Social care - It's not complicated any more

Nearly a year ago, I wrote a blogpost looking at the social care statistics for adults with learning disabilities up to 2013/14, called “It’s complicated” (http://chrishatton.blogspot.co.uk/2015/01/its-complicated-whats-happening-in.html ). This week, I’ve been blogging (mainly) about some of the recently released social care statistics for 2014/15:

·        On the shrinking number of people with learning disabilities in official sight (http://chrishatton.blogspot.co.uk/2015/11/the-disappeared.html )

·        On the shrinking number of adults with learning disabilities in paid employment (http://chrishatton.blogspot.co.uk/2015/11/crushed-by-wheels-of-industry-if-only.html )

·        On the shrinking number of adults with learning disabilities getting personal budgets (http://chrishatton.blogspot.co.uk/2015/11/you-can-have-any-colour-as-long-as-its.html )

·        On the shrinking number of learning disability nurses (http://chrishatton.blogspot.co.uk/2015/11/nurse-nurse.html )

Can you spot the general trend yet?

In this final post of the week, I want to talk about some of the ‘big ticket’ items of social care – where people are living, what support they’re getting, and how much it costs. This uses newly released official statistics for social care in England in 2014/15 (see http://www.hscic.gov.uk/catalogue/PUB18663) and provisional statistics on social care expenditure for 2014/15 (see http://www.hscic.gov.uk/catalogue/PUB18445/pss-exp-eng-14-15-prov-rpt.pdf ). As with many other official statistics there have been major changes to the data collected in 2014/15, making last year something of a year zero and comparisons to previous years difficult. So, in this final post of the week I’m going focus on what I think can be reasonably compared over time, focusing on what’s happening in 2014/15.

Changes in the data collected make errors of interpretation even more likely than usual, so please do say if I’ve got anything horribly or slightly wrong and I’ll update the post accordingly.

Where are people living?

The first graph below shows where councils report adults with learning disabilities aged 18-64 to be living, from 2009/10 to 2014/15.

The black line at the top represents the number of adults with learning disabilities aged 18-64 known to the council (up to 2013/14) or getting long-term support from the council (in 2014/15). The thing that jumps out from this is the sudden drop from 2013/14 to 2014/15 (from 141,980 people in 2013/14 to 124,325 people in 2014/15). Is this drop because there were around 17,000 people in 2013/14 known to the council but not getting long-term support – so they’ve been excluded from the 2014/15 figures? Or is at least part of this drop because services have been withdrawn from some people?

The graph below gives us some clues. If the drop from 2013/14 to 2014/15 was simply about not counting people who weren’t getting long-term support from the council, then we might expect a big drop in the numbers of people living with family/friends and maybe in tenancies with private landlords too. There are big drops here: people living with family/friends dropped from 52,090 people in 2013/14 to 44,785 people in 2014/15; and tenants with a private landlord dropped from 16,690 people in 2013/14 to 12,425 people in 2014/15.

There is also a big drop in the number of people that councils report to be in inpatient services, from 1,035 people in 2013/14 to 490 people in 2014/15 – a long way short of the 2,705 people with learning disabilities reported to be inpatient services at end of March 2015 by health commissioners (see http://www.hscic.gov.uk/catalogue/PUB18793/ldsm-sep-15-exec.pdf ). Once a person with learning disabilities goes into an inpatient service, do councils not see them as getting long-term support from them?

So – some of the drop in numbers from 2013/14 to 2014/15 might be due to excluding people with learning disabilities known to the council but not getting long-term support from the statistics in 2014/15. But there are also consistent drops in the number of adults with learning disabilities in living situations that honk long-term support to me, including:

·        People in care homes – from 25,755 people in 2013/14 to 23,215 people in 2014/15

·        People in nursing homes – from 2,040 people in 2013/14 to 1,360 people in 2014/15

·        People as owner-occupiers/in shared ownership housing – from 3,755 people in 2013/14 to 2,460 people in 2014/15

·        People as tenants in local authority/arms-length management/registered social landlord housing – from 16,690 people in 2013/14 to 12,425 people in 2014/15

·        People in supported accommodation/supported lodgings/supported group homes – from 24,485 people in 2013/14 to 23,075 people in 2014/15

·        People in shared lives arrangements – from 3,550 people in 2013/14 to 3,100 people in 2014/15

The only form of living accommodation where the number of people increased from 2013/14 to 2014/15 was sheltered/extra care housing – from 890 people in 2013/14 to 1,195 people in 2014/15.

Some of these changes – for example the drop in the number of people in residential care and nursing care – are consistent with longer-term trends (see the second graph below). But others – for example the drop in the number of people in shared lives arrangements – reverse long-term trends of expansion. Some of this has to be withdrawal of significant support from adults with learning disabilities.

Unfortunately, changes to the statistics mean that we cannot track the number of adults with learning disabilities using specific community-based services such as day centres and home care into 2014/15. Information on the number of adults using ‘short-term’ support is also not readily available for 2014/15. The only clues we have here are in the new peculiar statistical category of "New and existing adult clients where the sequel to a request for support was short-term support to maximise independence, and what followed". I don't know whether this means that there are other requests for support going uncounted because they don't result in any support at all or in long-term support straight away, or if this is how all new 'requests for support' are counted [notice that people are requesting support now, not getting what support they are entitled to].

