Number of adults in receipt of long-term care continues to fall despite rising council spending

The number of people receiving long-term care from councils has declined for the third year running, despite rising expenditure over this period, according to a new report.

NHS Digital’s Annual report on adult social care activity and finance` and Finance Report, published earlier this week, also showed there had been a fifth consecutive reduction in the number of carers being supported by councils.

Overall, the number of people receiving long-term care has decreased each year since 2015-16, to 841,850 in 2018-19, with an overall decline of 30,670 (3.5%). 

This was mainly driven by a decrease in the numbers of older people receiving long-term care, which fell by 39,060 to 548,435 since 2015-16, amid a slight increase in the number of 18- to 64-year-olds receiving long-term support.

The fall in numbers supported comes despite a third consecutive year of real-terms rises in spending on adult social care by English councils. 

In 2018-19, gross spending was £18.7 billion, an increase of £807m on the previous year. This represents a 2.6% increase in real terms, which follows real-terms rises of 0.4% and 1% over the previous two years.

Unpaid carers ‘propping up crumbling social care system’

For the fifth consecutive year, the number of carers receiving support from their local authorities has also decreased. 

In 2018-19, 22% (96,380) fewer carers were assessed or received support from their local authority in 2018-19 compared to 2014-15. 

Carers UK chief executive Helen Walker called the figures “appalling”. 

She added: “Despite breaks being essential for carers’ wellbeing, the number receiving respite has also reduced by almost a quarter.”

“The fast-diminishing support for unpaid carers is simply not good enough at a time when more and more family members are having to step in to care for loved ones. Unpaid carers are propping up our crumbling social care system and being left without vital practical support and much-needed breaks from caring.

“Families desperately need government to act now to deliver increased long term funding for social care, including more funding for breaks, so they can care without putting their lives on hold.”

Despite the fall in the numbers of carers supported, expenditure on their support grew by 5.5%, from £154m in 2017-18 to £163m in 2018-19.

Effectiveness of the Care Act

Under the Care Act 2014, unpaid carers are entitled to a carer’s assessment where they appear to have needs to support. 

Carers UK said in a statement that five years on, many local authorities are recognising carers more, but unprecedented funding pressures are having an impact on what they do. 

“With more family members stepping in to care for loved ones – as many as 8.8 million adults in 2019 – we would expect to see more carers receiving assessments and support from their local authorities. 

“A significant and sustained increase in long-term funding for social care would see the Care Act being more effective in its purpose of supporting families with care needs,” the statement said.

Rising cost of residential care

The story of rising expenditure against falling numbers of people receiving support was reflected in the ongoing rises in unit costs for support.

For example, the unit weekly cost of providing residential care to a person aged 65 has risen each year since 2015-16, going up from £549 to £636 in 2018-19 over that period. 

The increases are likely to reflect the rising costs of the national living wage for staff and other costs arising from high vacancies and turnover in the workforce.

Senior fellow at The King’s Fund Simon Bottery said it is positive that more money is finding its way into social care, but that the figures from the report confirm a “worrying trend”. 

“They (local authorities) appear to be using extra money to shore up fragile local care markets by increasing the fees they pay to independent and voluntary sector care providers,” he said. 

Care providers’ operating costs have risen significantly in recent years due to a range of factors such as inflation and increases to the national living wage, he added. 

“All of this means that we are spending more money to support fewer people at a time when demand is increasing rapidly, given that 16,000 fewer people received long-term support last year, it is likely that more older and disabled people may be living with unmet needs.”

Bottery said the report highlighted the need for more short-term investment to tackle immediate pressures. 

“This must happen along with fuller long-term reform of the social care system so that is meets the needs of people who need support, their families and carers.”