Following widespread austerity measures introduced in 2009/10, public funding for adult social care has fallen substantially. In particular, funding for social care for people aged 65 and older has been particularly hard hit, falling by 21% between 2009/10 and 2015/16. While some additional money in recent years has reversed some of these cuts, these funding decisions are likely to have had a number of consequences for users of social care, their carers and for other related public services. But what do we really know about their impact?
How do social care funding cuts affect the NHS?
One potential impact of the cuts that has started to receive increasing attention is their knock-on effects on the NHS. There is growing evidence that a lack of good quality social care increases the use of NHS services. For example, a recent Improvement Analytics Unit report found that an enhanced care package for care home residents reduced emergency hospital admissions by 23%.
I recently co-authored a working paper, funded by the Health Foundation as part of their Efficiency Research Programme, that examines how recent cuts to local authority funding for social care have impacted A&E departments. We found that cuts to funding for social care for people aged 65 and older has directly led to increased use of A&E services.
Our findings indicate that cuts to social care funding have made it more likely for older people to visit A&E at least once in a year. In 2009/10, around 23 in every 100 people aged 65 and older visited A&E at least once. We found that in 2015/16, an additional four people in every 100 aged 65 and older visited A&E at least once, as a direct consequence of these funding cuts. This means that a larger share of the older population is attending hospital because of the reductions in the quality or quantity of social care that they receive.
A&E departments are therefore now dealing with a much larger volume of older patients. This is tough both for hospitals – whose current struggles to meet their waiting times targets have been widely publicised – and for patients who could have avoided a hospital visit if they had received other care in a timely fashion.
These results suggest that at least some NHS services are linked to social care. Our paper focused on the spillovers between social care and the use of only one particular hospital service. However, it’s very likely that interactions between social care and health care extend to other parts of the NHS. And the size of these spillovers could be even greater elsewhere. The number of ‘delayed discharges’ (where patients are medically ready to be discharged from hospital but are prevented from doing so due to a lack of appropriate post-hospital care availability) attributed to social care has rocketed in recent years. Primary care – the first point of call for many patients - is also likely to bear much of the burden of funding cuts.
What are the wider consequences of social care funding cuts?
Of course, the possible impact of cuts to public funding for social care are not only limited to effects on the NHS. Reduced funding is likely to have much wider consequences for (potential) users of social care and their families. Losing or receiving worse quality care could have negative effects on the quality of life of (potential) users of social care. And (potential) informal carers – who actually provide the vast majority of social care for the older population in England – may experience a greater physical, mental and financial burden. Understanding these consequences, and in particular how people have sought to find alternative care, are essential in thinking about how we should provide and pay for social care.
So what stops us understanding this? Unfortunately, a major problem is a lack of data. Good data on the quantity and type of care received by older people are rarely available to policymakers and researchers. Indeed, due to changes in the way the data are collected and reported, it is impossible to know with certainty even how the number of people receiving public social care across the country has changed in the last few years, let alone who is receiving this care or what it includes. If policymakers are serious about understanding the issues involved with social care then this needs to change, and the sooner the better.
George Stoye (@TheIFS) is a Senior Research Economist at the Institute for Fiscal Studies