Anyway, for what it's worth, in 2014/15 there were 555 requests for support from 'new clients' with learning disabilities in this category. Nearly half  (40%) got no support as they had 'no identified needs', and over a third (38%) ended up getting some form of long-term support, with relatively few getting ongoing low-level support (6%) or other short-term support (6%). For me, what happened to the 1,200 'existing clients' who apparently requested short-term support 'to maximise independence' is more worrying, and clearly shows services being withdrawn. Of this group, less than half (44%) continued to get a long-term support service of some kind with a further 13% getting low-level ongoing support or some other short-term support. Fully 465 people (39%) got no support as they had 'no identified needs'.

What are social services spending on support for adults with learning disabilities?

As with the social care statistics, the social services spending statistics have also changed quite a lot in 2014/15, but using some rickety assumptions I think there are some ways of comparing spending information from earlier years into 2014/15.

Let’s start with the spending picture just for 2014/15, in the graph below. A good thing about the new statistics is that we now for the first time get information on adults with learning disabilities aged 65 years or more. Some of these new categories of spending are consistent with earlier years, but some things which were previously broken down for adults with learning disabilities (such as equipment & adaptations, and assessment & care management) are in 2014/15 only reported generically (a revealing change in itself).

Using the new spending categories, for adults with learning disabilities aged 18-64, the biggest single slice of social services spending (despite the decreasing number of people in them) was residential care (£1.7 billion), following by supported living (£892 million), with supported accommodation coming in at £278 million and nursing care at £61 million. In total, £457 million was spent on direct payments (although we don’t what the direct payments themselves were spent on), £352 million was spent on home care, and £611 million was spent on “long-term – community – other”, which I’m guessing mainly includes day care. [Incidentally, as a social scientist I wouldn’t design a coding system that has so much ‘other’ in it – you’re on the road to not having categories at all and just calling everything ‘stuff’]. In total, this social services spending on ‘long-term support’ for adults with learning disabilities aged 18-64 adds up to £4.36 billion.

What of the ‘short-term support’ – hopefully being offered to at least some of the adults with learning disabilities nudged out of the statistics in 2014/15? Well, we don’t know much about what such short-term support might be, but we know that in total £88 million (2% of the total) was spent on short-term support for adults with learning disabilities aged 18-64 in 2014/15.

For the 15,320 adults with learning disabilities aged 65 or over, £544 million in total was spent on long-term support, mostly on residential care (£255 million) or supported living (£111 million). The princely sum of £7.7 million was spent on short-term support for this group.

Trying to squish these categories of spending with those used up to 2013/14 is tricky, but I've had a go for the long-term support categories in the graph below, for adults with learning disabilities aged 18-64. Ignore the apparent bump in spending in 2011/12 – this is due to almost 2,000 people with learning disabilities (and almost £900 million) being transferred from NHS responsibility to social services responsibility as part of Valuing People Now. To put this graph together, I've mashed up the following old and new spending categories:

• Old - residential care. New - residential care
• Old - nursing care. New - nursing care
• Old - supported & other accommodation. New - supported accommodation + supported living
• Old - home care. New - home care
• Old - direct payments. New - direct payment
• Old - day services + meals + other community services. New - other long-term support

Just looking from 2013/14 to 2014/15, there are apparent sharp absolute reductions in spending on residential care, nursing care, home care and other community long-term support, with direct payments spending staying static and only supported & other accommodation increasing (quite sharply, too). What’s going on here? First, councils are clearly under the cosh when it comes to spending, and social services budgets which were relatively protected for people with learning disabilities compared to other groups up to 2013/14 have been taking their share of the battering in 2014/15.

Second (and this is an issue for another blogpost at another time when I understand it better), does the mirrored rise in supported accommodation/drop in residential care reflect meaningful changes in people’s homes or large-scale deregistering/relabelling of registered care homes into various types of ‘supported living’? While this may reduce the costs for social services departments (see the final graph below on the unit costs of residential care and supported living up to 2014/15), it may well increase the costs to the taxpayer, as agencies can become registered social landlords (with no cap to the amount of housing benefit that can be claimed) tied in closely to the ‘support’ provided. And these increased costs can come with no benefit (or even any noticeable difference) to the lives of people with learning disabilities living there.

In contrast to last year’s blog, I think the statistics for social care in 2014/15 are much less complicated. Adults with learning disabilities are now sharing in the withdrawal of social services attention and support that other groups of people have already experienced. If ever there is a time for a radical shift in control over state resources to people with learning disabilities and families, that time is now.

Sources

Health and Social Care Information Centre. Community Care Statistics, Social Services Activity, England 2014-15 http://www.hscic.gov.uk/catalogue/PUB18663

Health and Social Care Information Centre (2015). Personal Social Services: Expenditure and Unit Costs England 2014-15, Provisional release http://www.hscic.gov.uk/catalogue/PUB18445/pss-exp-eng-14-15-prov-rpt.pdf