Adult social care in England statistics: background quality and methodology

Question 1

Introduction

Accepted Answer

The Department of Health and Social Care (DHSC) publishes a range of monthly statistics on adult social care in England. As ‘official statistics’, they are produced in accordance with the Statistics and Registration Service Act 2007 and the UK Statistics Authority’s Code of Practice for Statistics, and meet high standards of trustworthiness, quality and public value.

Client level data (CLD) and data on the estimated uptake of digital social care records (DSCRs), which also feature in the ‘Adult social care in England, monthly statistics’ publication, are classified as official statistics in development.

This ‘Background quality and methodology’ document sets out information on the data sources and methodology used to generate the reports and data tables published as part of the ‘Adult social care in England, monthly statistics’ publication. It gives detail on the context, sources, quality and coverage of data used in the monthly statistics publication. The main body of this methodology document relates to data taken from management information submitted by care providers in England to a data collection and insight tool called Capacity Tracker. ‘Annex A: official statistics in development - digital social care records’ at the end of the document relates to the estimated uptake of DSCRs by registered adult social care providers. ‘Annex B: official statistics in development - client level data’ relates to information on people receiving long-term support taken from the new CLD collection.

Statistics that are covered

These statistics currently cover:

occupancy levels in care homes
full course COVID-19 vaccinations in social care settings for staff
autumn 2023 COVID-19 booster vaccinations in social care settings for staff
flu vaccinations for the 2023 to 2024 season in social care settings for staff and residents
visiting in care homes
COVID-19-related absence rates in care homes and domiciliary care settings
estimated uptake of DSCRs
information on people receiving long-term support from the CLD collection, updated on a quarterly basis

Statistics that are no longer covered

The content of the report has frequently changed since it was first published, in order to reflect ongoing changes to the data sources used.

Previously, the monthly statistics publication also covered the following topics which were removed - for example, because the data collection ceased, access to data sources changed or because of limited information on data quality:

infection prevention and control (IPC) measures, including staff movement across different social care settings and payment of full wages when care home staff were isolating due to COVID-19 - collection ceased on 4 April 2022
flu vaccinations for the 2021 to 2022 season for social care staff and residents - collection ceased on 4 April 2022, at the end of the flu vaccination campaign
staffing levels in care homes - collection ceased on 3 August 2022, following feedback from stakeholders suggesting the statistics did not accurately reflect the workforce pressures faced by the sector
personal protective equipment (PPE) availability in care homes and domiciliary care - publication ceased in September 2022, due to limited information on response rates to these questions
autumn 2022 COVID-19 booster vaccinations - collection ceased on 22 February 2023 at the end of the autumn 2022 COVID-19 booster vaccination campaign
flu vaccinations for the 2022 to 2023 season for social care staff and residents - collection ceased on 29 March 2023, at the end of the flu vaccination campaign
COVID-19 testing for staff, residents and visitors of care homes - due to changes to the access and availability of Test and Trace data, publication stopped after June 2023
full course COVID-19 vaccinations in social care settings for residents (COVID-19 vaccination and booster data for care home residents is now published by NHS England)

The collection of first and second dose COVID-19 vaccine data ceased on 31 August 2022. Instead, providers are now asked about whether individuals have received a full course of the vaccine.

Question 2

Data sources and collection

Accepted Answer

Occupancy, COVID-19 and flu vaccination, visiting and staff absence rates data in the monthly statistics publication is taken from management information submitted by care providers in England to a data collection and insight tool called Capacity Tracker.

Background on Capacity Tracker

Capacity Tracker was originally developed by NHS England and the Better Care Fund to enable the system to better manage hospital discharges by identifying available capacity in care homes. It enables care homes to share their vacancies in real time, meaning hospital discharge teams and other health professionals can rapidly search availability throughout England.

Capacity Tracker was identified as a suitable tool for COVID-19 data collection from care providers. Its repurposing was announced via the government’s action plan (15 April 2020) and joint letter (17 April 2020) from DHSC and NHS England together with the Care Quality Commission (CQC) and the Care Provider Alliance.

From May 2020 to 31 March 2022, providers received a financial incentive, via the Adult Social Care Infection Control and Testing Fund to submit data on Capacity Tracker. The Adult Social Care Infection Control and Testing Fund provided funding from local authorities to ensure that IPC measures were in place to curb the spread of COVID-19. To support the monitoring of the fund, questions tracking the adult social care sector’s implementation of IPC measures were collected. Providers self-report their responses and were expected to submit on a weekly basis. The fund ended on 31 March 2022, resulting in the reduction of the number of questions asked via Capacity Tracker, but care providers were still encouraged to keep submitting answers for the remaining questions.

Current Capacity Tracker requirements

On 31 July 2022, the submission of a core subset of data via Capacity Tracker was made mandatory through a provision in the Health and Care Act 2022 which received Royal Assent in April 2022. Care providers are mandated to update Capacity Tracker with the required data within a designated 7-day reporting window. This window opens at the start of the 8th day of each month and runs until the end of the 14th day of each month, or the next working day where the 14th day falls on a weekend or public holiday. This includes data on:

care home bed vacancies, including total number of beds and occupancy
COVID-19 and seasonal flu vaccination
safe visiting in care homes
staff absences related to COVID-19

The guidance on the mandatory data collection was updated on 14 July 2023. As of 31 July 2022, providers will, where possible, be given 3 months’ notice before new data fields become mandatory.

The Adult Social Care Information (Enforcement) Regulations 2022 were made on 10 November 2022 and came into force on 1 December 2022.

Changes to Capacity Tracker will be reflected in the monthly statistics publication as and when they occur.

Occupancy data

It has been mandatory for providers to submit care home bed vacancy data, including total number of beds and occupancy, on a monthly basis since 31 July 2022.

The current Capacity Tracker data collection on care home bed vacancies started in June 2022, when fields were updated to identify the total number of beds, occupied or used beds, (vacant) reserved beds and (vacant) accepting admissions beds. Prior to this, care home occupancy was derived from a location’s total number of beds and number of vacancies.

Care home providers self-report their total number of beds, number of occupied beds, number of vacant and admittable beds, and number of vacant and reserved beds. The number of (vacant) non-admittable beds is automatically derived from the remainder of total beds that have not been accounted for.

COVID-19 and flu vaccination data

It has been mandatory for providers to submit vaccination data on a monthly basis since 31 July 2022.

The Capacity Tracker data collection on first and second doses of the COVID-19 vaccination began in December 2020 for care homes, and in February 2021 for independent CQC-registered domiciliary care providers and other settings including non-registered providers and local authority employed providers.

As of 1 September 2022, the collection was simplified to only request data on a full primary course of COVID-19 vaccinations. For most people, a full primary course is defined as 2 doses of COVID-19 vaccination. However, for a small number of people, a full primary course may mean a different number of doses. This includes people who were vaccinated abroad, people who have received a single-dose vaccination such as Janssen, or people who are severely immunosuppressed.

Providers self-report their total number of staff and residents and the number of staff and residents who have received the COVID-19 vaccination.

Until 31 August 2022, Capacity Tracker also included the collection of data on first and second booster doses for the COVID-19 vaccine, which were rolled out in September 2021 and April 2022 respectively. From 1 September 2022, these fields were removed and replaced by the collection of data on autumn 2022 booster doses. This is defined as any booster delivered under the autumn 2022 booster campaign, which started on 5 September 2022.

Data submission on autumn booster vaccination was mandatory from the October 2022 reporting window, but providers were encouraged to submit this data from the start of the autumn booster campaign in September 2022. On 22 February 2023, the collection of data on COVID-19 autumn booster vaccinations in social care settings was ceased. The full timeseries up to 19 February 2023 was published in the April 2023 data tables but does not feature in subsequent publications.

Flu vaccination data for the 2021 to 2022 season was collected in Capacity Tracker between September 2021 and March 2022 and featured in publications between November 2021 and May 2022.

Flu vaccination data for the 2022 to 2023 season was collected in Capacity Tracker between September 2022 and March 2023 and featured in publications from October 2022 to May 2023.

Flu vaccination data for the 2023 to 2024 season started to be collected on Capacity Tracker from 20 September 2023 and is included in the monthly statistics publication from November 2023 onwards.

Providers are only asked to review and submit the number of individuals who are reported to be vaccinated. Providers are not asked about those who are not vaccinated. This means that the number of individuals who have not received the vaccine cannot be directly derived from data published in these statistics as there may be a number of individuals whose vaccination status is unknown to the care provider.

Vaccination rates among care home staff vary substantially between those who are directly employed by the care homes and those employed by agencies operating within care homes. This could be due to different uptake rates of the vaccine as well as different proportions of staff whose vaccination status is unknown. Therefore, directly comparing the vaccination rate of directly employed staff with agency staff should be done with caution as the 2 groups are likely to have different percentages of staff whose vaccination status is unknown. Care homes are less likely to know the vaccination status of their agency staff due to the nature of their employment.

From 15 July 2023, questions on COVID-19 vaccination in social care settings became non-mandatory until the start of the seasonal booster campaign. The full timeseries is published in the October 2023 report, with a break in the data tables to illustrate when these questions became non-mandatory. The 2023 autumn booster campaign began on 11 September 2023, and therefore COVID-19 vaccination questions became mandatory on Capacity Tracker again from the start of the mandation window that opened on 8 October 2023 until the end of the seasonal booster campaign on 29 February 2024.

