Official Statistics

Adult social care monthly statistics, England: September 2023

Published 7 September 2023

Applies to England

Feedback

We’d like feedback from our users about how you use our products, how well these products meet your needs and how they could be improved.

For feedback and any further questions, contact asc.statistics@dhsc.gov.uk.

Main points

COVID-19 vaccination in social care settings

As of week ending 20 August 2023, the proportions who had received their COVID-19 full primary course vaccination were:

• 91.3% of total residents and 87.4% of total staff of older adult care homes
• 86.5% of total residents and 83.6% of total staff of younger adult care homes
• 81.5% of total domiciliary care staff

Please note that the questions around COVID-19 vaccination are non-mandatory from 15 July 2023 until the seasonal booster campaign begins. Because of this, figures may not be directly comparable with those from earlier publications.

Visiting in care homes

In the week ending 14 August 2023, 99.1% of care homes in England were able to accommodate residents receiving visitors. This figure has been stable since September 2022.

Staff absences due to COVID-19

In the week ending 14 August 2023, 0.2% of care home staff and 0.3% of domiciliary care staff were absent due to COVID-19 related reasons.

This proportion stayed the same for care home staff but increased for domiciliary care staff in the last month, compared to the week ending 14 July 2023 when 0.2% of domiciliary care staff were absent due to COVID-19 related reasons.

Introduction

This is a monthly publication by the Department of Health and Social Care (DHSC) of official statistics on adult social care in England. This statistical bulletin provides an overview on a range of information on social care settings, with a focus on the impact of COVID-19.

This report provides information on:

• uptake of full primary course of COVID-19 vaccinations in adult social care settings at national, regional and local authority level
• visiting in care homes at national, regional and local authority level
• staff absence rates due to COVID-19 in care home and domiciliary care at national, regional and local authority level

Data used in this publication is taken from Capacity Tracker. Capacity Tracker is a web-based digital insight tool 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. Since spring 2020 the tool has also been used by DHSC to gather COVID-19 related data to help monitor the sector’s response to the pandemic.

For more information on data sources, on the data previously published as part of this report and on other published sources of adult social care data, see the background quality and methodology note.

Publication updates

Updates on this report

From 15 July 2023, questions on COVID-19 vaccinations in social care settings are no longer part of the mandatory data collection until the seasonal booster campaign begins. The full timeseries is published in this report, with a break in the data tables to illustrate when these questions became non-mandatory.

Updates on future reports

The next publication will be released on 5 October 2023. Dates for future publications will be pre-announced on the GOV.UK publication release calendar.

Workforce

The monthly statistics on adult social care in England currently include some workforce data from Capacity Tracker, reported as the denominators for the staff vaccination rate and absence rate tables. This series is unweighted and can be affected by changes in provider response rates. It is therefore not suitable for inferring trends.

We have developed a new methodology for determining workforce growth based on Capacity Tracker:

• we calculate a monthly growth measure based on the proportional increase in headcount over the month in providers that were registered with the Care Quality Commission (CQC) and had a valid response in Capacity Tracker in 2 consecutive months
• we calculate the cumulative product of growth between months to estimate a growth time series for the workforce, indexed based on the size of the workforce at a benchmark date
• the data is cleaned to remove outliers. We only include providers who have given at least one non-zero response to Capacity Tracker by the start of the month, and that are CQC-registered

In the last publication, we said that we intended to include a new workforce series and asked for your feedback. This has been delayed and we intend to publish this series in a future release. This new series will use Capacity Tracker data to track trends in the rate of change in the size of the workforce within the year. It will rely on annual estimates of the absolute size of the workforce as of March each year from Skills for Care as baseline.

This workforce growth series would be complementary to Skills for Care’s workforce publications. The series should be viewed as experimental and estimates may be revised in future publications.

Introducing the new workforce series will ensure that we are transparent about the data that the government is collecting and that the publication reflects current priorities for the sector and is valuable to users.

We would welcome any feedback on this proposed change to the publication - please contact us at asc.statistics@dhsc.gov.uk.

COVID-19 vaccination in adult social care settings

How the data can be used

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 of the COVID-19 vaccine
• monitoring vaccination rates over time for the full primary course of the COVID-19 vaccine
• 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 the background quality and methodology note

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 the background quality and methodology note

The total number of staff and residents for each social care setting as well as the number reported to be vaccinated for COVID-19 are self-reported by the care provider and local authorities. As a result, the rates in this 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 on which vaccinations were reported by care providers rather than the dates on 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. This window will open at the start of the 8th day of each month and run 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 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 which 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 vaccination statistics, September 2023: data tables’ on the Adult social care in England, monthly statistics: September 2023 page.

