I got bills: Social care spending 2021/22 and people with learning disabilities

NHS Digital have recently released their annual tranche of statistics concerning social care for adults in England. This blogpost is the latest in a series about social care statistics concerning adults with learning disabilities in England, updating the statistics to include the latest 2021/22 figures. Because the reporting year for these statistics runs from April to March, these are the second set of annual statistics that might tell us something about the impact of the COVID-19 pandemic on social care services for adults with learning disabilities. When looking through these statistics it is important to remember the pressures local authorities have been under, which might have affected the quality of the information collected.

Councils with social services responsibilities return information to NHS Digital every year on how many adults are using various forms of social care, and how much councils spend on social care (this doesn’t include other types of state funding relevant to social care, such as housing benefit as part of supported living support). I've tried to use some of the statistics to answer three questions about spending on social care services for adults with learning disabilities (questions relating to how many adults with learning disabilities are using social care are in a previous blogpost).

Question 1: How much money are councils spending on social care services for adults with learning disabilities?

The graph below shows gross expenditure by local authorities on social care for adults with learning disabilities from 2014/15 to 2021/22, broken down by age band and categories of spending. It is important to remember that these figures do not include housing benefit (an essential component of supported living arrangements). These figures are also not adjusted for inflation, which as we enter a time of high inflation is going to be even more important to take into account. However, using 2014/15 as a baseline (there had already been real-terms cuts to social care budgets by this point), the graphs also includes lines of what expenditure would be if social care expenditure only increased in line with inflation, using adult social care inflation figures from the invaluable PSSRU publication Unit Costs of Health and Social Care (2021 edition). 

A couple of observations. Overall, despite the number of adults getting social care decreasing during 2021/22, social services expenditure continued its steady upwards trajectory in absolute terms in 2021/22 at an annual growth rate of 4% from 2014/15. Local authority gross expenditure on social care for adults with learning disabilities totalled £6.5 billion in 2021/22, 30% of all local authority expenditure on adult social care. For both adults with learning disabilities aged 18-64 and adults with learning disabilities aged 65+, increases in expenditure ran slightly ahead of inflation. This indicates local authorities trying to protect these budgets, while at the same time falling short of what would be needed given projected increases in the population of adults with learning disabilities needing social care support.

The two line graphs below show trends in expenditure on specific types of social care service for adults with learning disabilities aged 18-64 and 65+ (with different scales for the two age groups). Spending on supported living continues to increase and has now overtaken spending on residential care - these two are by far the largest components of social care expenditure to support adults with learning disabilities.

 

Question 2: How much are people paying for social care in 'client contributions'?

When looking at the figures above on expenditure, it is important to remember that this is gross current expenditure - it does not take account of any income that might be coming into local authorities providing social care services. One source of income is 'client contributions' - money for social care support that is paid by people drawing on social care support or those close to them.

The two graphs below show the amount of income received by local authorities in client contributions for different types of social care support, for services for adults with learning disabilities aged 18-64 and for adults with learning disabilities aged 65+. As with the earlier overall expenditure graph, using 2014/15 as a baseline the graphs also includes lines of what expenditure would be if client contributions for social care only increased in line with inflation, using adult social care inflation figures from the PSSRU publication Unit Costs of Health and Social Care (2021 edition). 

For both adults aged 18-64 and adults aged 65+, the biggest types of client contributions were for residential care and contributions under the 'fairer charging' regimen and its successors. Also for both age groups, client contributions over time have increased faster than inflation, and in total added up to £472.7 million in 2021/22, representing 7% of total gross social care spending.

Question 3: Are unit costs changing over time?

Unit costs for residential care and nursing care for adults with learning disabilities continued their upward trend in 2021/22 for adults aged 18-64. For adults aged 18-64, the average cost to local authorities of residential care was £1,726 per person per week and nursing care £1,568 per person per week. Unit costs were cheaper in 2021/22 for adults aged 65+ compared to adults aged 18-64 (£1,155 per person per week in residential care; £792 per person per week in nursing care), with unit costs decreasing for adults aged 65+ from 2020/21 to 2021/22. It is worth noting that unit costs are higher for these services for adults with learning disabilities aged 18-64 than for any other group of people getting social care.

 

Summing up

Social care spending for adults with learning disabilities reported in 2021/22 seems to continue longer-term trends, with increases just above inflation, continued increases in spending on supported living, and both supported living and residential care being the biggest types of social care spending. Client contributions also continue to rise faster than inflation year-on-year. There is a more mixed picture when it comes to the unit costs of residential and nursing care.

Given that there were 2,275 fewer adults getting social care at the end of March 2022 compared to the end of March 2020, with high inflation and staff shortages a present reality, what kind of a future are councils planning for? How much are councils spending on block contracts irrespective of whether people want to live there, and on 'voids' where people aren't even living? A future combining a high eligibility barrier with expensive, restrictive service options predominating seems the very opposite of value for money.