Accommodating COVID-19 safe visiting in care homes

It has been mandatory for providers to submit visiting data on a monthly basis since 31 July 2022. The Capacity Tracker data collection on COVID-19 safe visiting in care homes started in May 2020.

Care home providers self-report whether they are able to accommodate residents receiving visitors in all circumstances, exceptional circumstances or no circumstances. Exceptional circumstances are individually defined by each care home but are generally thought to be considered when residents are receiving palliative care.

This data was first collected as part of the subset of questions asked to monitor the implementation of IPC measures. Up until 4 April 2022, this subset of questions also included other questions which previously featured in the monthly statistics publication. These included questions about:

limitation of staff movement across different social care settings
payment of full wages when staff are isolating due to COVID-19 in care homes

The Adult Social Care Infection Control and Testing Fund, which was introduced to support adult social care providers in implementing IPC measures and reducing the rate of COVID-19 transmission within and between care settings, ended on 31 March 2022. On 31 March 2022, DHSC published infection prevention and control guidance on managing specific infections and a COVID-19 supplement to reduce the spread of COVID-19 in adult social care settings in England, which both applied from 4 April 2022.

As a result of the end of the fund and of the publication of the guidance on living with COVID-19, data on IPC collected via Capacity Tracker was cut back. The question on COVID-safe visitation in care homes remains, and the monthly statistics publication will continue to present this data. On 4 July 2022, the visiting questions changed in Capacity Tracker, which now asks about whether care homes have been able to accommodate visiting in the past month rather than in the last 7 days. Data after 4 July 2022 has remained consistent with data from before the question change. The question change is flagged in the data tables. On 3 April 2023, the COVID-19 supplement to reduce the spread of COVID-19 in adult social care settings in England was updated to reflect the removal of restrictions on visitors who were not symptomatic or had not tested positive under any circumstances. This supplement to the IPC guidance on managing specific infections was superseded by acute respiratory infection guidance on 31 January 2024.

It has been mandatory for providers to submit staff absence data on a monthly basis since 31 July 2022.

The Capacity Tracker data collection on staff absences related to COVID-19 started in December 2020 for care homes and independent CQC-registered domiciliary care providers.

Care home providers self-report their total number of staff in the establishment (nurses, care workers and non-care workers) and the number of staff absent due to COVID-19-related reasons.

Independent CQC-registered domiciliary care providers self-report the total number of staff who have face-to-face contact with care recipients and the number who are not working because of COVID-19.

Question 3

Data coverage

Accepted Answer

All data in the monthly statistics publication refers to social care settings in England only.

Data collection could be subject to change based on changes to the priorities and therefore the reporting in the monthly statistics publication will be adapted accordingly.

Capacity Tracker data

Currently all data fields from Capacity Tracker presented in the monthly statistics publication are part of the subset of data which has been mandated since 31 July 2022. Providers are required to submit this data on a monthly basis, within a designated 7-day reporting window (see the ‘Current Capacity Tracker requirements’ section above). The guidance on the mandatory data collection was updated on 14 July 2023. Prior to 31 July 2022, providers were expected to submit data weekly, but on a voluntary basis.

The Adult Social Care Information (Enforcement) Regulations 2022 were made on 10 November 2022 and came into force on 1 December 2022.

Response rates from August 2022 onwards cannot be used to estimate the rates of compliance with the mandatory provision of certain data items as set out in the adult social care provider information provisions. Response rates during the reporting window as set out in the adult social care provider information provisions are not equivalent to compliance rates because there may be extenuating circumstances in which a provider has not responded for legitimate reasons.

Occupancy in care homes

The statistics published in the accompanying tables present one data point per month from January 2023, which reflect the data reported during the reporting window that month, up to 11:59pm on the last day of the reporting window.

Any care home that has not submitted data within the reporting window is excluded from the relevant analysis for that month. This is to avoid skewing the data. The full response rates for all data points are available in the accompanying tables.

Care home occupancy figures reported in the monthly statistics publication are based on CQC registration data that changes monthly. Data on occupancy in care homes from January 2023 to January 2024 is based on care homes which were active as of 31 January 2024, that is, the date on which CQC registration data was last updated in Capacity Tracker when the February 2024 reporting window ended. Data for each month in this period therefore excludes care homes which were no longer active as of 31 January 2024.

Active Capacity Tracker locations are defined as having a CQC active status, excluding those with a current dormancy start date.

From February 2024 onwards, care home occupancy is based on care homes which were active as of the most recent CQC registration data update in Capacity Tracker at the end of that month’s reporting window. For data on the number of CQC registered beds, see the ‘Care directory with filters’ section of the Using CQC data page.

Care home occupancy rates are calculated using the reported total number of beds and the reported number of occupied beds. Occupancy rates are based on locations that submitted data during the relevant reporting window each month. If a location did not submit data in this period, it is excluded from reporting. Response rates are published in the data tables that accompany the monthly statistics publication.

COVID-19 and flu vaccination

From 15 July 2023, questions on COVID-19 vaccination in social care settings became non-mandatory until the start of the seasonal booster campaign. The full timeseries is published in the October 2023 report, with a break in the data tables to illustrate when these questions became non-mandatory. The 2023 autumn booster campaign began on 11 September 2023, and therefore COVID-19 vaccination questions became mandatory on Capacity Tracker again from the start of the mandation window that opened on 8 October 2023 until the end of the seasonal booster campaign on 29 February 2024.

The statistics published in the accompanying tables present weekly data points, even after August 2022. This is because weekly data updates are encouraged and weekly data points allow us to capture updates made by providers outside the monthly mandation window. Response rates are likely to be higher during the mandation window and may be lower in other weeks of the month. Therefore, weeks which coincide with the mandation window may see a bigger increase in vaccination rates, due to higher response rates in those weeks. These weeks are clearly flagged in the accompanying data tables.

Data on the proportion of social care staff and residents who have received an autumn 2022 booster dose of the COVID-19 vaccine is available from the October 2022 report. Providers were not mandated to submit this data until the October 2022 reporting window, but were encouraged to submit it from the start of the autumn booster campaign in September 2022. From 22 February 2023, the collection of data on COVID-19 autumn 2022 booster vaccinations in social care settings was ceased. The full timeseries up to 19 February 2023 was published in the April 2023 data tables but does not feature in subsequent publications.

Data on the proportion of social care staff who have received an autumn 2023 booster dose of the COVID-19 vaccine is available from the November 2023 report. Providers were not mandated to submit this data until the October 2023 reporting window, but were encouraged to submit it from the start of the autumn booster campaign in September 2023.

The methodology used to calculate response rates has been updated several times to improve accuracy. These changes affected the response rates, but not the vaccination rates.

From the July 2022 publication onwards, a provider is counted as having responded for each vaccination dose if the date of their last update on Capacity Tracker (which is recorded automatically when they access the system) is after the date at which the data field relating to that dose was added to the collection. However, providers with zero in every vaccination data field are still counted as non-responses.

Data for care homes and domiciliary care relates to up to 11:59pm on the day reported as the ‘week ending’. Since 9 October 2022, the weekly data points for COVID-19 and flu vaccination refer to weeks ending on a Sunday rather than weeks ending on a Tuesday. This change means that the data point for the week ending 9 October only covers 5 days rather than 7, so there are a lower number of additional vaccinations reported for that data point due to the shorter time period.

Older adult care homes are defined as care homes serving any older people (aged 65 and over), as identified from the latest CQC data on care homes in the ‘older people’ service user band. Some residents in these care homes may be aged under 65. The remainder of the care homes are classed as younger adult care homes. ‘Staff’ refers to both those directly employed by the care provider and agency staff.

The total numbers of residents and staff may include individuals who did not receive the vaccine for valid medical reasons, or where consent to receive the vaccination was not received.

The statistics published in the accompanying tables present weekly data points from December 2020 to the end of July 2022. From August 2022 onwards, the tables present one data point per month, which reflect the data reported during the mandation window that month, up to 11:59pm on the last day of the mandation window.

From August 2022 onwards, any care home that has not submitted data within the mandation window is excluded from the relevant analysis for that month. This is to avoid skewing the data. This means that the total number of care homes and staff varies over time and between tables. The full response rates for all data points are available in the accompanying tables.

Prior to August 2022, responses that were not submitted within the 7 days prior were also excluded each week. Each reporting week referred to data up to 2pm on the date stated as the ‘week ending’ and the 7 days prior.

Absence rates related to COVID-19 are calculated using the reported number of staff employed and the reported number of staff out of work that day because of COVID-19-related reasons. Absence rates might be affected by provider response rates.

Absence data started to be reported by care providers in Capacity Tracker from December 2020. However, in the first few months of collection, due to low response rates, the workforce data is incomplete, which affects the accuracy of the absence data during that period.

Providers who are the least likely to respond are likely to be those experiencing the most pressures on their staff, due to high levels of absences. As such, data from December 2020 to the start of February 2021 for care homes, and from December 2020 to the start of March 2021 for domiciliary care providers, is not presented in the monthly statistics publication.

COVID-19-related absences cannot be directly linked to staff positivity rates. This is because absences related to COVID-19 can cover a wide range of reasons, including but not restricted to:

testing positive for COVID-19
isolating
caring for someone who has tested positive for COVID-19
suffering from illness related to COVID-19

The total number of staff reported in these tables will be lower than the total care workforce, because only care homes who have filled in the relevant section of Capacity Tracker in the last 7 days (or during the mandatory reporting window where this is longer than 7 days) are included in the staff counts each week. If a care home has not recently responded to this question, their staff count will not be included.

