Adult Social Care Activity and Finance Report, England, 2021-22

Source: ASC-FR and SALT Collection, 2021-22, NHS Digital - See Tables 1, 2, 3, 15, 29 and 33 in Data Tables.

Local authorities received 1,978,550 requests for support from new clients in 2021-22, an increase of 9.3% since 2015-16. Note: as 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 time series trends in the Activity data, we have used 2015-16 as our starting point.

The total number of completed episodes of short term care to maximise independence (ST-Max) for both new and existing clients, where an outcome had been determined within the reporting period was 252,150. 87.1% (219,580) of these completed episodes were for clients aged 65 and over. Short term support to maximise independence is terminology introduced in the Adult Social Care Data Dictionary 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.

Overall, the number of clients receiving long term care during the year has decreased since 2015-16, to 817,915 in 2021-22. This has been mainly driven by clients aged 65 and over receiving long term care, with numbers down 58,485 to 529,010 since 2015-16. However, the number of clients aged 18-64 receiving long term care has increased slightly over the period, increasing by 3,880 to 288,905 since 2015-16.

Since last year there has been a decrease in the number of clients in long term care during the year, down 23,325 (2.8%). This decrease is driven by those aged 65 and over which accounts for 96.6% of the drop. Some local authorities told us this was influenced by; a reduction in availability or capacity of services, services paused or closed, and staff shortages over the reporting period. 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 £22.0 billion. This represents an increase of £0.7 billion (3.4%) from the previous year. Local authorities reported income from specific and special grants of £1.5 billion in 2019-20, this increased to £3.0 billion in 2020-21 and has remained at £3.0 billion in 2021-22 due to COVID-19 funding e.g. Infection Control Fund, Workforce Capacity Fund being reported and recognised as Specific and Special Grants in ASC-FR.

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.

Gross current expenditure has increased £0.7 billion since 2020-21, which is a 3.4% increase in cash terms and a 3.9% increase in real terms. As shown in Figure 3, this is the sixth consecutive year gross current expenditure in real terms has increased since the last increase in 2009-10.

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.

Up until 2020-21 real terms was greater than cash terms. However, last year for the first time cash terms was greater. For examples of comparative spend in 2008-09 and last year please see Appendix A.

Source: ASC-FR Collection, 2021-22, NHS Digital - See Table 4 in Data Tables, and ONS deflators found here https://www.gov.uk/government/statistics/gdp-deflators-at-market-prices-and-money-gdp-september-2022-quarterly-national-accounts

In additional to the usual funding of adult social care through council tax and grants from central government (such as improved Better Care Fund), local authorities have been able to use an adult social care precept to raise additional funds.

Local authorities with adult social care responsibilities have been able to increase council tax by up to an additional 3% over 2021-22 and 2022-23. Local authorities could decide to utilise all 3% in 2021-22, split it over the two years or use it all in 2022-23. This is in addition to the usual funding of adult social care through council tax. This precept applies to London boroughs (including the City of London), county councils, metropolitan districts, and unitary authorities.

• The additional adult social care precept flexibility in 2021-22 generated £610 million.
• Of 152 authorities with adult social care responsibilities, 148 utilised some, or all, of their precept flexibility for 2021-22. Of these, 100 authorities utilised the full 3%.

Figure 4 below provides a summary of gross current expenditure on adult social care and how this expenditure is allocated.

The table below shows total gross current expenditure and its constituent parts compared to last year. As a whole, gross current expenditure has risen by 3.4%, with increases in both long and short term support. Other GCE has decreased this year but still remains considerably higher than 2019-20 as much of the COVID-19 funding e.g. Infection Control Fund, Workforce Capacity Fund, was to support the sector rather than supporting the care of individuals so guidance continues to report this as Commissioning and Service Delivery costs.

Table 2: Gross current expenditure, by care type, 2019-20, 2020-21 and 2021-22

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.

For users specifically interested in this metric, an additional set of Net Current Expenditure Data Tables based on data collected in the ASC-FR are available.

Net current expenditure on Adult Social Care is also collected by the Department for Levelling Up, Housing and Communities as part of the Local Government Revenue Outturn (RO) returns, and published here: https://www.gov.uk/government/collections/local-authority-revenue-expenditure-and-financing

Additional categories were introduced into RO3 in 2020-21 to capture COVID-19 discharge costs, disbursement payments to care providers and other payments to care providers – although these categories have not been added to the ASC-FR data collection these costs should be included for completeness, and net current expenditure totals in both collections are still expected to reconcile.

Of the £26.9 billion total expenditure in 2021-22, 70.5% (£18.9 billion) is funded directly by the local authority (this includes capital charges and is known as net total expenditure, as seen in Figure 7 below). This represents a 2.6% increase (£0.5 billion) from 2021-22.

One area of central funding is the improved Better Care Fund. The value of the iBCF in 2021-22 was £2.1 billion.