to continue with children's services for a few clients aged 18 or over; these clients should be included within the adult returns. Most of the submitted data is mandatory however there are a number of voluntary items in the SALT collection.

As 2014-15 was the first year of the SALT data collection (and therefore experienced 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 time series trends in the Activity data, we have used 2015-16 as our starting point.

Through the respective collections’ working groups, NHS England 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 2021 English census is the most current ONS population data available at the disaggregation required for this report.

Client Level Data: The DHSC commissioned project to transition the current aggregate return for social care activity to client level became mandatory from 1 April 2023, with the first two quarterly submissions made in July and October 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 has 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.

COVID-19: Year on year trends continue to be influenced by factors relating to the pandemic into 2022-23, such as the cessation of increased funding that was made available in 2020-21 and 2021-22. NHS England have worked closely with local authorities to gather extra context on how the pandemic has impacted both care provision and reporting during and post-pandemic. Therefore data for 2022-23 is also likely to be subject to more local variation than in pre-pandemic years.

The known strengths and limitations associated with this year’s data (some of which continue to be linked to the 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 tables.

Post-pandemic the impacts of the COVID-19 pandemic are still prominent and local authorities continue to report this:

SALT

ASC-FR

The degree to which the statistical product meets user needs in both coverage and content

The report covers activity and expenditure for local authorities in England on social care services for adults aged 18 and over, by service provision and primary support reason. Information on a number of accounting categories is also included such as income from the NHS, grants provided to voluntary organisations and gross and net expenditure. A number of the measures within Adult Social Care Outcome Framework (ASCOF) draw on data from the SALT collection.

Full details on the collections, and the relationship between SALT and ASCOF, can be found on the adult social care data hub.

The data is used by central government and by local authorities to assess their performance in relation to their peers. It is also available for use by researchers and charities e.g. The Kings Fund looking at local authority performance and by clients and the public to hold local authorities and government to account. It has also been used previously by the Care Quality Commission (CQC) for their Annual Performance Assessment (APA), by Age UK, by the Office for National Statistics (ONS) and the National Audit Office (NAO).

The proximity between an estimate and the unknown true value

The accuracy of the SALT and ASC-FR data is the responsibility of the local authorities who submit the data to NHS England. Both returns are aggregate collections taken from administrative systems. As NHS England does not have access to the individual records behind the aggregate counts, we are reliant on local authorities to assess their own data quality however we aim to assist in this process by providing a bespoke data quality report (point 3 below).

In many instances, assessing reliability depends on local knowledge, as each local authority determines the approach taken in their area. What may be an anomaly in one area could be considered standard practice elsewhere. However, a range of activities are undertaken (outlined in more detail below) to check and improve data quality. Discussions with local authorities have provided useful anecdotal information about distributions and trends.

NHS England perform validation checks within the data returns 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 were then able to review and resubmit data ahead of the deadline or provide explanations for any identified issues.

The submission and validation process for each collection is carried out as follows:

1. The local authority collates the data for submission in the relevant collection form. This form includes inbuilt validations to allow local authorities to check their data for common issues prior to submission.
2. Local authority submits data by the mandated deadline.
3. All local authorities who met this deadline receive a data quality report covering critical validations and providing some derived totals allowing local authorities to confirm their data is correct.
4. NHS England reviews the quality of all files submitted and may provide additional support to local authorities with significant data quality issues.
5. Local authorities can resubmit data to amend any identified quality issues.
6. Final deadline for submission.
7. Following the final deadline NHS England will carry out analysis of the quality of final data. Although local authorities cannot resubmit data after this point, they may be contacted for additional clarification or context.

The validation checks carried out throughout this process included:

• Validations across worksheets to check figures across different tables that store the same data.
• Checks for missing data items.
• Checks for instances of recorded activity without associated expenditure and vice versa.
• Comparing the unit costs with those from other local authorities and flagging outliers.

The data submitted was completed to a high degree, with the final returns yielding a very high national completeness score for both collections. For those local authorities that made a submission, 99.99% of mandatory cells we completed for SALT and 99.85% for ASC-FR.

The final validation stage consisted of looking at the responses to the validation checks mentioned above to see if there are clear instances where data submitted is implausible or local authorities have submitted data not in line with the guidance for the data collection.

