Adult Social Care Activity and Finance Report, England - 2020-21

The following table shows reporting measures and year on year changes. Many of the year on year changes are likely to be influenced by the COVID-19 pandemic.

Table 1: Reporting measures with year-on-year change, 2019-20 and 2020-21

Gross current expenditure on adult social care by local authorities was £21.2 billion. This represents an increase of £1.6 billion from the previous year, a 8.1% increase in cash terms and a 1.3% increase in real terms. Local authorities reported income from specific and special grants has increased from £1.5 billion to £3.0 billion since the previous year.

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, 2020-21

Source: SALT Collection, 2020-21, NHS Digital - See Table 9, 21, and 34 in Reference Data Tables. Please 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.

Total expenditure on adult social care by local authorities in 2020-21 was £26.0 billion (up £2.7 billion since 2019-20, a 11.8% uplift), 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 3.

In 2020-21 gross current expenditure on adult social care (which accounts for spending by social care departments and also includes client contributions), was £21.2 billion, and this is the measure of expenditure used throughout this report (except where otherwise stated).

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, 2020-21

Source: ASC-FR Collection, 2020-21, NHS Digital - See Table 3 in Reference Data Tables. The sizes of the images are indicative and are not to scale.

Gross current expenditure has increased £1.6 billion since 2019-20, which is a 8.1% increase in cash terms and a 1.3% increase in real terms. As shown in Figure 3, this is the fifth consecutive year gross current expenditure in real terms has increased since the last increase in 2009-10.

Source: ASC-FR Collection, 2020-21, NHS Digital - See Table 15 in Reference Data Tables

Figure 4: Overview of gross current expenditure on adult social care, 2020-21

Source: ASC-FR Collection, 2020-21, NHS Digital - See Table 14, 19, 20 and 46 in Reference Data Tables. Numbers may not add up due to rounding.

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 £20.7 billion in 2020-21. A full time series of the estimated public spend on adult social care can be found in the table below.

Table 3: Net current expenditure on adult social care services in cash terms, by source of funding, 2009-10 to 2020-21

Source: ASC-FR Collection, 2020-21, NHS Digital

The remaining 29.1% (£7.6 billion) of total expenditure is funded by income from other sources, which has increased by 15.4% (£1.0 billion) since 2019-20 (as seen in Figure 6 below). Other Income and client contributions have decreased, while income from the NHS (including the Better Care Fund and recharges for activity funded under COVID-19 hospital discharge arrangements) and joint arrangements have both increased.

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 £2.0 billion income from Better Care Fund, which accounted for 49.8% 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 3.

It should be highlighted that 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 collected within the NHS Digital returns.

Source: ASC-FR Collection, 2020-21, NHS Digital - See Table 6 in Reference Data Tables and previous publications

Figure 7: Overview of total local authority expenditure and income on adult social care, 2020-21

Source: ASC-FR Collection, 2020-21, NHS Digital - See Table 3 in Reference 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. 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.