A count of all staff, for all care homes who have responded to Capacity Tracker at least once, can be found in the vaccination tables and is provided as a denominator to the staff vaccination rate. This is because the vaccination rates are cumulative and therefore include all care homes, whether they have replied recently or not.

There has been a growing interest in using these statistics to monitor trends in staff headcount over time.

We have investigated the data in more detail to better understand its quality and the underlying drivers of changes in staff headcount over time. Our investigation showed that staff headcount trends, as presented in these tables, are driven by multiple factors, including changes in Capacity Tracker response rates over time which makes it difficult to distinguish between changes in response rates and genuine changes in staff headcounts. As such, we do not recommend that the vaccination rate denominator is used to estimate changes in staff headcount over time. We will continue to monitor the quality of this data and will provide more information here if anything changes.

This does not affect the resident and staff vaccination rates which are published in the accompanying COVID-19 vaccination statistics data tables. These statistics can be used to monitor vaccination trends over time.

Question 4

How the data can be used

Accepted Answer

Occupancy in care homes

This data can be used for:

comparing occupancy rates across local authorities and regions in England as self-reported by care providers
monitoring trends in occupancy rates over time, paying careful attention to the caveats presented in this document

This data cannot be used for:

comparing with occupancy rates in other countries of the UK
monitoring changes in the number of beds over time, due to the effects of response rates
monitoring trends in occupancy rates over time without considering the caveats presented in this document
identifying ‘suitable’ vacancies, as all admissions are subject to the appropriate clinical assessment and individual choice

Care home occupancy figures reported in the monthly statistics publication are based on CQC registration data that changes monthly. More details on reported occupancy data and updates to CQC registration data can be found in the ‘Data coverage’ section above.

Data is included in the monthly statistics publication for locations that submitted data within that month’s reporting window.

This data can be used for:

comparing vaccination rates across local authorities and regions in England as self-reported by care providers for:
- the full primary course and autumn 2023 booster doses of the COVID-19 vaccine
- flu vaccinations for the 2023 to 2024 season
monitoring vaccination rates over time for:
- the full primary course and autumn 2023 booster doses of the COVID-19 vaccine
- flu vaccinations for the 2023 to 2024 season
estimating the size of the adult social care workforce at a given time, using the total staff headcount provided in the accompanying tables, while carefully considering the caveats presented in this document

This data cannot be used for:

estimating the number of social care staff or residents who have not been vaccinated
comparing with vaccination rates in other countries of the UK
directly comparing vaccination take-up rates between different types of care home staff (directly employed and agency staff)
estimating the number of vaccinations delivered each day
monitoring adult social care workforce size trends over time using the total staff headcount provided in the accompanying tables without carefully considering the caveats presented in this document

The total number of staff and residents for each social care setting as well as the number reported to be vaccinated for COVID-19 and flu are self-reported by the care provider and local authorities. As a result, the rates in the monthly statistics publication refer to the percentage of staff and residents reported to be vaccinated by care providers. This means that the number of individuals who have not received a vaccine cannot be directly derived from the data published in these statistics as the vaccination status of some individuals may be unknown to the care provider.

The dates in this section refer to the dates upon which vaccinations were reported by care providers rather than the dates upon which vaccinations were administered.

Some care providers have reported the total number of staff or residents but not the numbers vaccinated. As a result of this, vaccination rates are affected by response rates and may be underestimated.

Among care home staff, there is a substantial difference in reported vaccination rates for COVID-19 vaccinations between staff directly employed by care homes and staff employed by agencies operating within care homes. This could be due to, for example but not exclusively, different uptake rates, vaccination status not being known to the care provider, or the nature of employment and information available to the care homes.

From 31 July 2022, providers were mandated to complete Capacity Tracker on a monthly basis. Providers are required to update Capacity Tracker with the required data within a designated 7-day reporting window (see the ‘Current Capacity Tracker requirements’ section above).

This means that response rates are likely to be higher during the mandation window and may be lower in other weeks of the month. Therefore, weeks that coincide with the mandation window may see a bigger increase in vaccination rates, due to higher response rates in those weeks. These data points are flagged in the accompanying ‘COVID-19 and flu vaccination statistics, April 2024: data tables’ on the Adult social care in England, monthly statistics: April 2024 page.

From 15 July 2023, questions on COVID-19 vaccinations in social care settings became non-mandatory until the seasonal booster campaign began. As such, these figures may not be directly comparable with those from earlier publications. Questions on COVID-19 vaccination in social care settings became mandatory on Capacity Tracker again from the start of the reporting window that opened on 8 October 2023 until the end of the seasonal booster campaign on 29 February 2024.

From 9 October 2022, the weekly data points for COVID-19 and flu vaccination refer to weeks ending on a Sunday rather than weeks ending on a Tuesday. This change means that the data point for the week ending 9 October only covers 5 days rather than 7, so there are a lower number of additional vaccinations reported for that data point due to the shorter time period.

In the accompanying COVID-19 and flu vaccination statistics data tables, the total staff count is provided as the denominator used to calculate the staff vaccination rate. There has been a growing interest in using these statistics to monitor trends in staff headcount over time.

We have investigated the data in more detail to better understand its quality and the underlying drivers of change in staff headcount over time. Our investigation showed that staff headcount trends, as presented in these tables, are driven by multiple factors, including changes in Capacity Tracker response rates over time. This makes it difficult to distinguish between changes in response rates and genuine changes in staff headcounts. As such, we do not recommend that the vaccination rate denominator is used to monitor or estimate changes in staff headcount over time. We will continue to monitor the quality of this data and provide more information here if anything changes.

These caveats do not affect the resident and staff vaccination rates, which are published in the accompanying COVID-19 and flu vaccination statistics data tables. These statistics are internally consistent and can be used to monitor vaccination trends over time.

COVID-19 vaccinations

The NHS started administering vaccinations for COVID-19 in England on 8 December 2020. Social care staff and residents of care homes were prioritised for the vaccine according to the Joint Committee on Vaccination and Immunisation (JCVI) recommendation. For more information, see Priority groups for coronavirus (COVID-19) vaccination: advice from the JCVI.

On 15 August 2022, the JCVI issued advice and formally launched the COVID-19 autumn 2022 booster vaccination campaign for the following individuals:

residents in a care home for older adults and staff working in care homes for older adults
frontline health and social care workers
all adults aged 50 years and over
persons aged 5 to 49 years in a clinical risk group, who are household contacts of people with immunosuppression, or who are carers

NHS vaccination teams started visiting care homes to administer the vaccine on 5 September 2022, a week before the formal launch of the campaign.

From 1 September 2022, providers were mandated to submit data on the numbers of residents and staff who have received a full primary course and are no longer asked about first and second doses separately. A full primary course does not include COVID-19 boosters. For most people, a full primary course is defined as 2 doses of COVID-19 vaccination. For a small number of people, however, including people who were vaccinated abroad, people who have received a single-dose vaccination such as Janssen, or people who are severely immunosuppressed, a full primary course may mean a different number of doses.

From 1 September 2022, providers were also encouraged to submit data on individuals who have received their autumn 2022 COVID-19 booster vaccine. An autumn booster is defined as any booster delivered under the autumn booster campaign, which started on 5 September 2022. Data on autumn 2022 boosters is available from week ending 13 September 2022. It became mandatory for providers to submit data on autumn booster vaccinations from the October reporting window. The full timeseries for first and second doses and first and second booster doses of COVID-19 vaccination up to 31 August 2022 (including vaccination in other care settings) can be found in the accompanying ‘COVID-19 and flu vaccination statistics, up to 31 August 2022: data tables’ on the Adult social care in England, monthly statistics: October 2022 page.

On 21 December 2022, NHS England published additional operational management information to track the number of COVID-19 boosters administered to residents of all adult care homes in England during the 2022 autumn winter campaign - see ’Tracking autumn boosters for care home residents using operational data’ on the NHS supplementary information page. In the NHS England publication, Capacity Tracker is used as a primary data source to estimate the number of autumn boosters administered to residents, but for those care homes without Capacity Tracker data entries, the number of vaccines administered is either collected via a complementary survey or taken from the National Immunisation Management System (NIMS). The NHS England publication therefore presents 2 vaccination rates: one using Capacity Tracker data only and one using a combination of the 3 data sources.

The NHS England publication also presents the percentage of ‘eligible’ residents reported to be vaccinated with an autumn booster. This measure uses the number of residents who have received a full primary vaccination course as the denominator instead of the total number of residents, and is therefore not directly comparable to the vaccination rate presented in these DHSC adult social care in England monthly statistics.

From 22 February 2023, the collection of data on COVID-19 autumn booster vaccinations in social care settings was ceased. These tables were removed from May 2023 onwards, but historical data is still available in prior editions of the monthly statistics publication.

From 29 March 2023, providers were asked to record spring booster vaccinations among care home residents in Capacity Tracker. Previously, data on boosters has been published in this report. Spring boosters were published by NHS England using a new methodology. The last publication of this campaign, ’Spring boosters for older adult care home residents to 4 July 2023’, can be found on the NHS COVID-19 vaccinations webpage.

