Social care services provide vital support to help people with day-to-day living, but the system was under considerable pressure even before the onset of the coronavirus (Covid-19) pandemic. The pandemic highlighted the challenges faced by the sector, contributing to high numbers of excess deaths in care homes. News that over 90% of residents of older adult care homes have had a first dose of a Covid-19 vaccine is welcome, however concerns remain about vaccination uptake among social care staff and identifying unpaid carers for vaccination. The costs of responding to the pandemic, such as supporting staff to self-isolate and providing PPE and testing, have put further financial pressure on care providers. With no sign yet of long-awaited reform, the sustainability of social care is under question.
In this QualityWatch indicator update, we looked at longer term trends in the quality of social care using the latest available data, which mostly covers time periods before the Covid-19 pandemic, including care users’ and carers’ experiences of services. We also looked at more recent data on outbreaks of acute respiratory infections in care homes during the pandemic. A summary of our social care indicators is shown below. Click on the links for more detailed content and analysis.
Acute respiratory infection outbreaks in care homes
- In the first wave of the Covid-19 pandemic, the number of outbreaks of acute respiratory infections in care homes increased dramatically. In week 10 (beginning 2 March 2020), there were 17 new outbreaks, increasing to 1,010 new outbreaks in week 15 (beginning 6 April 2020).
- Outbreaks fell during the summer of 2020, but increased again in winter, reaching a peak of 921 new outbreaks in week 1 of 2021 (beginning 4 January). By week 10 (beginning 8 March 2021), the number of new outbreaks had fallen to 91.
Care home bed availability
- Between 2012 and 2020, the overall number of available beds in care homes – both residential and nursing (where there is always a registered nurse on duty) – per 100 people aged 75 and over declined from 11.3 to 9.6 – a 15% decrease. Likewise, the number of nursing home beds per 100 people aged 75 and over fell from 5.2 to 4.7 – a 11% decrease.
Admissions to care homes
- For older adults (aged 65 and over), the rate of admissions to care homes decreased from 659 per 100,000 people in 2014-15 to 578 per 100,000 people in 2018-19, before increasing slightly to 584 per 100,000 people in 2019-20.
- The rate of admissions to care homes for younger adults (aged 18 to 64) fell from 14.1 per 100,000 people in 2014-15 to 12.8 in 2016-17, but subsequently increased to 14.6 in 2019-20.
Supporting older people’s recovery after illness or injury
- The proportion of older people (aged 65 and over) who are still at home 91 days after discharge from hospital into reablement services has varied little over time, reaching 82% in 2019-20.
- The proportion of older people who receive reablement services after discharge from hospital has fluctuated over time at around 3%. In 2019-20, 2.6% of older people discharged from hospital received the service.
Supporting people in employment
- The rate of employment among adults with a disability in the UK has increased over time, from 44% in Q1 2013/14 to a high of 54% in Q3 2019/20, before falling to 52% in Q3 2020/21.
- The proportion of adults with a learning disability in paid employment is very low and has fluctuated over time, from a high of 7.1% in 2011/12 to a low of 5.6% in 2019/20.
- The employment rate among adults with a long-term condition increased from 58% in Q1 2007/08 to 66% in Q4 2019/20, before falling slightly to 65% in Q2 2020/21.
- Between Q1 2007/08 and Q4 2019/20, the rate of employment among adults with a mental illness increased markedly from 27% to 52%. It has since fallen to 50% in Q2 2020/21.
Adults with learning disabilities who live in their own home or with their family
- The proportion of adults aged 18-64 with a learning disability who lived in their own home or with their family increased from 74% in 2014/15 to 77% in 2017/18, and it has remained constant since.
Patients’ overall experience of social care services
- Service users’ satisfaction with adult social care services has remained stable over time, with 64% of respondents saying they were ‘extremely or very satisfied’ in 2019-20.
Social care users and safety
- The Personal Social Services Adult Social Care Survey (ASCS) asks service users whether care and support services help them feel safe. Between 2014-15 and 2019-20, the proportion of service users who responded ‘Yes’, they do help them feel safe, increased slightly from 85% to 87%.
Carer-reported quality of life
- Between 2016-17 and 2018-19, the average carer-reported quality of life score decreased from 7.7 to 7.5 (out of a maximum score of 12), indicating a deterioration in their overall quality of life.
Carers’ views of social care quality
- In 2018-19, 39% of unpaid carers were ‘extremely’ or ‘very’ satisfied with the support or services they and the person they care for received from social services, but 7% of carers were ‘extremely’ or ‘very’ dissatisfied. This contrasts with 43% of carers who were ‘extremely’ or ‘very’ satisfied in 2012-13, and 4% who were ‘extremely’ or ‘very’ dissatisfied. However, the results are not directly comparable.
For more information and analysis about social care, see these recent Nuffield Trust blogs: