ruth thorlby & holly holder: social care for older people

© 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.


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?


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


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


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


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


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


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


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


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


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


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

www.qualitywatch.org.uk

ruth thorlby & holly holder: social care for older people

Health & Medicine