2. This area of expenditure has also been growing faster than any other part of adult social care
Figure 3: Growth in commissioned spend for working age and lifelong disabled adults 2019/20 to 2023/24
Impact on spend growth 2019/20 to 2023/34
Working age and lifelong disabled adults
Older adults physical and dementia
disabled adults looks to have increased by 32% from 2019/20 to 2023/24 (from £8.3bn to £10.9bn). This is compared to an increase of 25% for older adults and dementia, and to a 21% rise in inflation over the same time period.
Alongside being the largest area of spend in adult social care for at least the last five years, it has also been the fastest growing. As shown in Figure 2 below, net expenditure on adult social care support for working age and lifelong
132%
126%
Spend Growth Volume changes
1%
0%
Inflation changes (CPI)
21%
21%
Decreases in net contributions as % of spend Increase in average level of support per person
0%
7%
Figure 2: Expenditure on support trends per cohort, 2019 – 2024 lxiv
10%
-2%
95% 100% 105% 110% 115% 120% 125% 130% 135%
Volume may well become more of a factor influencing upward or downward trends in expenditure in the future. For example, there is likely to be an increase in the number of individuals who transition from disabled children’s services to adult services due to the increasing volume of, and average expenditure on, new 18-year-olds entering the system (see Section 5 – deep dive on 18–25 and SEND). Conversely, birth rates for the most common high need disabilities have reduced in the last 10 years with the introduction of non-invasive prenatal testing (NIPT) to the UK and which may therefore lead to a reduction in number of individuals and expenditure. For example, Down’s Syndrome births are estimated to have
1. Impact of change in the absolute number of people on expenditure As shown in Figure 4, evidence suggests that the total number of individuals has increased by only 0.7% since 2019/20, and even reduced over the period 2020–2022. The largest and highest areas of expenditure (learning disability, mental health, and physical support) have seen the smallest changes in volume of individuals receiving support. Due to the nature of their underlying condition, the turnover of individuals with a learning disability over a five-year period was only 2.8%, highlighting the very stable and predictable nature of this group of individuals.
2019/20
2020/21 2023/24 Working Age and Lifelong Disabled Adults (Total Net commissioned spend – England) CPI National Minimum Wage Older Adults Physical and Dementia (Total Net commissioned spend – England) 2021/22 2022/23
decreased by half in the UK lxv . The positive change in increasing life expectancy may also translate to some longer-term shifts in trends, but this has not impacted the growth of the last four years. Figure 4: Number of people accessing long term support from adult social care in England at the end of the year, by age band and primary support reason lxvi
3. Expenditure is increasing due to the type of care which working age adults and lifelong disabled adults are receiving This programme of work has sought to
2019/20
2020/21
2021/22
2022/23
Expenditure is increasing due to the type of care which working age and lifelong disabled adults are receiving. All areas of adult social care are seeing rising costs due to factors such as inflation and the minimum wage. However, the increase in average level of support per person is higher for working age and lifelong disabled adults than for older adults, and is due particular attention. This is summarised in Figure 3.
Learning Disability Support (18–64) Learning Disability Support (65+) Mental Health Support (18–64) Mental Health Support (65+)
126,775 16,070 44,485 26,980 69,950
125,480 15,865 45,120 25,035
124,635 16,805 43,505 25,495
125,795 16,690 45,470 26,790 72,775 3,260 4,480
examine various potential factors which may be driving this increase in expenditure. It has found that volumes of people supported and levels of health contributions have less of an impact on expenditure for this cohort than level of support provided.
Physical Support (18–64) Sensory Support (18–64) Sensory Support (65+) Support with Memory and Cognition (18–64) Social Support (18–64) Social Support (65+)
71,595 3,205 5,055
71,290 3,250 4,775
3,175 5,590
3,970
4,375
4,435
4,590
6,120 7,205
6,435 6,260
6,600 6,470
7,045 5,595
310,320
308,425
307,260
312,490
100%
99%
99%
101%
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