Does implementing strengths-based approaches improve adult social care outcomes in England? An econometric analysis of the Care Act 2014

BACKGROUND: Population ageing and strained healthcare budgets are making adult social care a pressing global challenge. In England, the Care Act 2014 reformed provision of social care by encouraging strengths-based approaches—which emphasize individual and community assets over deficits (i.e., weaknesses, limitations, needs, or problems). Subsequent commissioning and integration initiatives diversified practice, yet quantitative evidence on outcomes remains scarce. OBJECTIVE: To estimate the effect of the 2014 Care Acton adult social care outcomes across local authorities in England. METHODS: Partial proportional odds regression models were estimated on repeated cross-section survey data from 2010 to 2019 on a large representative sample of adult social care outcome recipients in England (n = 1659,564). Six dependent variables capturing service effectiveness and recipients’ experience with social care services, and several controls including age, sex, subjective health status, and region fixed effects, were considered. RESULTS: Estimates indicated that the reform led to improvements in recipients’ perceived quality of life, safety, and control over daily activities. Other dimensions, particularly satisfaction with the care and support services received, also improved but to a lesser degree and showing lagged effects. Distributional effects were observed, where the positive mean changes in service effectiveness and recipients' experience were mostly driven by improvements at the lower end of the outcome spectrum. CONCLUSIONS: Reforms incorporating strengths-based approaches can improve recipients’ reported outcomes and therefore alleviate the significant human and economic burden of adult social care. Future research should expand on this study and ultimately improve decision-making and outcomes for care recipients and providers.