Adult Social Care Activity and Finance Report, England, 2023-24

Source: SALT collection, 2023-24, NHS England - See Table 9 in Data Tables.

Figure 1b: Short term care to maximise independence (ST-MAX) for new clients, 2023-24

Source: SALT collection, 2023-24, NHS England - See Table 21 in Data Tables.

Figure 1c: Long term care, 2023-24

Source: SALT collection, 2023-24, NHS England - See Table 34 in Data Tables. The long term support figures in the diagram above relate to all those receiving care at some point in the year.

Total expenditure on adult social care by local authorities in 2023-24 was £32.0 billion, however this includes capital charges and some of this expenditure is offset by income from other sources such as the NHS. A full breakdown of how total expenditure is split between local authority spend and income from other sources can be found in Table 5 of Appendix C.

In 2023-24 gross current expenditure on adult social care (which accounts for spending by social care departments and also includes client contributions), was £27.1 billion, and this is the measure of expenditure used throughout this report (except where otherwise stated).

There were no specific funding measures in place to address the residual impact of the coronavirus (COVID-19) pandemic in 2023-24; however, these were in place in previous years (2020-21 and 2021-22) so this should be borne in mind when looking at longer term trends.

It is important to be aware of the constituent parts that contribute to calculating gross current expenditure, as shown in Figure 2, as any year on year changes to gross current expenditure will be driven by increases or decreases in one or more of these areas.

Figure 2: How gross current expenditure is calculated, 2023-24

Source: ASC-FR collection, 2023-24, NHS England - See Table 3 in Data Tables. The sizes of the images are indicative and are not to scale.

Gross current expenditure has increased £3.4 billion since 2022-23, which is a 14.2% increase in cash terms and a 7.5% increase in real terms. Figure 3 shows the trends over time in cash terms and real terms.

When looking at changes in monetary amounts over time it can be difficult to see whether more or less money has been spent as the real change is often masked by the effects of inflation. Therefore, it is useful to strip out the effects of inflation so the real change in expenditure can be examined.

Figure 4 provides a further breakdown of the latest year’s gross current expenditure on adult social care and how this expenditure is allocated.

Figure 4: Overview of gross current expenditure on adult social care, 2023-24

Source: ASC-FR collection, 2023-24, NHS England - See Table 14, 19, 20 and 46 in Data Tables. Numbers may not add up due to rounding.

The overall estimate of public spending on adult social care consists of the net current expenditure (local authority spend, and equivalent to gross current expenditure minus client contributions) plus planned spending on the minimum Better Care Fund for social care or direct with social care providers. It gives a total of £25.9 billion in 2023-24. A full time series of the estimated public spend on adult social care can be found in Table 5 of Appendix C.

Expenditure funded by the improved Better Care Fund and other Specific and Special Grants is captured in the data, but those grants are not reported as income in this collection. Figure 5 below shows how income from Specific and Special grants increased between 2016-17 and 2021-22, with a big jump in 2020-21 and 2021-22 due to COVID-19 funding such as the Infection Control Fund, and Workforce Capacity Fund which were reported and recognised as Specific and Special Grants in ASC-FR. In 2023-24 Specific and Special grants increased by 35.1% (to £3.4 billion) since the previous year.

Source: ASC-FR collection, 2023-24, NHS England.

The remaining 27.9% (£8.9 billion) of total expenditure is funded by income from other sources. This included 'Client Contributions' and 'Joint arrangements' which have increased since last year, 'Income from the NHS' (including the Better Care Fund (note: this is different to the improved Better Care Fund)), and 'Other income' which has decreased.

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.

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 £2.5 billion income from Better Care Fund, which accounted for 58% of their Income from NHS. 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.

Whilst Health and Wellbeing Boards use the Better Care Fund to support integrated health and social care, finance data is available on how local authorities spend this funding but data on the associated activity, or lower-level detail on how this funding is spent is not included within the NHS England data collections.

Figure 6: Overview of total local authority expenditure and income on adult social care, 2023-24

Source: ASC-FR collection, 2023-24, NHS England - See Table 3 in Data Tables. Net estimate of total public spend is based on local authority expenditure plus NHS Better Care Fund spend, some of which is spent directly by the NHS and so would not be included in the ASC-FR return made by local authorities. Although the Income from the NHS reported by local authorities in the ASC-FR return does include some Better Care Fund spending, it will also include local arrangements with the NHS. Therefore, the Income from NHS and Better Care Fund figures in the diagram above are related but are not directly comparable.