With an ageing population and concerns about how to fund social care, the sustainability of social care in the UK is under question. The long-awaited social care green paper has still not been published and Jeremy Hunt, Britain’s longest-serving health secretary, admitted after stepping down from the post that funding cuts had gone “too far”.
Social care provides support to help people with day-to-day living. This includes older people with conditions such as dementia, but also younger adults and children with learning disabilities and other long-term conditions.
This QualityWatch update looks at how the quality of social care for adults has changed over time. It also goes further to examine the quality of life and views of carers, and the proportion of adults with a learning disability who are able to live at home or with their family.
Overall, the data highlights a significant decline in care home capacity, although it is difficult to determine whether there has been an increase in the provision of home care to counterbalance this. Service users’ satisfaction with social care services has been maintained in recent years, but this indicator fails to measure those who are not receiving care. The proportion of older people who receive reablement services after discharge from hospital has remained low at around 3%, and the most common reason for delayed transfers of care is people awaiting a care package in their own home. Meanwhile, carers have reported a fall in the support they and the person they care for have received from social services, which is reflected in a decrease in their quality of life.
Below is a summary of our indicators relating to support for adults with care needs, with links to more detailed content and analysis.
For more information about social care, see these recent Nuffield Trust blogs:
- What should a good social care system look like?
- What principles should underpin the funding system for social care?
- Unpaid carers: informal yet integral
Care home bed availability
- Between 2012 and 2018, the number of beds in care homes (nursing and residential) per 100 people aged 75 and over declined from 11.3 to 10.1 – a 10% decrease. Likewise, the number of nursing home beds per 100 people aged 75 and over fell from 5.2 to 4.9 – a 7% decrease.
- The shift in social care policy towards providing care at home rather than in residential settings, may explain some of the fall in bed availability. But without reliable data on the number of people receiving home care, it could also indicate a fall in social care provision for older people.
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 586 per 100,000 people in 2017-18.
- For younger adults (aged 18 to 64), the rate fell from 14.1 per 100,000 people in 2014-15 to 12.8 in 2016-17, but subsequently increased to 14.0 in 2017-18.
- The overall decrease in the number of admissions of adults to care homes could be interpreted as an improvement in the quality of home-based social care, resulting in delayed admission. But it could also represent a fall in social care provision, which comes at a time when the population is ageing.
Service users’ satisfaction with adult social care services
- Adult social care service users’ satisfaction with the care they receive has remained largely stable over time. However, in the most recent year there was a statistically significant increase in the proportion of service users who were “extremely or very dissatisfied”.
- In 2017-18, 65% of service users were “extremely or very satisfied” with the care and support services they received, 25% were “quite satisfied” and 2% were “extremely or very dissatisfied”.
- These results are more favourable than those from the Survey of Adult Carers in England (see below). One interpretation is that, despite funding constraints which have led to a fall in the volume of care provided, the quality of care for those that do receive it has been maintained.
Social care users and safety
- Between 2014-15 and 2017-18, the proportion of adult social care service users who reported that care and support services help them in feeling safe increased slightly from 84.5% to 86.3%.
Carers’ views of social care quality
- In 2016-17, 39% of carers were “extremely” or “very” satisfied with the support or services they and the person they cared for received from social services. Between 2012-13 and 2014-15, the proportion of carers who were “extremely” or “very” satisfied decreased from 43% to 41%. The 2016-17 results are not comparable to those from previous surveys due to changes in the eligible population.
- The proportion of carers who “always” felt involved in discussions about the support or services provided to the person they cared for decreased from 42% in 2012-13 to 41% in 2014-15. In 2016-17, 39% of carers “always” felt involved or consulted and 8% “never” felt involved or consulted.
Carer-reported quality of life
- Based on the 2011 census, there are around 6.5 million carers in the UK who provide unpaid care for ill, older or disabled family members and friends. With an ageing population and people living longer with multiple chronic conditions, this number is expected to increase rapidly.
- Between 2012-13 and 2016-17, the average carer-reported quality of life score decreased from 8.1 to 7.7 (out of a maximum score of 12), indicating a deterioration in their overall quality of life.
Adults with learning disabilities who live in their own home or with their family
- For people with a learning disability, having appropriate accommodation has a strong impact on their safety and overall quality of life, while also reducing social exclusion.
- The proportion of adults aged 18-64 with a learning disability who live in their own home or with their family increased from 59% in 2010-11 to 77% in 2017-18.
Supporting people in employment
- There is strong evidence that being in work improves people's quality of life and wellbeing. Despite this, there are significant barriers to employment for people with a mental illness, learning disability or long-term condition.
- The rate of employment among adults with a mental illness increased markedly from 27% in Q1 2007/08 to 48% in Q3 2018/19. This may partly reflect a true improvement in employment rate, but it could also be due to de-stigmatisation of mental illness in recent years. People are now more likely to self-report that they have a mental health disorder in the Labour Force Survey, which could disproportionally affect the employment rate.
- The proportion of adults with a learning disability in paid employment has fluctuated over time, from a high of 7.1% in 2011-12 to a low of 5.7% in 2016-17.
- The employment rate among adults with a long-term condition increased from 58% in Q1 2007/08 to 65% in Q3 2018/19.
Supporting older people’s recovery after illness or injury
- Reablement services aim to maximise people's independence and ability to live at home, in order to minimise their need for ongoing support and dependence on public services. They tend to be provided to older people who have just been discharged from hospital or are entering the care system following a crisis.
- One measure of care quality is the proportion of people aged 65 and over who are still at home 91 days after discharge from hospital into reablement services. The proportion of older people still at home after 91 days has varied little over time, reaching 82.9% in 2017-18.
- The proportion of older people who received reablement services after discharge from hospital declined from 2013-14 onwards, but increased in 2017-18 to 2.9%.