Publication, Part of Adult Social Care Activity and Finance Report
Adult Social Care Activity and Finance Report, England, 2022-23
National statistics, Official statistics, Accredited official statistics
2016-17 updated cash and real term NCE and GCE figures
Table 4 of the Net Current Expenditure and Gross Current Expenditure Tables the cash and real term figures for 2016-17 have been corrected. The correction has also taken place in Figure 3 Cash vs Real
16 February 2024 14:37 PM
Long term care
Long term care is provided to clients on an ongoing basis and varies from high intensity provision such as nursing care, to lower intensity support in the community such as the provision of direct payments to arrange regular home care visits. Long term care has no fixed time period and is delivered for as long as it is required.
Note: There are differences in how information on long term care is collected between the ASC-FR and SALT returns.
For example, activity data includes those receiving long term care with a Primary Support Reason (PSR) of Social Support, whereas this PSR is not included in long term expenditure (instead being recorded as a combined short term/long term spend total).
In addition, information regarding support settings is recorded using different categories between the returns, and so this data cannot be directly compared.
Therefore, care must be taken when comparing the two returns; some comparisons of general trends can be made, but more direct comparisons, such as an average cost per person, are not recommended.
Key findings
Over three quarters (77.8%) of total gross current expenditure is spent on long term care (£18.4 billion), which consists of residential, nursing and community care. This represents an increase of £1.9 billion (11.2%) compared to 2021-22.
Gross current expenditure is spent on long term care evenly between the two age groups, 49.6% (£9.1 billion) on clients aged 18-64 and 50.4% (£9.3 billion) on clients 65 and over.
Source: ASC-FR collection, 2022-23, NHS England - See Table 17 in Data Tables and previous publications.
Source: SALT collection, 2022-23, NHS England - See Table 2 in Data Tables and previous publications.
In total, 835,335 clients were supported at some point in the year, with 629,050 of these clients (75.3%) in receipt of long term support at year end. Of this latter group, 466,040 clients (74.1%) had been receiving long term support for one year or more.
The 18-64 age group has a higher proportion of clients in long term care at year end receiving long term support for one year or more (84.8%), compared to those aged 65 and over (66.6%).
Demographics of those in long term care
In 2022-23, 9 in 1,000 population of 18-64 year olds received long term support during the year, while 52 in 1,000 population aged 65 and over received this type of support.
Although just over one-third (35.1%) of long-term activity was provided to clients in the 18-64 age group in 2022-23, this age group accounted for just under half (49.6%) of the gross current expenditure for long term care during the period.
One explanation for this is that long term support for 18-64 year olds typically covers more complex care needs, and as a result, unit costs for both nursing and residential are much higher for this age band (unit costs are not available for community care). This is explored in more detail in the section regarding Primary Support Reasons.
Almost 6 in 10 (56.8%) clients receiving long term support at the year-end are female. Data is not collected on gender split for short term care.
The proportion of female clients increases further when we consider those in a residential home those supported in a nursing home (both 60.8%).
Office for National Statistics (ONS) 2021 mid-year population figures for England show that there are more women than men aged 65 and over (accounting for 54.2% of the total population in this age group). Therefore, the numbers receiving long term care within the year may partially be a result of differences in the population for this age group.
Figures 15 shows a breakdown of the ethnicity of those in long term care, compared to the general population.
Source: SALT collection, 2022-23, NHS England - See Table 41 in Data Tables and 2021 census data https://www.nomisweb.co.uk/datasets/c2021ts021
When analysing data by support setting, there are some notable differences which can be seen in Figure 16. For example, 9 in 10 clients that are supported in a residential or nursing setting were from a white ethnic background compared to 8 in 10 clients in the community and prison setting.
Source: SALT collection, 2022-23, NHS England - See Table 41 in Data Tables.
Long term care by support setting
Activity
Support setting is the primary setting where the client receives services. Expenditure and activity data collect information regarding support setting using different categories. The main difference is for the community care setting. Expenditure data is captured using a mixture of delivery mechanism and support setting, whereas activity data is captured by delivery mechanism only. Comparisons regarding support setting are limited between the two data sources, and discussion of the two collections has been separated in this section.
