Adult social care services

This indicator uses routinely published data to understand the quality of adult social services in England.

Qualitywatch

Indicator

Last updated: 19/12/2024

Background

Adult social care services in England encompass a range of support designed to assist individuals over 18 years old with personal care and daily activities, particularly those facing illness, disability or age-related challenges. These services include personal care (e.g. help with dressing and washing) and broader support to take part in social activities or employment. Unlike the NHS, social care is not universally free. Access to publicly funded adult social care services is means-tested by local authorities, with support primarily available to those with significant needs and limited financial resources. Individuals with assets exceeding £23,250 are typically required to fund their own care.

The adult social care sector in England faces significant challenges. Despite numerous inquiries and reviews over the past three decades, comprehensive reform has been lacking, leading to deep systemic issues. Approximately 400,000 people are awaiting assessments for their social care needs, indicating substantial delays in service provision. Local authorities are experiencing budgetary pressures, often resulting in overspending, while the workforce contends with over 100,000 vacant positions, highlighting severe staffing shortages. For more information, visit this October 2024 briefing on the state of social care in England and possible future actions.


The number of requests for access to adult social care services received by local authorities from all new individuals who were not in receipt of long-term support increased from 1,809,980 in 2015/16 to 2,085,720 in 2023/24. 2022/23 was the first time the requests for support from new individuals received by local authorities surpassed 2.0 million.

In 2023/24, 68% (1,427,375) of requests for support were received from new individuals aged 65 years, and 32% (658,350) were from those aged 18 to 64 years, compared with 72% (1,309,855) and 28% (500,125) respectively in 2015/16.

The proportion of requests deemed eligible and that received any form of support decreased from 42.6% in 2015/16 to 41.1% in 2023/24; the decrease over the same time period for 18- to 64-year-olds was from 32.5% to 29%, and for those aged 65 or over there was a slight increase from 46.5% to 46.7% (data not shown). There’s no publicly available data on the reasons why local authorities reject applications, so no conclusion can be made on what is driving these trends.


There are several outcomes for new individuals not in receipt of long-term support who request access to adult social care services from local authorities: short-term care (including short-term care to maximise independence — ST-Max), long-term care, low-level support, 100% NHS funded care, end-of-life care, directed to universal services or signposting, and no support provided.

For people aged 18–64 in 2023/24, 11% received short-term care, a slight increase from 9% in 2015/16. Similarly, for those aged 65 and over, the percentage rose from 20% in 2015/16 to 23% in 2023/24. This could indicate a shift in care provision patterns toward short-term care.

Between 2015/16 and 2023/24, long-term care remained stable at 6% for those aged 18–64, and slightly declined, from 10% to 9%, for those aged 65 and over. Low-level support saw a decline in its overall proportion of both age groups, from 16% to 11% for new individuals aged 18–64, and from 17% to 12% for those aged 65 and over.

End of life care support and 100% NHS funded care represent a very small proportion (0.3% and 1% respectively) of all requests received from new individuals in 2023/24.

The percentage of requests that resulted in no support being provided increased slightly for both groups between 2015/16 to 2023/24 — respectively, 33% to 34% for the 18–64 age group and 27% to 28% for the over-65s. It is important to note that an individual can receive more than one type of support, but they can only be recorded against one of the support categories. For more information, see the ‘About this data’ section.


The proportion of individuals in receipt of adult social care support who said they were satisfied with their care and support decreased slightly from 65% in 2017/18 to 64.4% in 2022/23.

Since 2017/18, a slightly higher proportion of men than women have reported being satisfied with their care and support. In 2022/23, 65.8% of men and 63.5% of women in receipt of adult social care support reported that they were satisfied with their care and support.

During the same period, a higher proportion of people aged 18–64 have reported their satisfaction with their care than those aged 65 or over. In 2022/23, 68.0% individuals aged 18–64 in receipt of adult social care support reported that they were satisfied with their care and support, compared with 61.9% of the older age group.

Due to the Covid-19 pandemic, data for the 2020/21 survey is missing from this time series. See the ‘About this data’ section for more information. 


We know that for people with a learning disability, appropriate accommodation has a strong impact on their safety and overall quality of life, while also reducing social exclusion. However, many people with a learning disability do not have a choice about where they live or who they live with.

The proportion of adults aged 18–64 in England who received long-term support during the year for a learning disability, and lived in their own home or with their family, increased from 74% in 2014/15 to 79% in 2022/23.

Between 2020/21 and 2021/22, the number of adults with a learning disability who were living in their own home or with their family decreased slightly from 104,624 to 104,430, though the proportion increased from 78% to 79% because of a decline in the number of adults who received long-term support for a learning disability during the year (from 133,658 to 132,450). In 2022/23, there were increases in both the number of adults receiving long-term support for a learning disability, and those living in their own home or with their family (to 133,721 and 107,590 respectively). The proportion who received support and lived in their own home or with their family in 2022/23 was 80.5%, the highest it has been in the last 11 years.


The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. As part of their regulatory requirement, they conduct inspections on social care services at location-level against 5 categories: safe, effective, caring, responsive to people’s needs and well-led. These adult social care services can be rated as ‘inadequate’, ‘requires improvement’, ‘good’ or ‘outstanding’. More information can be found in the ‘About this data’ section. Inspections are conducted on social care services at location-level against 5 categories: safe, effective, caring, responsive to people’s needs and well-led. These adult social care services can be rated as ‘inadequate’, ‘requires improvement’, ‘good’ or ‘outstanding’. More information can be found in the ‘About this data’ section.