On 26 May 2023, the JCVI issued advice on the COVID-19 autumn 2023 booster vaccination campaign, for the following individuals:

residents in a care home for older adults
all adults aged 65 years and over
persons aged 6 months to 64 years in a clinical risk group, as defined in tables 3 and 4 of the COVID-19 chapter of the Green Book
frontline health and social care workers
persons aged 12 to 64 years who are household contacts, as defined in the Green Book, of people with immunosuppression
persons aged 16 to 64 years who are carers, as defined in the Green Book, and staff working in care homes for older adults

From September 2023, providers were encouraged to submit data on individuals who have received their autumn 2023 COVID-19 booster vaccine. An autumn booster is defined as any booster delivered under the autumn booster campaign, which started on 11 September 2023. Data on autumn 2023 boosters is available from week ending 24 September 2023. It became mandatory for providers to submit data on autumn 2023 booster vaccinations from the start of the October 2023 reporting window, which opened on 8 October 2023, until the end of the seasonal booster campaign on 29 February 2024.

Since November 2023, all COVID-19 vaccination information for care home residents is published by NHS England on its COVID-19 vaccinations webpage.

The national influenza (flu) immunisation programme aims to provide direct protection to those who are at higher risk of influenza associated morbidity and mortality. Groups eligible for NHS influenza vaccination, from 1 September 2023, are based on the advice of JCVI. More details can be found in the national flu immunisation programme 2023 to 2024 letter.

During the winter 2023 to 2024 flu vaccination campaign, frontline social care workers, carers and everyone aged 65 years and over are eligible for a flu vaccine. Social care workers who are in direct contact with people who receive care and support services should have the flu vaccine provided by their employer. However, there are circumstances where frontline staff, who are employed by specific social care providers without access to employer led occupational health schemes, can access the vaccine through the NHS free of charge.

This report covers cumulative flu vaccination rates for the 2023 to 2024 season in the below adult social care groups:

residents in older adult care homes
staff directly employed by older adult care homes
agency staff working in older adult care homes
staff directly employed by younger adult care homes
agency staff working in younger adult care homes
domiciliary care staff registered to independent CQC providers
residents of younger adult care homes

Data is self-reported by care providers and local authorities, who may submit their resident and staff numbers but not the number receiving the flu vaccination, resulting in a lower reported percentage vaccinated. An overview of response rates for the numbers vaccinated is provided below.

Data on flu vaccination rates for the 2023 to 2024 season is available from 24 September 2023.

Accommodating COVID-19 safe visitation in care homes

This data can be used for:

estimating the number and proportion of care homes that indicate they are accommodating COVID-safe visits within the care homes in line with government guidance
monitoring trends over time
comparisons across local authorities and regions in England

This data cannot be used for:

estimating the number of visitors in care homes and their infection or vaccination status
comparing with other countries of the UK
estimating rates of compliance with the mandatory provision of certain data items as set out in the adult social care provider information provisions. Response rates for visiting questions during the reporting window as set out in the adult social care provider information provisions are not equivalent to compliance rates because there may be extenuating circumstances in which a provider has not responded for legitimate reasons

This data is self-reported and is therefore affected by response rates. From August 2022 onwards, any care home that has not submitted data within the mandation window is excluded from the relevant analysis for that month. Prior to August 2022, responses that were not submitted within the 7 days prior were also excluded each week.

Visiting guidance and data trends

There are currently no restrictions on visiting in care homes under normal circumstances where individuals are not symptomatic or have not tested positive. However, during periods of outbreak or when a resident is COVID-positive, visits may need to be limited to one visitor at a time for each resident.

The question on COVID-safe visitation in care homes is still included in the data collection. In July 2022, the question changed from asking care homes whether residents had been allowed visits in the last 7 days to whether residents had been allowed visits in the last month.

Since 31 July 2022, this question is part of the subset of data that providers are mandated to submit on a monthly basis. For more information, see the ‘Data quality’ section below.

The table below summarises the changes in guidance on allowing care home residents to have visitors since December 2020.

Table 1: changes in visiting guidance since December 2020

Date	Guidance
From 3 April 2023	No restrictions on visiting for individuals who are not symptomatic or who have not tested positive under any circumstances
From 31 August 2022	Visitors providing personal care no longer need to test before a visit
From 4 April 2022 to 30 August 2022	No restrictions on visitation in care homes. Every care home resident should have one visitor who can visit in all circumstances (including during periods of isolation and outbreak) Visitors are not required to test before a visit, unless providing personal care Visitors providing personal care do not need to test more than twice a week
From 31 January 2022 to 3 April 2022	No limits on the number of named visitors, with testing and guidance to support safe visiting in place
From 15 December 2021 to 30 January 2022	Residents are permitted to have 3 named visitors for regular visits with testing in place
19 July 2021 to 14 December 2021	No limits on the number of named visitors, with testing and guidance to support safe visiting in place
17 May 2021 to 18 July 2021	Residents are permitted to have 5 named visitors for regular visits with testing in place
12 April 2021 to 16 May 2021	Residents are permitted to have 2 named visitors for regular visits with testing in place
8 March 2021 to 11 April 2021	Residents are permitted to have one named visitor for indoor visits with testing in place
6 January 2021 to 7 March 2021	No indoor visits permitted due to the national lockdown
1 December 2020 to 5 January 2021	Indoor visits permitted with testing in place (from 19 December 2020 - no indoor visits permitted in tier 4 areas)

Note: timelines for guidance are accurate as of 4 April 2024.

More information on the current visiting guidance can be found in the acute respiratory infections guidance, which accompanies the infection prevention and control in adult social care settings guidance.

Staff absence rates

This data can be used for:

estimating the number and percentage of staff absent because of COVID-19-related reasons
monitoring trends in COVID-19-related absence rates over time
comparisons across local authorities and regions in England

This data cannot be used:

as a sole indicator of all workforce pressures faced by the social care sector, since they only cover COVID-19-related absence
to directly compare absence rates related to COVID-19 between domiciliary care and care home staff
for comparing with other countries of the UK
for linking COVID-19-related absence rates with test positivity rates
for inferring trends about staff headcounts as these are partly driven by response rates

Absence rates related to COVID-19 are calculated using the reported number of staff employed and the reported number of staff out of work that day because of COVID-19-related reasons. Both the number of total staff employed and the number of staff absent might be affected by provider response rates as only numbers reported by providers in the last 7 days (or during the mandatory reporting window where this is longer than 7 days) are included in the total counts.

Absence data started to be reported by care providers in Capacity Tracker from December 2020. However, low response rates in the first few months of collection mean that the workforce data is incomplete, which affects the accuracy of the absence data during that period.

Providers who are the least likely to respond are likely to be those experiencing the most pressures on delivery due to high levels of staff absence. For this reason, data from December 2020 to the start of February 2021 for care homes, and from December 2020 to the start of March 2021 for domiciliary care providers, are not presented in the monthly statistics publication.

COVID-19-related absences cannot be directly linked to staff test positivity rates. This is because absences related to COVID-19 can cover a wide range of reasons, including but not restricted to staff:

testing positive to COVID-19
self-isolating
caring for someone who has tested positive to COVID-19
suffering from illness related to COVID-19

For more information, see the ’Data quality’ section below.

Absence rate statistics presented in this section were added for the first time in February 2022, following growing general interest in workforce pressures from various sources.

From 31 July 2022, workforce absence data is part of the subset of data that providers are mandated to submit on a monthly basis. Only data submitted during the monthly mandation window are included in these statistics.

COVID-19-related absence rate statistics alone are not sufficient to give a full picture of workforce pressures faced by the sector - however, they may provide some insight on some of the challenges. Additional statistics, such as general absences, retention or recruitment could provide a more complete picture.

Question 5

Data quality

Accepted Answer

This section measures the adult social care statistics against the dimensions of quality set out by the Government Statistical Service for statistical outputs.

Any feedback on these statistics is welcome and can be sent to asc.statistics@dhsc.gov.uk.

Relevance

These are monthly DHSC statistics on adult social care in England. This statistical bulletin provides an overview on a range of information on social care settings.

These statistics are published to provide an overview of the adult social care sector, providing transparency and insight. The monthly statistics publication aims to improve access to various data on adult social care by providing a comprehensive, easily accessible bulletin.

Accuracy

Occupancy, visiting in care homes and staff absence due to COVID-19

Coverage is limited to care providers registered with and providing data to Capacity Tracker. Data is self-reported by care providers and can be influenced by response rates. More details on response rates can be found in the ‘Data coverage’ section above.

Care home occupancy figures reported in the monthly statistics publication are based on CQC registration data that changes monthly. More details on reported occupancy data and updates to CQC registration data can be found in the ‘Data coverage’ section above.

COVID-19 and flu vaccination

Coverage is limited to care providers registered and providing data to Capacity Tracker. As data is self-reported by care providers for their staff and residents, trends in the data must consider response rates as some care providers report the total number of staff or residents but not the number vaccinated.

Additionally, a proportion of staff and residents will have an unknown vaccination status. This will have an impact on the deviation from the true value for all care providers. More details can be found in the ‘Data coverage’ section above.

In order to classify older and younger adult care homes, we use a combination of the monthly CQC care directory registers and the CQC application programming interface (API) for newly active care homes. When a care home is not found in either data source, the care home is classified as a younger adult care home until data is made available. This data can be found on the CQC webpage, Using CQC data.

Validation checks are implemented by the data supplier to ensure the number of staff or residents vaccinated entered by care providers cannot be higher than the number of staff or residents.

Reliability

The data tables for the monthly statistics publication are produced by a reproducible analytical pipeline (RAP) using the statistical software ‘R’. This reduces the likelihood of certain processing errors by minimising the amount of manual processing or compiling of data. All stages in this pipeline are quality assured by a professional analyst.

