Projections of adult social care demand and expenditure in England, 2023 to 2043

This paper presents updated projections prepared for the Department of Health and Social Care of demand for long-term care for older people and younger adults in England to 2043 and associated future expenditure. The projections were produced using updated versions of the Care Policy and Evaluation Centre’s aggregate long-term care projections models and the CARESIM microsimulation model developed by Ruth Hancock. The projections cover publicly funded social care for both older people and younger adults and privately funded social care for older people. The key findings of the research are: • Public expenditure on social services for older people is projected to rise under the current funding system from £12.4 billion in 2023 to £25.3 billion in 2043 at constant 2023 prices and under a set of base case assumptions about trends in the drivers of longterm care demand and in the unit costs of care services. • Public expenditure on social services for younger adults is projected to rise under the current funding system from £13.5 billion in 2023 to £21.7 billion in 2043 at constant 2023 prices and under a set of base case assumptions about trends in the drivers of longterm care demand and in the unit costs of care services. These findings need to be treated with some caution. They are based on a set of assumptions about future socioeconomic and demographic trends. They relate to current patterns of care and the current funding system and do not take account of any of the funding reforms which have been proposed in recent years. They do not allow for the potential impact of rising expectations or other behavioural changes. Our estimates for the base year of 2023/24 take account of mortality during the COVID-19 pandemic years through use of 2023/24 data on service users and expenditure, but the projections do not take account of the potential future long-term impacts of the pandemic on excess deaths, numbers of service users, or social care expenditure. Nor do they take account of the implementation of the Employment Rights Bill or of Fair Pay Agreements.