Since 2019, the majority of adult social care services have consistently been rated as ‘Good’, with a slight decline from 79.6% in 2019 to 78.0% in 2024. The percentage of adult social care services rated ‘Outstanding’ remains stable, at 4.3% in 2019 and 4.7% in 2024. However, the proportion of social care services requiring improvement has increased from 14.6% in 2019 to 16.5% in 2024, while ‘Inadequate’ ratings have remained consistently low, at 1.2% in 2019 and 1.1% in 2024.


 

About this data

Adult Social Care Activity and Finance Report

Requests for support and what happens next

This indicator uses data from the of the Short and Long Term (SALT) data return from the Adult Social Care Activity and Finance Report on requests for support and their outcomes. It focuses on the number of requests for support received by local authorities from ‘new clients’ which are defined as individuals not currently in receipt of long-term support at the time of the request. The data includes only those requests for which an outcome, also referred to as a sequel, was determined within the reporting period. This means the dataset may include requests received in a previous year if their outcomes were finalised during the current year.

The outcomes of requests for support are categorised into three primary areas: short-term care to maximise independence (ST-Max), long-term care, and other support. We have grouped the outcomes in the following manner:

  • Short-term care includes:
    • Short Term Care: to maximise independence
    • Short Term Care: other short term
  • Long Term Care includes:
    • Long Term Care: Nursing
    • Long Term Care: Residential
    • Long Term Care: Community
    • Long Term Care: Prison
  • Low-level support
  • 100% NHS Funded Care
  • End of Life
  • Universal services/signposting
  • No support includes:
    • No Services Provided - Deceased
    • No Services Provided

Each request can only be recorded under one sequel, determined using a top-to-bottom hierarchy that prioritises which outcome to record when multiple sequels apply. Requests for support are defined as inquiries or applications for access to adult social care services and can be initiated by clients or on their behalf.

For more information, please visit Adult Social Care Activity and Finance Report, England, 2024-25

Adult Social Care Outcomes Framework

Satisfaction of care and support

This indicator uses data from outcome measure 3A of NHS Digital's Adult Social Care Outcomes Framework (ASCOF). The measure shows the proportion of all adults (aged 18–64) in receipt of social care services who said they were satisfied with their care and support, reported in percentages.

Assistance in completing the questionnaire was categorised as help from a care worker, someone in the same household, or someone outside the household. The largest group (28.3%) received help from someone outside their household, up from 26.6% in 2021/22. Those reporting no help dropped slightly to 23.2% from 23.6% in 2021/22. Therefore, caution should be applied when interpreting this question on satisfaction of care and support, as only a minority of respondents completed it alone.

Due to the impact of Covid-19, the 2020/21 ASCS survey was voluntary and only 18 Councils with Adult Social Services Responsibilities (CASSRs) participated. Consequently, England, Regional, and Council Type outcomes were not calculated, and only the average of the 18 CASSRs was provided for comparison. Data from 2021/22 can be compared with earlier years but not with 2020/21. Data from 2020/21 is not reported in this indicator.

Data for this indicator is collected from each local authority. In 2020/21 Hackney Council did not submit their data because of a cyber-attack. To ensure 2020/21 data is comparable with previous years, NHS Digital calculated the aggregate totals using 2019/20 data from Hackney Council. In 2023/24, the Isles of Scilly, City of London and Hackney did not have ASCOF outcome scores for this measure. Further details can be found in the Adult Social Care Activity and Finance data quality report.

For more information, please see the Adult social care outcomes framework: handbook of definitions.

Residence

This indicator uses data from outcome measure 1G of NHS Digital's Adult Social Care Outcomes Framework (ASCOF). The measure shows the proportion of all adults (aged 18–64) whose primary support reason is learning disability support, who are ‘known to the council’, and who are recorded as living in their own home or with their family.

The definition of individuals ‘known to the council’ is that they are adults of working age with a primary support reason of learning disability support who have received long-term support during the year.

‘Living on their own or with their family’ is intended to describe arrangements where the individual has security of tenure in their usual accommodation – for instance, because they own the residence or are part of a household whose head holds such security.

Prior to 2014/15, all adults with learning disabilities who were known to the council were included. In 2014/15 the eligible population was changed to include only those clients who received a long-term service in the reporting year and had a primary support reason of learning disability support.

Data for this indicator is collected from each local authority. In 2020/21 Hackney Council did not submit their data because of a cyber-attack. To ensure 2020/21 data is comparable with previous years, NHS Digital calculated the aggregate totals using 2019/20 data from Hackney Council. Further details can be found in the Adult Social Care Activity and Finance data quality report.

For more information, please see the Adult social care outcomes framework: handbook of definitions.

CQC ratings

This measure uses data from inspection ratings of adult social care services conducted by the Care Quality Commission (CQC). The frequency of the inspections depends on the information they receive and the information they collect. Ratings are based on five key questions: whether services are safe, effective, caring, responsive to needs, and well-led. The ratings— ‘inadequate,’ ‘requires improvement,’ ‘good,’ and ‘outstanding’—are reported for all active services as of August 1, 2024, with ‘insufficient evidence to rate’ included separately.

The ratings presented, as of 1 August 2024, use the previous inspection framework, as the newer single assessment framework introduced in 2024 is still in its early implementation phase. Comparative analysis with previous years will not be possible due to this transition.

For more information, please visit The state of health care and adult social care in England 2023/24 – Appendix (CQC ratings chart)

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