Statistical disclosure control methods

In order to prevent individuals or care providers from being identified in the data accompanying the monthly statistics publication, disclosure control methods have been applied.

Occupancy, COVID-19 and flu vaccination, visiting in care homes and workforce absence

At local authority level, counts are rounded to the nearest 5 to avoid identification of care homes when the counts are low. At regional level, some counts are rounded to the nearest 5 to avoid the disclosure of suppressed counts. For COVID-19 and flu vaccination, visiting and workforce absence, counts which are less than 3, and the related percentages, are suppressed. For occupancy, counts which are less than 5, and the related percentages, are suppressed.

Timeliness and punctuality

Occupancy, COVID-19 and flu vaccination, visiting in care homes and workforce absence

These statistics are updated on a monthly basis and the data in each publication relates to up to 2 weeks prior to the publication date. The lag is to allow time for data to be collected and ensure quality assurance processes can be carried out.

Since 31 July 2022, providers are mandated to update a subset of data every month, within a designated 7-day reporting window (see the ‘Current Capacity Tracker requirements’ section above). Data is included in the monthly statistics publication for locations that submitted data within that month’s reporting window. As of September 2022, the monthly statistics publication is released on the first Thursday of each month instead of the second Thursday of each month, in order to keep the lag between data input and publication to approximately 2 weeks.

As noted above, care home occupancy figures reported in the monthly statistics publication are based on CQC registration data that changes monthly. More details on reported occupancy data and updates to CQC registration data can be found in the ‘Data coverage’ section above.

The frequency of these publications will be evaluated while DHSC continues to assess the needs of users and stakeholders.

More timely data on COVID-19 vaccinations in adult social care in England is available through other sources. More details on this can be found in the ‘Data sources and collection’ section above.

Comparability and coherence

Capacity Tracker data is self-reported from care providers and comparability over time is influenced by response rates. The latest response rates and how they influence the timeseries can be found in the ‘Data coverage’ section above.

COVID-19 vaccination

Up until the start of February 2023, NHS England also published data on vaccinations in adult social care settings as part of its broader statistical release on COVID-19 vaccination.

DHSC and NHS England’s published data on COVID-19 vaccinations in adult social care settings follow the same methodology and use the same data source, but there are some differences, such as:

for data relating to the reporting period prior to April 2022, where the monthly statistics publication reports data collected up to 11:59pm on a Tuesday, NHS England used data collected up to 11:59pm on a Sunday. However, from April 2022 NHS England also used data collected up to 11:59pm on a Tuesday. From 9 October 2022, both publications use data collected up to 11:59pm on a Sunday
a small amount of data may be collected after the respective reporting periods
regional breakdowns - data in the monthly statistics publication uses the administrative regions of England and NHS England uses NHS regions

Outputs from DHSC’s adult social care monthly statistics publication are also compared against internal DHSC analysis carried out by other professional analysts in the department.

Workforce statistics

In December 2021, an additional workforce report providing more information on the pressures faced by the adult social care workforce was published as part of this data collection. This information was received through an ad hoc survey and has been published as part of this collection as a one-time event. The survey covers more detailed insight into current workforce pressures faced compared to 6 months previously. This includes issues relating to recruitment, retention, staff morale and use of agency staff. See the adult social care workforce survey: December 2021 report.

The workforce survey complements the regular collection by providing the opportunity to have a deeper exploration of workforce issues, which is possible in an ad hoc survey but would be too burdensome for the regular collection. The workforce survey collected information from both care homes and domiciliary care providers.

Skills for Care publishes estimates of the number of adult social care filled posts as a measurement of the size of the adult social care workforce - see:

Differences in data sources and methodology mean that these statistics are not comparable to those published in this report.

Skills for Care’s monthly tracking data on staffing is based on the unweighted responses of a relatively small cohort of providers who have updated records in the Adult Social Care Workforce Data Set in each respective month. This data may not be representative of the sector as a whole and therefore may only be indicative of general trends. Skills for Care uses a wider definition of domiciliary care than is used in Capacity Tracker and includes other services delivered in the user’s own home, such as supported living and extra care housing.

Skills for Care also publishes monthly estimates of the average number of days lost due to sickness, which are not comparable to the absence rates published in this report. This is because of similar reasons explained above and due to the nature of Skills for Care’s estimate which is not specific to COVID-19-related absences.

Table 2: statistics published by other UK nations

DHSC publishes monthly adult social care data for England only. The other UK nations currently publish the equivalent data set out in the table below.

	Wales	Scotland	Northern Ireland
Care home occupancy rates	No published statistics	Publish annual statistics on care home occupancy by sector and main client group - Public Health Scotland: care home census for adults in Scotland - statistics for 2013 to 2023 No breakdowns for proportions of vacant and admittable or vacant and non-admittable beds	No published statistics
Adult social care COVID-19 vaccinations	Publish weekly statistics on a dashboard on COVID-19 vaccinations from management information for care home residents and social care staff (care home and domiciliary care staff) - Public Health Wales: latest vaccination summary Not comparable with our statistics because they are produced from management information, whereas our statistics are self-reported	Publish weekly statistics on a dashboard on COVID-19 vaccinations from management information for care home residents, care home staff and other social care staff (including domiciliary care staff) at a national level - Public Health Scotland: weekly national respiratory infection and COVID-19 statistical report Not comparable with our statistics because they are produced from management information, whereas our statistics are self-reported	Publish daily statistics on a dashboard on COVID-19 vaccinations for the general population at a national level - Northern Ireland COVID-19 vaccinations dashboard No specific breakdowns for care home residents or social care staff (care home or domiciliary care staff) Not comparable with our statistics, due to the absence of breakdowns for care home residents and social care staff
Adult social care flu vaccinations	No published statistics	Publish a weekly national respiratory infection and COVID-19 statistical report Not comparable with our statistics because they are produced from management information, whereas our statistics are self-reported	No published statistics
Social care staff absences	No published statistics	No published statistics	No published statistics
Visitation in care homes	No published statistics	Published monthly statistics on COVID-19 safe visitation in care homes on a dashboard from management information at a national and an NHS board level (organisations that are responsible for the delivery of healthcare services in Scotland) - Public Health Scotland: COVID-19 statistical report No longer updated - last update on 20 January 2023 Not comparable with our statistics because they are produced from management information, whereas our statistics are self-reported	No published statistics

Accessibility and clarity

These statistics are freely available on GOV.UK with all documents published in an accessible format. The statistical reports and ‘Background quality and methodology’ documents are published in HTML and accompanying data tables are published in OpenDocument Spreadsheet (ODS) format.

This ‘Background quality and methodology’ document is published to ensure users have sufficient information on how these statistics can be used.

The commentary is written with the aim of being clear and impartial. DHSC will continue to assess user and stakeholder needs to ensure the commentary sufficiently meets their needs.

Quality assurance

Each month, a substantive amount of time and resource is available for quality assurance throughout the data journey, from the initial data input to the statistical publication.

The following sections detail the steps taken to ensure the quality of the data published. However, because the data is self-reported by providers, there may be other small inaccuracies in the data which we are unable to identify through our quality assurance steps.

Data imputation and collection

The data is self-reported by adult social care providers via Capacity Tracker, a data collection tool owned and administered by North of England Commissioning Support Unit (NECS). Due to the nature of the data, there are risks of data being misreported or questions being misinterpreted.

To mitigate this, in collaboration with care providers and stakeholders, NECS and DHSC continuously work together to revise the questions asked to providers, ensure they are understood correctly and that providers are able to provide accurate data. Any changes in wording of questions are flagged within the monthly statistics publication as they might affect comparability over time. In addition, NECS provide ongoing support to providers via their support centre when they encounter difficulties with the collection system. Providers can call or email the support centre with technical queries and if they need guidance on specific questions, they can email DHSC directly.

In addition, the Capacity Tracker user interface includes numerous automated data validation checks - that is, data type and consistency checks which ensure that the data inputs are logical and realistic. A few examples include:

checks on fields to confirm the data entered has the correct data type - for example, where a numeric response is required, the system does not allow letters or special symbols
if the number of COVID-19 vaccination boosters inputted is greater than the number of the full course vaccinations inputted, the provider is unable to submit their data until the data is revised. Similarly, the number of full course vaccinations inputted must be less or equal to the total number of individuals recorded
if the number of COVID-19-related and non-COVID-19-related staff absences inputted is higher than the number of staff employed, the provider is unable to submit their data until the data is revised
counts of individuals (staff or residents) must be integers

Once data is submitted by providers, NECS then performs additional checks to ensure the data is inputted correctly. For example, if a value differs substantially from the previous value inputted by a provider, the NECS support centre contacts the provider to confirm the value.

Data downloads

A snapshot of data submitted by care providers is downloaded by DHSC analysts at the end of each mandation window. For vaccination data, the data is downloaded every week. The analyst then performs a series of checks on the data which includes ensuring that a realistic number of providers, compared to previous submission windows, have submitted data within a specific snapshot.

These data snapshots are then stored securely on DHSC systems, and only a restricted list of analysts have access to the data.

Data processing

The data is processed every month, via a RAP in RStudio. This RAP has been set up so that only limited manual intervention is necessary each month to produce updated outputs. This means that the risk of human error is minimised throughout the process.

The data processing steps include a data cleaning stage and additional validation checks on the input data. For example, for non-numerical values, the RAP automatically checks whether values are included in the list of expected values. If not, the analyst processing the data must manually change the value, either to the nearest value, or flag it as a missing value as appropriate. This affects a negligeable amount of data entries.

