ruth thorlby & holly holder: social care for older people
TRANSCRIPT
© Nuffield Trust and Health Foundation © Nuffield Trust
23 October 2013
Focus on access to social care for older people
Ruth Thorlby and Holly Holder,
Nuffield Trust
© Nuffield Trust and Health Foundation
Background
Central Government allocations to English local authorities reduced by 14% in real terms between 2011/12 and 2014/15.
In 2013, a further reduction of 10% was announced between 2014/15 and 2015/16.
The reductions come at a time when demand for publicly funded social care had already been rising faster than funding for several years.
There is concern that reductions in the volume or quality of publicly funded social care will lead to unmet need and pressure on health services.
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Research questions
How have local authorities have responded to reductions in their income?
Can we track trends annually?
Is it possible to say anything how changes in spending and activity have affected older adults’ health and wellbeing?
© Nuffield Trust and Health Foundation
Method
Background literature review
Exploration of survey data from:
• Social care service users
• Directors of Adult Social Care Services
• Established national surveys e.g. ELSA, HSE
Descriptive analysis of data published annually by NASCIS
2009/10 taken as a baseline year
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Percentage change in total net current spending (real terms) by local authority between 2009-10 and 2012-13
-60%
-40%
-20%
0%
20%
40%
60%
Perc
en
tag
e c
han
ge i
n n
et
cu
rren
t sp
en
din
g (
real
term
s),
2009/1
0-2
012/1
3
Local authority
Local authority
Average
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Trends in other sources of LA income for older adults
0
500
1000
1500
2000
2500
2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
Real
term
s i
nco
me b
y s
ou
rce (
£000s)
Financial year
Client Contributions
Joint Arrangements
NHS
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Change in real terms net current spending nationally by service area since 2005/6, older people
0
500
1000
1500
2000
2500
3000
2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
Net
cu
rren
t sp
en
din
g (
real
term
s)
by a
cti
vit
y (
£000s)
Financial year
Assessment and care management
Nursing care placements
Residential care placements
Supported and other accommodation
Home and day care
Direct Payments
Equipment and adaptations
Meals
Other services to older people
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Changes in service user numbers for community-based, residential care and nursing care services since 2009/10
60
65
70
75
80
85
90
95
100
105
2009/10 2010/11 2011/12 2012/13
Ch
an
eg
rela
tiv
e t
o in
dex y
ear
(2009/1
0 =
100)
Financial Year
Community Based Services
Residential Care
Nursing Care
© Nuffield Trust and Health Foundation
Changes in user numbers for different forms of community based care since 2009/10
0
20
40
60
80
100
120
2009/10 2010/11 2011/12 2012/13
Ch
an
ge r
ela
tiv
e t
o in
dex y
ear
(2009/1
0 =
100)
Financial Year
Home Care
Day Care
Meals
Equipment & Adaptations
© Nuffield Trust and Health Foundation
How have local authorities responded to the reductions in their income?
Annual Survey of Directors of Adult Social Services (ADASS) 2013/14
• 82% of savings from ‘efficiencies’
• 13% of savings from service reduction
• 5% of savings from increased income
Eligibility for publicly funded help:
• 87% of LAs now only give help to those with ‘substantial’ or ‘critical’ levels of need (2013/14) compared with 63% in 2005/6
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Change in the number of service users in receipt of high, intermediate and low-intensity social care support since 2009-10 for all adults
50
60
70
80
90
100
110
2009/10 2010/11 2011/12 2012/13
Ch
an
ge r
ela
tiv
e t
o in
dex y
ear
(2009/1
0 =
100)
Financial Year
Less than or equal to 2 hours Number ofService Users
More than 2 hours and less than or equal to5 hours Number of Service Users
More than 5 hours and less than or equal to10 hours Number of Service Users
More than 10 hours inc overnight/live in/24hour Number of Service Users
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Has quality suffered?
ADASS 2013/14 Survey
• 87% of respondents do not agree that quality of life for services users has suffered as a result of savings
• 93% do not think quality of care has suffered
• 28% believe that savings have increased pressure on the NHS
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Where do we go from here?
Three groups we need to watch:
• Social care users facing reduced services/higher contributions
• People who are no longer eligible for state funded help
• People who were never eligible for state funded help
• .. And their carers!
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23 October 2013
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