Use of hierarchies in support setting
An individual may receive care in multiple support settings throughout the year. To avoid double counting a hierarchy is used to ensure counts of those receiving support in the year are not duplicated.
An individual can only be counted under one setting in the hierarchy – for example if an individual received both residential and nursing care in the year, they would be counted under nursing care only.
For the purposes of this section therefore, analysis on support setting will focus instead on those receiving services at the end of the year. This provides a snapshot figure of the number of clients in each support setting at year end.
Data on the support settings for those receiving care in the year can be found in the data tables accompanying this report.
Source: SALT collection, 2022-23, NHS England - See Table 39 in Data Tables.
Expenditure
As seen in Figure 18 below, for both age groups, residential care accounted for the highest proportion of gross current expenditure.
However, all elements of community care (consisting of direct payments, home care, supported living and other long-term care) account for 49.3% of gross current expenditure on long term care for both age groups combined.
Source: ASC-FR collection, 2022-23, NHS England - See Table 43 and 44 in Data Tables
In 2022-23 gross current expenditure on long term care increased by £1.9 billion (11.2%) since the previous year, and an increase was seen across every support setting.
Source: ASC-FR collection, 2022-23, NHS England - See Table 45 in Data Tables and previous publication.
Primary support reason and long-term care
A Primary Support Reason (PSR) describes why the individual requires social care support. For example, an individual may have a learning disability but would not be recorded under PSR learning disability support if their primary reason for support identified at assessment falls under one of the other classifications. This is collected in both the activity and finance data collected by NHS England.
Some local authorities have previously reported difficulty in correctly allocating activity and expenditure across these categories, and this should be taken into consideration when analysing this data. Comparison of trends in the data, however, does provide useful insight into how long-term care is provided by local authorities.
Whereas ST-Max is predominantly provided to clients with a primary support reason of physical support, the picture in long term care is more varied. In particular, the most common primary support reason for the client needing support differs by age group.
46% of those aged 18-64 receiving long term support in the year had a primary support reason of learning disability
Source: SALT collection, 2022-23, NHS England - See Table 35 in Data Tables.
Although the expenditure return does not include the social support primary support reason, examination of this data shows a similar trend to that of activity data. Physical support accounted for the majority of gross current expenditure on those aged 65 and over, while learning disability support accounted for the majority of expenditure on those aged 18-64.
Source: ASC-FR collection, 2022-23, NHS England - See Table 45 in Data Tables.
Unit Costs
At England level, for clients aged 18 to 64 and 65 and over, learning disability support has the highest unit costs across all support settings (nursing, residential, both residential and nursing combined).
As seen in Figure 22, care for those clients aged 18-64 is more likely to be due to a primary support reason of learning disability, therefore these higher costs are likely to have more impact on their overall unit costs.
For clients aged 18-64 accessing services at year end, learning disability accounts for almost half (48.6%) of the activity by primary support reason. Of these, only 13.5% of all clients accessing services at year end were in a nursing setting. This increases to 47.8% for clients in a community support setting and even further to 60.6% of those in a residential care setting.
Post-pandemic, a number of local authorities advised that their unit costs were affected due to the ongoing impacts of the COVID-19 pandemic, and the cessation of associated funding to support the sector.
Figure 22: Overview of weekly unit costs of care per person by primary support reason, 2022-23
Source: SALT and ASC-FR collections, 2022-23, NHS England - See Table 53, 54, 37 and 38 in Data Tables.
Regional trends in long term care
The numbers of clients supported in long term care during the year varies regionally. The North West has the highest number of clients aged 18-64 accessing long term support during the year, with 1,000 clients per 100,000 population. In the 65 and over age group London is highest with 7,095 clients per 100,000 population, closely followed by the North East with 6,600 clients per 100,000 population.
From a local authority perspective, the local authorities with the six highest numbers of clients aged 65 and over accessing long term support per 100,000 are all in London.
Last edited: 5 March 2024 10:23 am