For example, for the question on whether visiting is allowed in a care home, approximately 0.12% of around 14,500 data entries included unexpected values each month, between November 2021 and July 2022. After July 2022, further validations checks were added at the input stage to avoid this reporting error.

Other checks that are performed automatically within the RAP include:

checking denominators are equal or greater than numerators, for any rate calculations
differentiating zero values and missing values
checking weekly variations and flagging any substantial change which might be due to data quality issues
checking timeseries values match those from the previous publication, which is a way to ensure previous snapshots of data have not been altered manually

All production code is written in-house. Any changes made to the code or new code added is rigorously tested and peer reviewed before it is incorporated in the production process.

In addition, version control is assured through the use of Git and GitHub. This version control software is used to track changes in code files and to ensure thorough verification and validation is performed every time the code is edited. Changes to a piece of code are systematically reviewed by a different analyst who takes on the role of quality assurer.

Statistical commentary

Text changes in the bulletin are made by one person and are then checked and cleared by another person afterwards.

Question 6

Cost and burden

Accepted Answer

Occupancy, COVID-19 vaccination, visiting and staff absences

The burden associated with providing data through Capacity Tracker varies among questions and in line with provider resources.

Until April 2022, some of these questions were to be reported daily (COVID-19 vaccinations, PPE, staffing levels, staff absences) and some weekly (infection control). Between May 2021 and 31 March 2022, care providers were expected to provide data regularly to Capacity Tracker as a condition of receiving Infection Control and Testing Funding. See Adult Social Care Infection Control and Testing Fund: round 3 for more details. The funding ceased in April 2022, but providers were still expected to provide weekly data up until July 2022.

From April 2022 to July 2022, all questions were expected to be reported weekly, to reduce the burden on providers and a subset of questions on IPC were removed to reduce the burden further. Since 31 July 2022, instead of a voluntary weekly update, it has been mandatory for providers to update a subset of data on Capacity Tracker each month, which further reduces the burden on providers. See guidance and impact assessment on the adult social care information provisions under the Health and Care Act 2022 for more information. Providers are still encouraged to submit data more regularly where possible.

A high burden on providers to supply data might impact the quality of the data in terms of accuracy, coverage and consistency. Responses that have been submitted outside the mandation window or more than 7 days before the date reported in the monthly statistics publication are excluded as part of the analysis for these statistics.

To improve coverage, the relevance of questions is regularly reviewed in collaboration with care providers and stakeholders and questions which no longer provide value are adjusted or removed.

Question 7

Revisions

Accepted Answer

Any revisions to past publications will be in line with DHSC’s revision policy. Any unscheduled or substantial revisions that do not fit into the scheduled revisions criteria will be highlighted accordingly.

Occupancy, COVID-19 vaccination, visiting and staff absences

Some data may be collected after the initial publication period and therefore may need to be revised over time.

Question 8

Annex A: official statistics in development - digital social care records

Accepted Answer

This section relates to the estimated uptake of digital social care records (DSCRs), which is classified as ‘official statistics in development’.

How the data can be used

This data can be used for measuring trends in estimated uptake of DSCRs.

This data cannot be used for comparing use of DSCRs by geography or types of care setting.

Data sources and collection

Data on the estimated uptake of DSCRs is obtained from the provider information return (PIR). The PIR is managed by CQC. Each adult social care provider registered with CQC is required to complete their return annually. This captures any changes that have been made to services and will consider how adult social care providers are ensuring their services are safe, effective, caring, responsive and well led. From December 2021, adult social care providers were also asked to capture whether a DSCR is in use within their care setting. The guidance on provider information returns for adult social care services was last updated in January 2024.

Data coverage

Data refers to the estimated uptake of DSCRs by registered adult social care providers in England only.

Data is self-reported by adult social care providers. All adult social care providers that are registered with CQC are required to submit their returns annually for each location. This usually coincides with the anniversary of their registration. This means that data reported each month represents a snapshot in time from a sample of roughly a twelfth of the CQC registered adult social care provider market.

Excluding dormant providers, responses have been received from 89% of adult social care providers that are currently registered with CQC. The remainder of these non-responses are likely to account for adult social care providers that have been newly established in the last 12 months due to limitations around the timeliness of this data source.

Data quality

Relevance

These are quarterly statistics on the estimated uptake of DSCRs by adult social care providers registered with CQC in England.

Accuracy

Coverage is limited to adult social care providers that have provided data through the PIR. Information is self-reported and adult social care providers registered with CQC are required to provide an updated position annually. This means that data reported each month represents a snapshot in time from a sample of roughly a twelfth of the CQC registered adult social care provider market. To account for any variation in monthly samples, this statistic is presented as an average of the use of DSCRs over the preceding 3 months.

Reliability

The accompanying ‘Estimated uptake of digital social care record statistics’ data table for the monthly publication sets out the number of adult social care providers that have self-reported as having a DSCR as a proportion of the total number of returns provided each month. The data table also sets out the position as a quarterly average over the preceding 3 months. The data table captures information provided since December 2021 and has been quality assured by a professional analyst.

Statistical disclosure control methods

Data has been provided nationally. There is no risk that individual adult social care providers can be identified in the data table.

Timeliness and punctuality

These statistics are updated on a quarterly basis and data in each publication relates to data provided over the preceding 3-month period. Information provided on the estimated uptake of DSCRs is presented as a quarterly average of self-reported usage over the preceding 3-month period. This accounts for any variation in monthly samples.

Comparability and coherence

The PIR is self-reported and comparability over time can be assessed from the baselined position gathered in December 2021. Additional information is now also being provided through Capacity Tracker and this provides an additional source of comparability. The PIR remains the primary source of data on DSCR usage. However, additional information provided through Capacity Tracker could be made available in the future.

Quality assurance

Data is provided monthly by CQC one month in arrears. This data is processed by the NHS Transformation Directorate and then made available to DHSC to quality assure content prior to publication.

Cost and burden

The burden of data collections sits with adult social care providers. However, attention has been paid to minimising the burden on adult social care providers. For this reason, data is collected through the existing mechanisms of the PIR.

Question 9

Annex B: official statistics in development - client level data

Accepted Answer

This section relates to adult social care client level data (CLD), which is classified as ‘official statistics in development’.

Purpose

Statistics from the new CLD collection have been introduced into the ‘Adult social care in England, monthly statistics’ publication as official statistics in development. This data is from administrative sources, submitted by councils with adult social services responsibilities (CASSRs) - referred to as ‘local authorities’ in this document. This methodology and data quality statement aims to provide users of these published statistics with a detailed, evidence-based assessment of their quality. This statement will be updated as new CLD-derived statistics are introduced into the publication.

Publication approach and plans

In Care data matters: a roadmap for better adult social care data, we set out our approach to using CLD and our commitment to sharing new information with the public and with national and local government. In line with this commitment and following engagement with local authorities, DHSC has started publishing information from CLD in the March 2024 publication of ‘Adult social care in England, monthly statistics’.

Since this is a new data collection, we expect there to be initial data quality issues and other complexities. Our engagement with local authorities has made us aware of implementation challenges and of variation in how services are organised and recorded locally. In line with the government’s standard for administrative data, we will continue to work with local authorities to address consistency in interpretation and data quality.

DHSC is working also with the CLD reference group, the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS) to understand how local authorities differ. This work aims to produce insights into the common activities carried out by local authorities and develop methods that generate comparable figures for benchmarking purposes.

When developing statistics for publication, DHSC will assess the data against the core dimensions of data quality set out in the government’s data quality framework.

The first publication focuses on people receiving long-term support, defined as support that is intended to be provided on an ongoing basis and has been allocated following an assessment of need. The published metric is ‘the number of people receiving local authority commissioned long-term support at the end of each month from 30 April to 31 December 2023’. This is reported at regional and local authority level, by support setting and by broad age group. National figures are also broken down by ethnicity, gender and age group.

After discussions with LGA and the CLD reference group, we agreed that the data is now of sufficiently high quality for publication of this metric. Local authorities have been able to view their own summary data since November 2023 via the DHSC CLD dashboard, with over 80% of local authorities now accessing it to gain insight into their own data. The figures in the monthly statistics publication are also comparable with figures published from the Short and Long Term Support (SALT) activity collection (SALT LTS001b in Table 38 of the Activity and Finance report, available in the ‘Resources’ section of the Adult Social Care Activity and Finance Report, England, 2022 to 2023).

We plan to include further information in future publications describing new demand for social care support, the extent of care plan reviews and waiting times for care.

To find out more about how DHSC uses CLD, see:

Overview of data collection

The CLD collection is the first national collection of social care records, covering requests for support, assessments and reviews and services provided or commissioned by local authorities as part of their duties under the Care Act 2014.

The aim of the new CLD collection is to improve knowledge about the care and support provided or commissioned by local authorities for adults. From 1 April 2024, it will replace the existing SALT collection as the primary source of information about local authority adult social care. The transition from annual aggregate to quarterly client level returns will also enable more timely and flexible analysis of adult social care data, together with linked health data in the future.

The project was developed from a data linkage pilot in North West England from 2015 to 2017. This involved local authorities and clinical commissioning groups in partnership with NHS Arden and Greater East Midlands Commissioning Support Unit (AGEM CSU) and DHSC. The national voluntary collection was established in 2018. The data specification was developed by DHSC with a local authority reference group of analysts representing all regions.

In line with directions given by the Secretary of State for Health and Social Care, CLD became mandatory from 1 April 2023 and local authorities are required to submit records to NHS England on a quarterly basis. The collection is operated by NHS AGEM CSU, acting as a regional data processor for NHS England.

