King's Fund Social care 360 review

This year’s report looks at 2023/2024 data.

It shows that 2023/2024 was the first year since 2015/2016 where local authorities not only spent more money on social care but also increased the number of people being supported due to a significant increase in local authority spending power.

The King’s Fund warns that this positive development is fragile and that loading unfunded costs on care providers will undermine it.

The review argues that successive governments have failed to take responsibility for the costs of introducing the statutory minimum wage in the social care sector. This had created an annual (until 2023/24) chain reaction of increased costs to providers, resulting in increased fees paid to them by local authorities but ultimately, fewer people accessing publicly funded long-term care as local authorities try to balance their books.

The government’s decision to increase employer’s National Insurance Contributions adds to this burden for both providers and local authorities.

Below we’ve outlined some key trends from the report.

Access

Demand continues to increase with requests for social care support rising from 2 million in 2022/23 to 2.1 million 2023/24. Of this increase:

• Requests from older people went up to 1.43 million from 1.39 million.
• Requests from working-age adults went up to 658,000 from 612,000.

In terms of people actually accessing care and support, this has increased for the first time since 2015/2016 but it is still below the total number receiving care and support in that year:

• The number of people receiving publicly funded long-term care rose from 835,000 in 2022/23 to 859,000 in 2023/24.
• This was made up of a small increase in the number of 18–64-year-olds receiving long-term care, from 293,000 to 300,000, and a larger increase in the number of older people receiving long-term care, from 543,000 to 559,000.
• When compared to 2015/2016 there has been an increase in the number of working-age adults accessing long-term care, from 285,000 to 300,000 (5.1%), and a fall in the number of older people receiving long-term care – down from 587,000 to 559,000 (-4.8%).
• Overall, 859,000 people received publicly funded long-term care in 2023/24 compared to 873,000 in 2015/16.

Expenditure and Providers

The total expenditure on adult social care in England increased by £1.9bn in 2023/24, reaching £32bn. In 2023/24, total expenditure was £4.6 billion more in real terms than in 2010/11.

In terms of how money was used by local authorities:

• For working-age adults, nearly two-thirds of money was spent on community-based care
• For older adults, nearly two-thirds of money was spent on care homes
• The two largest blocks of expenditure were on learning disability support for working-age adults (£7.1bn) and physical support for older people (£7.7bn).

The average rates paid by LAs have also increased, although we suspect not enough to cover the true cost of care:

• The average weekly fee paid by LAs in England for care home places for working-age adults rose by 3.8% to £1,696.
• The average weekly fee for older people’s care home places increased 6.5% to £951.
• The average hourly rate for externally commissioned home care rose 0.9% from £21.83 to £22.03 – well below the Homecare Association’s minimum price for home care.

Interestingly, according to the review, provider profitability does not appear to be a factor in increasing fees. There was no clear trend of increasing profits for the largest providers of publicly funded residential care between 2015 and 2023, while providers of homes for working-age adults show generally declining profits. It’s slightly different in homecare where profits increased from 6.3% in 2015 to 7.6% in 2023, though this is a fall from their peak of 10.8% in 2012.

Unpaid Carers

Concerningly, fewer unpaid carers now receive direct support due to constraints in local authority budgets.

The number of carers receiving direct support from local authorities was lower in 2022/23 than it was in 2015/16. There has also been a shift in the type of support they receive. Fewer carers (27% compared to 31% in 2015/16) now receive paid support and more receive advice, information and signposting (56% compared to 50% in 2015/16).

The number of people provided with respite care delivered to support their carers fell from 57,000 in 2015/16 to 36,000 in 2022/23.

Further reading

You can read the full report King's Fund form authors Simon Bottery and Danielle Jefferies here.

Find out more  here about the National Care Forum, the leading voice for not for profit social care and support providers here. BCOP re members of NCF.