This month, a National Audit Office report suggested that the implementation of the Better Care Fund – a policy pooling health and social care budgets at a local level – has so far failed to ease pressures on NHS hospitals arising from a lack of adult social care. Such pressures are only likely to grow in future, with the population aged 85 and over expected to increase by 84% between 2010 and 2030. If we are to plan and fund social care services adequately in the future, understanding the scale of future pressures on health and social care providers will be key.
This is an area that I’ve been working on, and I recently co-authored a new report from the Institute of Fiscal Studies (IFS) examining the current levels of domestic social care, and how demand might develop in the future. (The work was funded by the Health Foundation as part of their Efficiency Research Programme.) The extent to which demographic pressures translate into additional need will depend on how the health – and the need for assistance – among the older population changes. After all, an 85 year old in 2010 was very different to an 85 year old twenty years before, and may well need less help. Understanding how these needs are changing is therefore a key part of planning for future demand.
Our report suggests that men are reporting fewer difficulties over time: men born between 1925-34 are almost 5 percentage points less likely to report having a difficulty with everyday activities at a given age than men born between 1915-24. This difference is even bigger for men born later between 1935-44. This might provide some hope for policy makers that the need for care will increase more slowly than population growth suggests.
Another factor that may reduce the future need for state-funded care is the increasing availability of informal care. Thanks to an increase in life expectancy, people are now far more likely to be in a couple at an older age than they were in the past. This is particularly true for women, since the rise in male life expectancy has been greater, resulting in a smaller proportion of widows at all ages. Given that the majority of care is provided informally, and much of it by spouses, it’s not surprising that women born later receive more care from a spouse than those born earlier do at the same age.
What does this mean then for the future of social care provision? Well, on a per-person basis, the government may need to fund less care than in the past. But this will do little to counteract the sheer growth in the number of older people, and the corresponding increase in the demand for formal social care. Even if you take into account a reduction in how much care is needed on a per-person basis, estimates suggest that the amount of formal care for men aged 86-95 will be more than 40% higher in 2020 than in 2010, while for women it will increase by almost 30%. Further growth in the population means that these pressures will be even more acute by 2030: 123% higher for men and 54% higher for women.
So, what is the top line message for policy makers in all this? To me, it suggests that they should not be relying on reductions in future needs to offset additional costs of providing care in the future. Instead, they should take active steps now in order to plan how they should best fund and provide social care going forward.
Of course, this is likely to matter not only for the cost of providing social care, but also the cost of providing wider NHS services. As highlighted by the recent NAO report, a key part of future policy will be a focus on better integrating health and social care. Understanding the extent to which the availability (or lack) of social care services impacts the NHS is therefore critical, and made all the more pertinent when considering that funding for adult social care has been cut since 2010.
As part of another piece of research, we’ll be exploring the spillovers between NHS and social care in more detail, examining how geographical variation in reductions to social care spending over the past five years have related to changes in the use of NHS hospital services. (This is also funded through the Efficiency Research Programme). Quantifying the extent of these effects will help us to understand where money could be best spent in order to improve the efficiency of an integrated health and social care system for the UK in the future.
George Stoye is a Senior Research Economist at the Institute for Fiscal Studies.