DHSC continues to work with partners in AGEM CSU and NHS England to deliver the project centrally, engaging with local authorities through the CLD reference group, LGA, ADASS and case management system suppliers.

Further details about the collection, including the data specification and guidance, can be found on the CLD information page for local authorities on the AGEM website.

Data coverage

Local authority submissions

All 153 local authorities in England made CLD quarter 3 submissions in January 2024, covering the 9-month period from 1 April to 31 December 2023.

The monthly statistics publication:

excludes data from the Isles of Scilly because their submission did not include information about services
uses data from Rochdale’s quarter 2 submission from October 2023, covering the 6-month period from 1 April to 30 September 2023. This is because of a technical error in their quarter 3 submission which resulted in incorrect data being included in their ‘service type’ field, which is used to identify long-term support

CLD submissions work on a cumulative basis up until April 2024 (and then on a rolling 12-month basis). This means that a complete quarter 4 submission in April 2024 covering the 12 months from 1 April 2023 to 31 March 2024 from these 2 local authorities will allow future publications to update the statistics, including backdating the monthly timeseries.

Coverage of activity within local areas

Through CLD, local authorities provide individual records of activity undertaken to support adults and their unpaid carers as part of their duties under the Care Act 2014. It includes most local authority activity under part 1 of the act to provide information, advice and support to adults (18 and older) and their unpaid carers, with the exception of safeguarding activity. It excludes:

self-funders who arrange their care independently. CLD is based on local authorities’ case management systems. Services provided to people who pay the full direct cost of the care they receive and do not request or take up any offer of support planning or care management (for example, regular reviews) offered by the local authority will not usually be recorded on these systems
children’s social care and activity covered by the Mental Capacity Act 2005 (and amendments to it) and the Mental Health Act 1983. Deprivation of Liberty Safeguards (DoLS) assessments and Mental Health Act assessments (assessing whether a person needs to be detained in hospital) are not included in CLD
housing and homelessness services provided under the relevant legislation (Housing Act 1996, Homelessness Act 2002, Homelessness Reduction Act 2017, Domestic Abuse Act 2021)
services that are fully health-funded and/or where there is no social care component. This includes arrangements put in place by the local authority on behalf of the NHS and/or where the costs are recharged to the NHS. End of life care that is funded by the NHS is not in scope of this collection but should be included when it is funded by the local authority

Local authorities have informed us of some gaps in coverage for specific areas of activity, where records are not held on their local case management systems and not easily retrievable from financial systems or external partners. For example, in some cases carer services are externally commissioned and local authorities may need to put in place data sharing arrangements to receive individual data, for inclusion in their CLD return. Similar issues can arise with jointly funded reablement services provided by external NHS partners. These gaps in carer and reablement services do not affect statistics included in the current publication describing long-term support.

For data presented in the current publication, people are included in these statistics where local authorities have identified them as actively receiving long-term support at the end of the month. There are some circumstances where local authorities may not hold individual records of people receiving long-term support - for example, where people receive long-term social care support from NHS partners under section 75 agreements (local authorities and NHS bodies pool budgets).

Six of the local authorities whose data is included in the monthly statistics publication have notably lower (lower than 80%) published figures for long-term support than in their 2022 to 2023 SALT return under LTS001b. These are:

the Wirral (11% of figure in SALT)
Rochdale (17%)
Warwickshire (56%)
Lewisham (75%)
Portsmouth (76%)
Hammersmith and Fulham (78%)

This comparison uses the publication figures for 30 April 2023 and SALT figures for 31 March 2023. This could be due to problems with the validity and consistency of submitted data as well as incomplete submissions. For further details, see the ‘Comparability and coherence’ section, below.

Some local authorities have informed DHSC of technical issues in CLD submissions that will have a minor impact on published statistics. We will work with these local authorities to correct issues ahead of the next publication of these statistics.

Statistics in the publication

Data processing applied to all statistics

Statistics from CLD have been included in the DHSC adult social care statistics publication from March 2024. There are several common data processing steps which are applied to the raw data to generate the data for the publication - these are:

extracting data from the latest file submitted by each local authority covering the latest mandatory reporting period, up to 7 days after the submission deadline date
excluding records which fall outside of the latest mandatory reporting period
excluding any service users under the age of 18
imputing event end dates when a person has died and their date of death has been provided
creating a unique person identifier to count the number of people (see the following paragraph)

The anonymised NHS number is used to determine the number of unique people in the data. If the NHS number has not been provided, then the local authority’s unique person identifier is used, unless the local authority person identifier is already present in another event record with an associated NHS number. If this is the case, the associated NHS number is used, to prevent double counting of people.

The number of people receiving local authority commissioned long-term support

The March 2024 publication includes information on people receiving long-term services at the end of each month. This is reported by local authority, by support setting and by age group, and the national figures are broken down by ethnicity, gender and age group.

To calculate these figures, there are several additional processing steps applied to data, following those outlined at the start of this section - these are:

excluding any service records where the ‘service type’ is not long-term support
excluding any records where the ‘client type’ is carer
cleaning several fields required for the published tables (‘service type’, ‘gender’ and ‘ethnicity’)
deriving age at the latest point in an event - either the age at the event end date or, if the event is open and ongoing, the age at the reporting period end date
grouping the derived ages into their respective age bands

Before counting the number of people receiving long-term support, an attempt is made to identify unique service event records based on a set of distinct fields. These include the ‘person identifier’ (as described in the start of this section), ‘local authority code’, ‘event start date’, ‘client type’, ‘service type’, ‘service component’, ‘delivery mechanism’, ‘unit cost’, ‘cost frequency (unit type)’ and ‘planned units per week’. If any of these fields differ, the record is treated as a unique event.

The number of people in long-term support in the monthly statistics publication is reported as a snapshot at the end of each month and broken down by service and person characteristics recorded in CLD. Individuals can be under each breakdown - for example, if a client supported in residential care receives additional services in the community at the end of the month, they will be counted under both settings. The totals count people only once - as a result, summing multiple rows will not align with the overall totals.

How the data can be used

CLD has been published as official statistics in development. As a new data collection, we expect there to data quality issues and other complexities, and these should be considered in any use of the published data. Future publications will update the statistics contained in the adult social care monthly statistics publication, and these may change as data quality improves.

Figures describe the number of people receiving long-term support in England. Variations by local authority, age group, gender and ethnicity partly reflect differences in size and characteristics of these groups in the population. They cannot be used directly to infer differences in rates of use of long-term care.

Particular caution is advised when using the data to compare local authority long-term service user numbers, with reference to those noted as having poor coverage or other data quality issues.

The data can be used to gain insights into national trends and user characteristics.

Several local authorities have notified us of data quality issues that they intend to correct in future submissions, so we expect data quality and coverage to improve over time for these local authorities.

Individuals can be included under multiple breakdowns - the totals only count people once. In addition, all counts are rounded to the nearest 5. For these reasons, the data should not be summed across individual rows, and the total rows should be used instead.

Data quality

This section measures the adult social care statistics against the dimensions of quality set out by the Government Statistical Service for statistical outputs. Any feedback on these statistics is welcome and can be sent to asc.statistics@dhsc.gov.uk.

Relevance

These statistics are published to provide an overview of local authority commissioned adult social care, providing transparency and insight. The publication aims to improve access to various data on adult social care by providing a comprehensive, easily accessible bulletin.

Accuracy and reliability

The accuracy and reliability of the data is dependent on the quality of data submitted by local authorities. CLD returns are drawn from local authorities’ case management systems and should reflect the activity and outcomes at the time of the event with minimal additional processing required. Differences in local case management IT systems, processes and procedures influence how data is recorded and reported for the CLD collection. Even where the returns are an accurate description of local activity, differences in the way that activity is organised and recorded by local authorities needs to be understood and considered when attempting any comparative analysis or benchmarking.

As a new collection of administrative data, there will also be some unquantifiable data quality issues that could affect the accuracy and reliability of the published statistics.

DHSC has worked with the CLD local authority reference group to develop the CLD specification and guidance. DHSC produced a principles statement for local authorities (available on the CLD section of the AGEM CSU website) emphasising that local authorities should be pragmatic in providing submissions that best match the specification and guidance, paying particular attention to ensure that where a defined list applies, the submission matches this wording identically. DHSC and AGEM CSU also provide tools to local authorities to assess and improve the quality of their data and ensure their data aligns with the specification. The emphasis is on correcting data quality issues at source, with quality assurance processes to support this.

Local authorities are asked to use the comments box when they submit their data, to indicate where information is not currently available and describe plans to include it in future returns. Local authorities can also contact DHSC directly if further clarification of the guidance is needed.

The statistic describing the number of people receiving long-term support shows a high level of agreement with figures collated by local authorities themselves and submitted in their 2022 to 2023 SALT return under LTS001b. This provides reassurance that this statistic is an accurate description of long-term service user numbers. More details of this comparison can be found under the section on comparability and coherence.

Statistical disclosure control methods

Statistical disclosure control methods are applied to the CLD statistics in the monthly statistics publication to protect individuals from being identified. Counts below 5 are suppressed, indicated by [c] in the data tables, and all counts are rounded to the nearest 5 to prevent low counts being deduced.