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.  

We approached local authorities for additional context where outliers or inconsistencies were identified. Not everyone was able to respond and so the data quality summary excel file reflects those explanations received from local authorities, either at the point of submission or in response to our follow-up queries.

Bolton (STS001 Table 1a ) and Trafford (STS001 Table 1b) have both confirmed that there was a data entry error in their SALT data returns for requests for support. This does not affect the totals for those tables.

Post-publication, Telford & Wrekin identified an error in the SALT return. All the values in Column E on the LTS003 tab (CASSR Commissioned Support Only) should have actually been in column D (CASSR Managed Personal Budget). The consequence of this error is that their ASCOF 1C(1B) has been reported at 7.1% instead of 100% (as per previous years). Please see the Data Tables and Data Quality Tables for more detail.

St. Helens (LTS002A Table 1b) reported incorrect figures for the number of people 65+ moved to Nursing or Residential care from the community following an unplanned review. The totals are higher than the figures report. 

Calderdale have confirmed an error within LTS001B Table 3a, the data under Part Direct Payments split by Ethnicity for our Male cohort should be under CASSR Managed Personal Budget and vice versa.

Lincolnshire have reported an error within their ASC-FR submission, related to a specific 'non-salt' total: ‘Income from NHS’ for ‘Commissioning and Service Delivery’. The submitted figure of £62,957,000 should be £24,104,000. This impacts on the total amount of 'Income from NHS' reported for Lincolnshire.

Common issues local authorities advised us of in previous years include:

In ASC-FR

• Allocating expenditure by Primary Support Reason (PSR) in the ASC-FR can be challenging as many finance systems are not configured to collect this data.

In SALT

• Limitations with case management systems for reporting of some data items, particularly around full cost clients.
• Several local authorities have mentioned difficulties obtaining and/or quality assuring data from third party organisations such as mental health or carer data.

Information on the number of local authorities returning data at the mandated and final deadlines across both collections is available on the submissions tab of the accompanying Data Quality Summary file.

Returns were submitted by 151 of 152 local authorities for SALT.

Returns were submitted by 149 of 152 local authorities for ASC-FR.

Due to a serious cyber-attack, Hackney Council are still unable to submit in 2022-23 data to NHS England. There was also missing ASC-FR data for Tower Hamlets and Hillingdon.

In order to present England and Regional-level statistics that can be compared to previous years, NHS England have calculated estimates based on adding missing local authority data to 2022-23 regional and national totals.

These can be summarised as:

• adding 2019-20 Hackney SALT and ASC-FR data to 2022-23 totals
• adding 2021-22 Tower Hamlets and Hillingdon ASC-FR data to 2022-23 totals

We previously 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 therefore chose the option described above and have continued using this to be consistent over time.

The detailed Data Tables and CSV’s display Hackney, Tower Hamlets and Hillingdon local authority data as [x], denoting missing data.

Timeliness refers to the time gap between publication and the reference period. Punctuality refers to the gap between planned and actual publication dates

The SALT and ASC-FR data collections are undertaken annually, and a report is published each year. This report relates to the financial year 2022-23 and for the October publication (data tables only) is being released seven months after the period to which the data relates, and two months after the final data was submitted to NHS England. For the December publication (full suite of publication outputs) is being released nine months after the period to which the data relates, and four months after the final data was submitted to NHS England.

This publication has been released in line with the pre-announced publication date and is therefore deemed to be punctual.

Accessibility is the ease with which users are able to access the data, also reflecting the format in which the data are available and the availability of supporting information. Clarity refers to the quality and sufficiency of the metadata, illustrations and accompanying advice

This publication is available in HTML, in order to meet the Government Accessibility Standard. Data Tables are available to download from the NHS England website in Excel (.xlsx) and comma-separated values (.csv) format to allow the user access to the underlying data. Also provided through the publication pages are a Power BI interactive dashboard and supporting information to help the user understand the data more.

The publication includes many of the Government Statistical Service recommendations on improving accessibility of spreadsheets for users with disabilities. This guidance aims to help producers of government statistics and analysis meet the UK accessibility regulations for public sector websites.

For SALT, the numbers in the csv and data tables are rounded to the nearest five and data values between 0 and 4 have also been suppressed with [c], for disclosure reasons.