From 15 July 2023, questions on COVID-19 vaccinations in social care settings became non-mandatory and will remain so until the seasonal booster campaign begins. The full timeseries is published in this report, with a break in the accompanying data tables to illustrate when these questions became non-mandatory.

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.

For more information, see the background quality and methodology note.

In the accompanying COVID-19 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 will 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 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 latest COVID-19 booster vaccination campaign, for autumn 2022, 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 (see Tracking autumn boosters for care home residents using operational data) to track the number of COVID-19 boosters administered to residents of all adult care homes in England during the 2022 autumn winter campaign. 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 this 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 are now being published by NHS England using a new methodology. The latest publication of this campaign, ‘Spring boosters for older adult care home residents to 22 May 2023’ can be found on the NHS COVID-19 vaccinations page. The figure for the total number of residents in this publication is measured up to 23:59 on 22 May and therefore differs from the figure for the week ending 21 May.

Please note that the questions around COVID-19 vaccination are non-mandatory from 15 July 2023 until the seasonal booster campaign begins. Because of this, figures may not be directly comparable with those from earlier publications.

COVID-19 vaccinations in older adult care homes

For full response rates, see the accompanying ‘COVID-19 vaccination response rates, September 2023: data tables’ on the Adult social care in England, monthly statistics: September 2023 page.

Residents of older adult care homes

As of week ending 20 August 2023, in older adult care homes 91.3% of residents have been reported to have received a full primary course.

Staff of older adult care homes

As of week ending 20 August 2023, in older adult care homes 87.4% of staff have been reported to have received a full primary course.

COVID-19 vaccinations in younger adult care homes and domiciliary care settings

The following proportions of social care staff and residents have been reported to have received their COVID-19 vaccination doses.

Residents of younger adult care homes

For younger adult care home residents, as of week ending 20 August 2023, 86.5% of residents have been reported to have received the full primary course.

Staff of younger adult care homes

For younger adult care home staff, as of week ending 20 August 2023, 83.6% of staff have been reported to have received a full primary course.

Domiciliary care staff

For domiciliary care staff, as of week ending 20 August 2023, 81.5% of staff have been reported to have received a full primary course.

As data is self-reported by care providers, COVID-19 vaccination rates are affected by response rates. Questions around COVID-19 vaccination are non-mandatory from 15 July 2023 until the seasonal booster campaign begins. Because of this, figures may not be directly comparable with those from earlier publications.

For full response rates, see the accompanying ‘COVID-19 vaccination response rates, September 2023: data tables’ on the Adult social care in England, monthly statistics: September 2023 page.

Accommodating COVID-safe visitation in care homes

How the data can be used

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 which providers are mandated to submit on a monthly basis. For more information, see the background quality and methodology note.

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 1 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 7 September 2023.

More information on the current visiting guidance can be found in the COVID-19 supplement, which accompanies the infection prevention and control in adult social care settings.

In the week ending 14 August 2023:

• 99.1% of care homes in England were able to accommodate visits in or out of the care home for residents in all circumstances during the last month. This is the same as in July 2023. This proportion has broadly increased since the end of January 2022, but has shown little variation since September 2022
• a further 0.4% were able to accommodate visits in exceptional circumstances. This is the same as in July 2023. This figure has broadly declined since April 2022 with the exception of a slight increase between September and October 2022 and another slight increase between February and March 2023. Exceptional circumstances are individually defined by each care home but are generally thought to be considered when residents are palliative

Regional variation has steadily decreased over the past year as more and more providers are able to accommodate visitation across all regions.

Figure 1: percentage of care homes accommodating or limiting visits for residents, England, 4 January 2022 to 14 August 2023

The proportion of care homes accommodating visiting for residents has broadly increased since mid January 2022 with the exception of slight decreases in early January 2022, early April 2022 and early July 2022. This number has stabilised since September 2022.

Source: Capacity Tracker

Note: the dotted lines in this chart represent the implementation of the changes in care home visiting guidance or changes to the visiting question in Capacity Tracker:

• A: from 31 January 2022, no limits on the number of named visitors, with testing and guidance to support safe visiting in place
• B: from 4 April 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)
• C: from 4 July 2022, the visiting questions in Capacity Tracker changed so care homes were asked whether residents had been allowed visits in or out of the care home in the last month, instead of in the last 7 days
• D: from 31 July 2022, providers are mandated to submit data on visiting on a monthly basis. From August 2022 onwards the data points in this graph are monthly instead of weekly

This data can be found in table 1 of the accompanying ‘Visiting and workforce statistics, September 2023: data tables’ on the Adult social care in England, monthly statistics: September 2023 page, in addition to data by region and local authority.

Adult social care workforce

Staff absence rates

How the data can be used

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 this 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 background quality and methodology note.

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 which 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.

In care homes

Data on care home staff absences related to COVID-19 is available from 9 February 2021.

