Source: ASC-FR Collection, 2018-19, NHS Digital - See Table 4 in Reference Data Tables, and ONS deflators found here https://www.gov.uk/government/statistics/gdp-deflators-at-market-prices-and-money-gdp-september-2019-quarterly-national-accounts
Adult Social Care Activity and Finance Report, England - 2018-19 [PAS]National statistics, Official statistics
- Publication Date:
- 22 Oct 2019
- Geographic Coverage:
- Geographical Granularity:
- Country, Regions, Councils with Adult Social Services Responsibilities (CASSRs), Local Authorities
- Date Range:
- 01 Apr 2018 to 31 Mar 2019
1. Activity and Finance Overview
Overall trends in activity and expenditure
While expenditure has risen every year since 2015-16, three main activity measures report mixed trends, so the increase in expenditure may be linked to the increasing costs in the provision of care.
Local authorities received 1,914,535 requests for support from new clients in 2018-19, an increase of 3.8% (70,615 requests) since 2018-19, and an increase of 5.7% since 2015-16. At a local authority level, more than a half (85 of 152 local authorities) saw an increase in requests compared to last year.
The total number of completed episodes of short term care to maximise independence  (ST-Max) was 255,275. This is an increase of 3.8% (9,240 episodes) from 2017-18. Eighty-six per cent (219,390) of these completed episodes were for adults aged 65 and over. The number of completed episodes of ST-Max for new clients increased by 5.1% compared to the previous year, whereas for existing clients the number of episodes dropped by 4.6%.
Overall, the number of clients receiving long term care has decreased each year since 2015-16, to 841,850 in 2018-19. This has been mainly driven by clients aged 65 and over receiving long term care, with numbers down 39,060 to 548,435 since 2015-16. However, the number of clients aged 18 to 64 receiving long term care has increased slightly over the period, increasing by 8,390 to 293,415 since 2015-16. More detail can be found in the long term care section of this report.
Gross current expenditure on adult social care by local authorities was £18.7 billion. This represents an increase of £807 million from the previous year, a 4.5% increase in cash terms and a 2.6% increase in real terms. Some local authorities provided comments regarding the change in expenditure for their authority, citing factors including the improved Better Care Fund and an increase in those requiring support for complex needs, leading to much higher costs of providing care.
What is the Improved Better Care Fund?
In the Spring Budget 2017, the government announced that an additional £2 billion would be given to councils in England over the next 3 years for adult social care. According to the grant determination, the funding can be spent on three purposes:
- Meeting adult social care needs
- Reducing pressures on the NHS, including supporting more people to be discharged from hospital when they are ready
- Ensuring that the local social care provider market is supported
This effect can also be seen in the average costs of care per week for residential and nursing care (known as unit costs) which have risen in 2018-19.
The average cost of residential care for a person aged 65 and over per week was £604 in 2017-18, but has now risen to £636, while the cost of nursing care for the same age band has increased from £638 to £678 a week. For those aged 18 to 64, the number of clients in residential or nursing care are much smaller, but a similar effect can be seen with unit costs increasing, from £921 to £976 a week for nursing care and from £1,274 to £1,320 a week for residential care.
The csv files accompanying this report provide a full breakdown of all expenditure and activity figures provided by local authorities as part of the ASC-FR collection.
Figure 1: Overview of adult social care activity provided or organised by local authorities, 2018-19
Trends in expenditure
Total expenditure on adult social care by local authorities in 2018-19 was £22.2 billion (up £882 million since 2017-18, a 4.1% uplift), however this includes capital charges and some of this expenditure is offset by income from other sources such as the NHS.
In 2018-19 gross current expenditure on adult social care (which accounts for spending by social care departments and also includes client contributions), was £18.7 billion, and this is the measure of expenditure used throughout this report (except where otherwise stated).
Why do we use gross current expenditure?
Gross current expenditure covers the amount of spend by local authorities that is not offset by income from clients and does not include a capital charge. It is the fiscal metric used to denote local government spending, so unless otherwise stated gross current expenditure is used as the main source for figures in this report.
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
Gross current expenditure has increased £0.8 billion since 2017-18, which is a 4.5% increase in cash terms and a 2.6% increase in real terms. As shown in Figure 3, this is the third consecutive year gross current expenditure in real terms has increased since 2009-10.
Figure 3: Gross Current Expenditure in cash and real terms, 2008-09 to 2018-19
Cash Terms versus Real Terms
A comparison in cash terms compares corresponding values between years, without any form of adjustment. A comparison in real terms accounts for the effect of inflation between figures, and so allows for the comparison of corresponding values, whilst controlling for any changes in the value of the pound.
More information on the process of obtaining these adjusted figures using Gross Domestic Product (GDP) deflators is available in Appendix A.
