Social care finances and adults with learning disabilities - 2024/25 update

The Department of Health and Social Care have recently released their annual tranche of statistics concerning social care for adults in England (these were previously published by NHS Digital, then NHS England until this year). 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 2024/25 figures. While the underlying information used seems to be the same, there have been changes this year to how the information is extracted (from individual records of people drawing on social care) and how the information is reported. This has led to improvements in some aspects of the information made public about adults with learning disabilities (particularly in information about people aged 65+), but less specific information sometimes being reported.

I have written a blogpost on the 2024/25 employment figures contained in the social care statistics, and one on how many adults with learning disabilities were drawing on social care in 2024/25. This third blogpost in the trilogy will focus on social care finances relating to adults with learning disabilities in 2024/25.

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

The two graphs below show gross expenditure by local authorities on social care for adults with learning disabilities from 2014/15 to 2024/25, broken down by categories of spending. One graph is on spending for adults with learning disabilities aged 18-64, and one for adults aged 65+ - it is really important to notice that the scales for the two graphs are very different (much more is being spent related to adults aged 18-64 than for adults aged 65+). 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 big real-terms cuts to social care budgets by this point), the graphs also include lines of what expenditure would be if social care expenditure was increasing in line with inflation, using adult social care inflation figures from the previously available and invaluable PSSRU publication Unit Costs of Health and Social Care, and more recently from Kings Fund reports on social care.

 

A couple of observations. Overall, from 2014/15 to 2024/25, social services expenditure related to adults with learning disabilities continued its upwards trajectory in absolute terms, despite there being two years during the height of the Covid-19 pandemic when the number of people getting social care reduced. For adults with learning disabilities aged 18-64, expenditure increased at a compound annual growth rate of 5.9% per year, from £4.4 billion in 2014/15 to £7.8 billion in 2024/25. This represents 67% of all social care expenditure related to adults aged 18-64. For adults with learning disabilities aged 65+, expenditure increased at a compound annual growth rate of 6.9%, from £540 million in 2014/15 to £1.1 billion in 2024/25. This represents 8% of all social care expenditure related to adults aged 65+. Across both age groups, social care expenditure related to adults with learning disabilities represents 36% of all adult social care expenditure.

For both adults with learning disabilities aged 18-64 and adults with learning disabilities aged 65+, increases in expenditure ran 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. It’s also important to remember that this social services expenditure includes expenditure from people’s own pockets in the form of client contributions (of which more later).

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 substantially overtaken spending on residential care - these two are by far the largest components of social care expenditure to support adults with learning disabilities. These are also the two categories of social care spending showing the biggest recent increases, although higher inflation means that most categories of social care spending are increasing in absolute terms (even if not in real terms) after some years of relatively flat spending.

 

 

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 2016/17 as a baseline the graphs also include lines of what expenditure would be if client contributions for social care only increased in line with inflation.

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, particularly in recent years. The compound annual growth rate for client contributions for adults with learning disabilities aged 18-64 in absolute terms is 7.4%, from £307 million in 2016/17 to £542 million in 2024/25. For adults with learning disabilities aged 65+, the compound annual growth rate in client contributions is 8.9%, from £66 million in 2016/17 to £129 million in 2024/25. This means that 8% of all social care expenditure related to adults with learning disabilities comes from client contributions.

Question 3: Are services charging more over time?

Unit costs (how much money services charge per person per week) for residential care and nursing care for adults with learning disabilities continued their upward trend in 2024/25 for adults aged 18-64, with a period of relatively little change in unit costs being replaced by big year-on-year increases partly related to increased inflation. For adults aged 18-64, the average cost to local authorities of residential care was £2,224 per person per week and nursing care £2,058 per person per week. Unit costs were cheaper in 2024/25 for adults aged 65+ compared to adults aged 18-64 (£1,441 per person per week in residential care; £1,319 per person per week in nursing care), with unit costs. 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 2024/25 seems to accelerate 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. Big increases in inflation have had a huge impact on the increasing costs of social care services for adults with learning disabilities. Client contributions also continue to rise much faster than inflation year-on-year, as do unit costs. 

With people with learning disabilities and those close to them paying more and more in 'client contributions' (two thirds of a billion pounds in 2024/25), is scarce public and personal money being spent in the best ways? Why do so few people with learning disabilities own their own homes, when people are charged so much to effectively rent a place that is all too often, as George Julian documents here, dangerously awful? Why is so much professional time (and money) being spent on fending off and humiliating people who might need a little bit of help now and again in the name of eligibility, rather than investing in people to help them get the most out of life? I do worry about writing this kind of blogpost now, when the hills are alive with pernicious cries of 'overdiagnosis' and 'burden' on councils. and people with learning disabilities are increasingly being erased in blanket policy and service formulations of neurodiversity. Spending less isn't any kind of solution - working with people with learning disabilities and those close to them to spend it better is.