Absence rates in care homes stayed the same over the last month. In the week ending 14 August 2023, 0.2% of care home staff were absent due to COVID-19 related reasons.

Care home staff absence related to COVID-19 reached a peak of 2.9% in the week ending 11 January 2022 and has remained below 1.0% since August 2022.

In the week ending 14 August 2023, there was some regional variation, with COVID-19 related staff absence rates ranging between 0.1% and 0.3% across all regions. Since the week ending 14 July 2023, absence rates fell or remained the same in all regions, with the exception of the West Midlands and Yorkshire and the Humber, where absence rates increased from 0.1% to 0.2% and 0.2% to 0.3% respectively.

Data on absences and response rates can be found in tables 2 and 5, respectively, of the accompanying ‘Visiting and workforce statistics, September 2023: data tables’ on the Adult social care in England, monthly statistics: September 2023 page.

In domiciliary care

Data on domiciliary care staff COVID-19 related absences is available from 2 March 2021. Absence rates in domiciliary care settings are not directly comparable with those in residential care homes.

In the week ending 14 August 2023, 0.3% of domiciliary care staff were absent because of COVID-19 related reasons. This figure has increased since the week ending 14 July 2023, when 0.2% of domiciliary care staff were absent because of COVID-19 reasons.

In the week ending 14 August 2023, there was some regional variation, with regions reporting absence rates between 0.2% and 0.4%. Over the last month, absence rates increased in all regions with the exception of the East of England and the North West, where absence rates stayed the same at 0.2% and 0.4% respectively.

Data on absences and response rates can be found in tables 3 and 6 of the accompanying ‘Visiting and workforce statistics September 2023: data tables’ on the Adult social care in England, monthly statistics: September 2023 page.

Figure 2: percentage of staff absent due to COVID-19 related reasons, England, 4 January 2022 to 14 August 2023

Since the peak of 2.9% in January 2022, there have been 2 further spikes in care home staff absence rates, in late March 2022 and mid July 2022. For domiciliary care absence, following a peak of 4.8% in January 2022, there have been a further 3 spikes, in late March 2022, mid July 2022 and mid October 2022. From November 2022 to April 2023, absence rates due to COVID-19 related reasons remained broadly stable in both care homes and domiciliary care settings and decreased between April and June 2023. Absence rates have remained the same over the last month among care home staff, but have increased among domiciliary care staff.

Source: Capacity Tracker

Notes:

• the proportion of staff absent due to COVID-19-related reasons is not comparable across care settings
• the dotted line in these charts represents the move to monthly reporting after the start of the mandatory data provision implemented on 31 July 2022. From August 2022 onwards the data points in these graphs are monthly instead of weekly

This data can be found in tables 2 and 3 of the accompanying ‘Visiting and workforce statistics, September 2023: data tables’ on the Adult social care in England, monthly statistics: September 2023 page, in addition to data by region and local authority.

Terminology

Care home

Facilities providing residential care. The data in this bulletin refers to Care Quality Commission (CQC)-registered care homes.

Older adult care homes

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. A small number of residents within care homes serving older people may be aged under 65.

Younger adult care homes

Care homes not 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.

Domiciliary care

Services providing personal care for people living in their own homes. The data in this bulletin refers to domiciliary staff employed by independent CQC-registered providers.

Staff

Unless specified, staff can refer to staff directly employed by a provider and/or through an agency.

About this data

These statistics are being published as a part of a wider landscape of statistics on adult social care. The Government Statistical Service (GSS) compiles a UK adult social care database of official statistics on adult social care across the 4 nations of the UK. This is updated on a monthly basis.

The UK Statistics Authority (UKSA) conducted a review of adult social care statistics in England which called for:

• better leadership and collaboration across different organisations publishing official statistics. This publication has been produced in collaboration with other statistics providers of COVID-19 adult social care data and DHSC will endeavour to work with various stakeholders as more data is published through this publication

• addressing of gaps in available data, particularly in privately funded care. This bulletin aims to plug some of that gap by including data on residents privately funding their care in addition to those funded by local authorities

• improving existing official statistics. These statistics are badged as official statistics and more data will be added iteratively based on user needs

Data sources

Data on visiting in care homes, staff absence and vaccinations is taken from self-reported data submitted by care providers in England through a data collection and insight tool called Capacity Tracker. From 31 July 2022, this data is part of the subset of data which providers are mandated to submit on a monthly basis.

More detailed information about data sources can be found in the background quality and methodology note. This document also includes detailed information on:

• data coverage
• data quality
• relevance
• accuracy and reliability
• timeliness and punctuality
• comparability and coherence
• accessibility and clarity
• cost and burden

Revisions

Any revisions to past publications will be in line with DHSC’s revision policy and highlighted in future publications accordingly.