In additional to the usual funding of adult social care through council tax and grants from central government (such as improved Better Care Fund), in the last three years, local authorities have been able to use an adult social care precept to raise additional funds.
- The additional adult social care precept in 2018-19 generated £538 million, down from £552 million in 2017-18.
- 148 out of 152 local authorities with adult social care responsibilities utilised some or all of this 3% precept in 2018-19
When considering year on year changes at a local authority level, the change in gross current expenditure was variable, with 25 local authorities reporting a decrease since the previous year.
Local authority level data showing the differences in expenditure levels between 2017-18 and 2018-19 can be found in Table 3 of the reference data tables which accompany this report.
Figure 4 below provides a summary of gross current expenditure on adult social care and how this expenditure is allocated.
Table 1 shows total gross current expenditure and its constituent parts compared to last year. As a whole, gross current expenditure has risen by 4.5%, with increases in all constituent parts. This is largely due to long term support which makes up the majority of the total gross current expenditure. Short term support, which makes up the smallest proportion of gross current expenditure, has seen a growth of 4.4% (£25 million) from the previous year.
Table 1: Gross current expenditure, by care type, 2017-18 and 2018-19
Figure 4: Overview of gross current expenditure on adult social care, 2018-19
Public spending on adult social care
Users of this report may be interested in the overall estimate of public spending on adult social care, which consists of the net current expenditure (local authority spend) plus planned spending on the minimum Better Care Fund for social care or direct with social care providers, to give a total of £17.9 billion in 2018-19. A full time series of the estimated public spend on adult social care can be found in Table 2 below.
Table 2: Net current expenditure on adult social care services in cash terms, by source of funding, 2009-10 to 2018-19
Why might you use net current expenditure?
Net current expenditure is useful for understanding how much of adult social care is funded from local authority monies – be they raised locally such as council tax (including the adult social care precept), business rates, etc, or where they are centrally funded such as the improved Better Care Fund or the local government finance settlement.
Net current expenditure removes capital charges and external income and is thus not impacted by changes in client contributions and income from the NHS, the two largest income components.
For users specifically interested in this metric, an additional set of net current expenditure reference tables based on data collected in the ASC-FR are available.
Net current expenditure on Adult Social Care is also collected by the Ministry of Housing, Communities & Local Government as part of the Local Government Revenue Outturn returns, and published here: https://www.gov.uk/government/collections/local-authority-revenue-expenditure-and-financing
Income – how is social care funded?
Of the £22.2 billion total expenditure in 2018-19, 72.0% (£16.0 billion) is funded directly by the local authority (this includes capital charges and is known as net total expenditure, as seen in Figure 6 below). This represents a 5.0% increase (£761 million) from 2017-18.
One area of central funding is the improved Better Care Fund, which increased from £1.1 billion in 2017-18 to £1.5 billion in 2018-19. Expenditure funded by Specific and Special Grants such as the improved Better Care Fund is captured in the data, but those grants are not reported as income in this collection.
The remaining 28.0% (£6.2 billion) of total expenditure is funded by income from other sources, which has increased by 2.0% (£122 million) since 2017-18 (as seen in Figure 5 below). Income from joint arrangements has decreased, while income from the NHS, client contributions (up for the fourth consecutive year) and other income have all increased.
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 £1.8 billion income from Better Care Fund, which accounted for 66.1% of their Income from NHS. Please note that 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, reported in Table 2.
What is the Better Care Fund?
The £5.3bn Better Care Fund was announced by the Government in the June 2013 spending round, to ensure a transformation in integrated health and social care. The Better Care Fund (BCF) creates a local single pooled budget to incentivise the NHS and local government to work more closely together around people, placing their wellbeing as the focus of health and care services, and shifting resources into adult social care and community services for the benefit of the people, communities and health and care systems.
Figure 5: Income, by income source, 2015-16 to 2018-19
Figure 6: Overview of total local authority expenditure and income on adult social care, 2018-19
2014-15 was the first year of the SALT data collection, and due to 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 trends in the Activity data, we have used 2015-16 as our starting point.
For both new and existing clients, where an outcome had been determined within the reporting period.
Short term support to maximise independence is terminology introduced in the EQ-CL framework to describe a range of services that are of short duration (typically being provided for a few weeks) and that have the explicit aim of trying to minimise the person’s use of ongoing social care services.
Full details of all comments provided by councils can be found in the data quality tables which accompany this report.
To note, the breakdowns on long term and short term support include all support, not just those with the relevant sequel following a request. The long term support figures in the diagram above relate to all those receiving care at some point in the year.
A full breakdown of how total expenditure is split between local authority spend and income from other sources can be found in Table 2
Numbers may not add up due to rounding
Net current expenditure is total expenditure excluding capital charges and less all income.
Full details of the sources of these data can be found in Appendix B
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. It is important to note that 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.