ASC-FR does not collect counts of people and as such is not subject to suppression.

Coherence is the degree to which data that are derived from different sources or methods, but refer to the same topic, are similar

SALT is a statutory data collection to collect Short and Long Term (SALT) support information across England; there are no current alternative sources of this data with which these can be compared.

ASC-FR analyses expenditure by type of service and type of expenditure and income and complies with the 2022-23 Service Reporting Code of Practice (SeRCOP). The SeRCOP guidelines provide details of what should be included within each of the ASC-FR reporting lines. More details about SeRCOP can be found on the CIPFA website.

The Department for Levelling Up, Housing & Communities (DLUHC) publish information on expenditure collected from local authorities via the RO3 return. Expenditure on social care can be seen in the report entitled ‘Local authority revenue expenditure and financing England: 2021 to 2022 final outturn’ which can be accessed via the GOV website.

Comparability is the degree to which data can be compared over time and domain, for example, geographic level

Whilst there were no mandatory changes to this year’s data collections, additional guidance was provided to local authorities in 2020-21 and 2021-22 to advise that activity funded under COVID-19 hospital discharge arrangements should be captured in SALT, so long as it meets the definition of care provided under the Care Act and is being commissioned by the LA. This may mean that more clients were included in the collection over those reporting periods; local authorities also told us that they would have supported some of these clients anyway so the impact of this may vary from authority to authority.

In 2020-21 and 2021-22, all adult social care COVID-19 related costs should be captured in ASC-FR. Whilst separate lines have been added to the RO3 return for new COVID-19 associated categories, these could not be added to the ASC-FR data collection at short notice due to the associated timescales required by the change process without impacting the timeliness of the published data. It is acknowledged that some of the spending (for example, on COVID-19 hospital discharge arrangements, or by the Infection Control Fund) may not directly relate to people whose care is supported by the local authority however a decision was taken that given the increased funding, these costs should be 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. Note, there were no specific COVID-19 related finance arrangements remaining in 2022-23.

Trade-offs are the extent to which different aspects of quality are balanced against each other.

For the 2022-23 reporting period, two submission periods were made available for local authorities. This was consistent with last year’s return. Data Quality reports and support were made available to those local authorities who submitted by the first deadline. Local authorities were able to make updates to their data during the validation period. Further detail is available in our data quality tables however it is important to consider this when reviewing this year’s data and changes over time.

The processes for finding out about users and uses, and their views on the statistical products

There are established Working Groups whose aim is to manage the development of both data collections to reflect the requirements of users and policy. The groups include representatives from NHS England, Department of Health and Social Care, and local authorities.

User feedback on the format and content of the 2022-23 Adult Social Care Activity and Finance report, as well as on the SALT and ASC-FR collections, is invited; please send any comments to [email protected]

Information about the Social Care collection materials 2023 is available at the adult social care data hub.

Changes to upcoming collections can be seen in the most recent September letter.

The data collection process used in this publication is subject to assurance by the Data Alliance Partnership Board. This is to ensure that data collections do not duplicate other collections, minimise the burden to all parties and have a specific use for the data collected.

The burden of the SALT and ASC-FR collections has been assessed and approved, and the burden of any changes to the collection are similarly assessed to ensure that they do not create undue burden for local authorities.

The procedures and policy used to ensure sound confidentiality, security and transparent practices

All statistics are subject to a standard NHS England risk assessment prior to issue. The risk assessment considers the sensitivity of the data and whether any of the reporting products may disclose information about specific individuals. Methods of disclosure control are discussed, and the most appropriate methods implemented. As a result of this process, finance data is unsuppressed and unrounded whilst activity data is rounded to the nearest five.

NHS England aims to be transparent in all its activities. A description of the collection process and any issues with the quality of the 2022-23 activity and finance data are documented in the data quality tables.

SALT and ASC-FR data is submitted to NHS England through a secure electronic file transfer system called Strategic Data Collection Service (SDCS). The submitted files are transferred from SDCS and stored on a secure network with restricted access folders.

Please see links below for more information about related NHS England policies:

Statistical Governance Policy

Freedom of Information Process

Data Access Request Service

Privacy and data protection

Small Numbers Procedure