Developing an Adult Social Care baseline of financial expenditure for a local council
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Context
Transformation Nous (TN) was commissioned by a Council corporate director to perform a comprehensive diagnostic of the Council’s activity and expenditure.
The study was commissioned in the context of an increase in demand for long-term care placements and packages. The diagnostic developed a baseline of the Council’s current expenditure, how this changed from previous years (in terms of activity and unit costs) and how expenditure compared to its statistical neighbours, regionally and nationally.
By benchmarking against other places, the diagnostic enabled the Council to identify areas of opportunity to improve the cost effectiveness of provision while improving outcomes and maximising independence for residents.
Approach
Analysed several publicly available datasets – including Adult Social Care Financial Returns reports (ASC-FR), Short and Long Term (SALT) data and Adult Social Care Outcome Framework (ASCOF) – and local Council datasets to develop a detailed baseline of the Council’s expenditure and activity for all service types and primary support needs in adult social care.
Benchmarked the Council against its statistical neighbours, regional and national averages to identify where the Council’s activity and expenditure appeared to be an outlier. Neighbours were based on those from the CIPFA model which uses over 40 metrics from a wide range of social‐economic indicators to determine the closest socio-demographic and economic neighbours.
Engaged with system colleagues to test and refine insights and agree recommendations and next steps.
Key findings
Annual total expenditure per capita for adult social care in the Council increased by one of the smallest amounts from 2018/19 to 2022/23, compared to the Council’s statistical neighbours. In 2022/23, the Council had a total expenditure per capita which was in the middle-range (see Figure 1).
The increase in Council’s total annual expenditure (2018/19 vs 2022/23) was mainly driven by an increase in spend on long-stay support, which represents around three quarters of total expenditure (see Figure 2).
Compared to its statistical neighbours, the Council spends one of the highest proportions of its total expenditure on long-stay support, while other similar Councils spend a higher proportion on short-stay support and other activities (e.g., social support, assistive equipment and technology, social care activities etc) (see Figure 3).
In 2022/23, 48% of the Council’s total expenditure was spent on older adults (65-years-old or over) and 52% on working-age adults (18-64-years-old). There has been an increase in spend across both age groups since 2018/19 (see Figure 4).
For working-age adults, the Council spends the highest proportion of its expenditure on adults with learning disabilities. Spend on care provision for working-age adults increased from £59M in 2018/19 to £71M in2022/23. Since 2018/19, expenditure for nursing homes increased by the third highest percentage (+50%), driven both by a 26% increase in total activity (2,600weeks in 2022/23) as well as a 24% increase in the average unit cost (£1,150 in2022/23) (see Figure 5 and 6).
For older adults, the 14% increase in total expenditure since 2018/19, reaching £65M in 2022/23, was mainly driven by a significant increase (+£7M) in spend on care for adults with learning disability support needs (see Figure7). The Council’s spend on older adults with physical support needs is among the highest compared to its statistical neighbours.
Expenditure on care within nursing and residential homes increased by 21% to £17M and 67% to £25M respectively from 2018/19 to 2022/23, with the Council spending among the highest proportions of its total expenditure on care for older adults within nursing homes compared to its statistical neighbours (see Figure 8 and 9).
The number of adults receiving social care funding increased by22% since 2018/19 to 5,793 in 2022/23 and the number of care package line items increased by 19% to 7,211 for the same period.
In 2023, 4,071 line items were funded for individuals aged 65+, 2,796 for individuals aged 26-64 and 384 for individuals aged 18-25 (see Figure 10). The number of care package line items funded for physical support as a primary support reason increased by the most since 2018/19 from 3,288 in 2019 to 4,496 in 2023 with mental health decreasing by 12% from 772 to 678 (see Figure 11).
Identified opportunities
These findings have identified that while the Council’s total expenditure on ASC increased by a smaller number compared to its statistical neighbours, the Council benchmarked higher for its total expenditure on long-stay support provision.
ASC services are currently exploring areas of opportunity to reduce demand for long-stay support services while maximising independence and improving outcomes for residents, including:
Improving the quality of short-stay support services, e.g. reablement, by developing outcomes-based incentives for providers
Expanding accessibility to, and utilisation of supported living and extra care accommodation, particularly for individuals transitioning from children to adult social care services, to reduce the likelihood of individuals requiring long-stay care home placements
Continuing the Council’s trend of a rise in the number of adults receiving direct payments to increase the flexibility for residents to choose how they want their care to be delivered