Timeliness and punctuality

CLD is a quarterly collection, and the submission schedule (available to view on the CLD section of the AGEM CSU website) mandates that data must be provided by the end of the month following the mandatory reporting period. CLD statistics in the monthly statistics publication are produced using the single latest submission from each local authority providing it covers the latest mandatory reporting period. The data cut is taken one week after the submission deadline. For example, data covering 1 April 2023 to 31 December 2023 must be submitted by the end of January 2024. This is then processed for the publication on 7 February 2024 and included in the March 2024 publication.

While the adult social care statistics publication is released monthly, updates to the statistics derived from CLD are planned quarterly. This data is published approximately 10 weeks after the end of each reporting period and approximately 5 weeks after each submission deadline.

From April 2024 onwards, submissions will cover a 12-month rolling reporting period. Local authorities can revise data in submissions within this 12-month reporting period, which may result in revisions to the statistics in this report.

Comparability and coherence

We compared statistics from CLD to similar statistics from the 2022 to 2023 SALT return. Through SALT, local authorities submit aggregated data each year describing support to adults and their unpaid carers. However, CLD makes a quarterly collection of individual social care records which are then centrally processed and aggregated. At the end of 2024, we will be able to directly compare statistics from CLD and SALT for 2023 to 2024 and further information on work being carried out by NHS England is available in Central transformation principles.

For the statistic contained in the monthly statistics publication - the number of people receiving local authority commissioned long-term support at the end of each month - we compared the earliest figure in the publication (30 April 2023) to the SALT figure under LTS001b for 31 March 2023, just one month earlier. LTS001b is a snapshot measure of the number of people supported by the local authority at the year-end where the support is long term. We expect that records submitted via CLD with the service type ‘long-term support’ will be the same services, since the list of service types was based on the long-term support categories in SALT.

The SALT and CLD derived figures are very close for the 151 local authorities whose data was compared, as figure 1 shows. Note that Hackney did not make a SALT return in 2022 to 2023, the Isles of Scilly is not included in the monthly statistics publication and Cumbria County Council was split to form Westmorland and Furness Council and Cumberland Council in April 2023.

Figure 1: comparison of number of long-term service users by local authority reported via CLD and SALT for 150 local authorities (151 from April 2023)

Figure 1 shows a close correlation between the published statistic at 30 April 2023 and the SALT figures under LTS001b at local authority level. There are 6 data points coloured red to indicate the published statistic is below 80% of the SALT comparator.

There are small differences in coverage and methodology that mean we do not expect the figures to match exactly. In the monthly statistics publication, individuals will be counted under multiple categories if they receive long-term support in multiple settings at the end of the month. These totals (rather than the data by setting) are comparable with LTS001b, whereby a person is counted in only one support setting based on a hierarchy.

Accessibility and clarity

These statistics are freely available on GOV.UK, with all documents published in an accessible format. The statistical reports and this data quality statement are published in HTML and accompanying data tables are published in OpenDocument Spreadsheet (ODS) format. Additionally, the commentary is written with the aim of being clear and impartial.

The section ‘How the data can be used’ is included to ensure users have sufficient information to use and interpret the data appropriately.

The CLD statistics are published as official statistics in development. As such DHSC will continue to engage with users and stakeholders to ensure the statistics develop in line with user needs.

Quality assurance

Overview

Working with NHS England and AGEM CSU, we provide accessible data quality reports to local authorities to help them improve the completeness and accuracy of their data as it relates to specific areas of analysis. We will continue to make clarifications to the guidance where needed to support consistent returns.

CLD is submitted quarterly by local authorities with adult social care responsibilities. To produce their returns, local authorities extract data from their case management and financial systems, and in some cases collect data from partners (where activity is outsourced and appropriate data sharing agreements are in place). Local authorities carry out processing to compile their return as a csv file, in line with the CLD specification. An Excel data validation tool is provided to enable local authorities to check that their data conforms to the formatting of the specification and outputs basic aggregations to support sense checking.

The collection is operated by AGEM CSU in their capacity as NHS England’s North West Data Services for Commissioners Regional Office (DSCRO). Local authorities upload their returns to the NHS England Data Landing Portal (DLP) and AGEM CSU ingests the data into a central NHS England database. Automated data validation checks are carried out to evaluate whether the data meets expected data types and defined list values and NHS number tracing is performed. AGEM CSU then provides data validation reports back to local authorities, including optional NHS number tracing results.

Due to the variation in the way that activity is organised and recorded across local authorities, the specification will not always fit with local terminology or recording. Guidance is provided to support local authorities mapping local definitions to the CLD specification. DHSC is committed to regularly reviewing and updating this guidance and continued co-development of the data specification with NHS England and the local authority CLD reference group.

DHSC analysts access CLD remotely via a secure repository hosted by AGEM CSU. Checks are carried out after each quarterly submission deadline to ensure that all local authorities have submitted a return covering the required reporting period and identifying any key data quality issues to be addressed.

Data validity

The table below provides a summary of the validity of the data presented in the publication. Data is evaluated as valid where it meets expected data types and defined list values, in line with the specification, or where it is provided blank and may be legitimately blank. For example, ‘event end date’ should be left blank for services that are open and ongoing. Note that any invalid blanks will be incorrectly evaluated as valid - for example, where an event has ended but the ‘event end date’ has been left blank. Also note that these figures show the validity of the fields contained in submitted records, and do not represent coverage of activity where records themselves are missing.

In the table below, the first column (‘All services data’) shows the validity of all 3 million rows of services data submitted in quarter 3 by the 152 local authorities with data included in the publication. The second column (‘Data included in statistics’) shows the validity of the 1.4 million rows of deduplicated services data included in the published statistics, where filtering has been applied to select long-term services only and to exclude carers and under 18s. Additional service data fields are used to improve the deduplication process but are not presented in the table below. Note that the published statistics count the number of people, not the number of services, using a combination of the anonymised NHS number and local person ID (as detailed above in the ‘Statistics in the publication’ section).

Table 3: percentage of rows with a valid data entry for 10 critical data fields

Data field	All services [3 million rows] (% with valid entry)	Data used to produce statistics [1.4 million rows] (% with valid entry)
Client type	97.86	98.75
Date of birth	98.65	99.98
Date of death	99.99	100.00
Ethnicity	99.52	99.57
Event end date	99.15	99.79
Event start date	99.57	100.00
Gender	100.00	100.00
Local authority person unique ID	100.00	100.00
NHS number	93.86	96.19
Service type	99.73	99.96

Note: due to the large volume of records, percentages may be 100.00% even if there are a small number of invalid entries.

Data processing

The data is processed every month, via a RAP. This RAP has been set up so that only limited manual intervention is necessary each month to produce updated outputs. This means that the risk of human error is minimised throughout the process.

All production code is written in-house. Any changes made to the code, or new code added, is rigorously tested and peer reviewed before it is incorporated in the production process.

In addition, version control is assured through the use of Git and GitHub. This version control software is used to track changes in code files and to ensure thorough verification and validation is performed every time the code is edited. Changes to a piece of code are systematically reviewed by a different analyst who takes on the role of quality assurer.

Statistical commentary

Text changes in the bulletin are made by one person and are then checked and cleared by another person afterwards.

Revisions

From April 2024 onwards, submissions will cover a 12-month rolling reporting period. Local authorities can revise data in submissions within this 12-month reporting period. The monthly statistics publication uses the latest submission covering the mandatory reporting period. Each quarter, the full timeseries will be updated with the latest data, which may result in revisions to the statistics in this report.

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Introduction

Statistics that are covered

Statistics that are no longer covered

Data sources and collection

Background on Capacity Tracker

Current Capacity Tracker requirements

Occupancy data

COVID-19 and flu vaccination data

Accommodating COVID-19 safe visiting in care homes

Staff absences due to COVID-19-related reasons

Data coverage

Capacity Tracker data

Occupancy in care homes

COVID-19 and flu vaccination

Visiting in care homes and staff absences due to COVID-19-related reasons

How the data can be used

Occupancy in care homes

COVID-19 and flu vaccination in adult social care settings

COVID-19 vaccinations

Flu vaccination in adult social care settings

Accommodating COVID-19 safe visitation in care homes

Visiting guidance and data trends

Adult social care workforce

Staff absence rates

Data quality

Relevance

Accuracy

Occupancy, visiting in care homes and staff absence due to COVID-19

COVID-19 and flu vaccination

Reliability

Statistical disclosure control methods

Occupancy, COVID-19 and flu vaccination, visiting in care homes and workforce absence

Timeliness and punctuality

Occupancy, COVID-19 and flu vaccination, visiting in care homes and workforce absence

Comparability and coherence

COVID-19 vaccination

Workforce statistics

Accessibility and clarity

Quality assurance

Data imputation and collection

Data downloads

Data processing

Statistical commentary

Cost and burden

Occupancy, COVID-19 vaccination, visiting and staff absences

Revisions

Occupancy, COVID-19 vaccination, visiting and staff absences

Annex A: official statistics in development - digital social care records

How the data can be used

Data sources and collection

Data coverage

Data quality

Relevance

Accuracy

Reliability

Statistical disclosure control methods

Timeliness and punctuality

Comparability and coherence

Quality assurance

Cost and burden

Annex B: official statistics in development - client level data

Purpose

Publication approach and plans

Overview of data collection

Data coverage

Local authority submissions

Coverage of activity within local areas

Statistics in the publication

Data processing applied to all statistics

The number of people receiving local authority commissioned long-term support

How the data can be used

Data quality

Relevance

Accuracy and reliability

Statistical disclosure control methods

Timeliness and punctuality

Comparability and coherence

Accessibility and clarity