1. Unmet need for social care Tania Burchardt, Polina Obolenskaya and Polly Vizard London School of Economics Social Policy Association annual conference, 15 th July 2014

2. The puzzle Why do surveys of adult social care users in England show high levels of satisfaction with services, despite: ― significant spending cuts ― revelations about poor quality care

3. The pieces User survey results Trends in social care expenditure – relative to demand Trends in social care activity Unmet need: evidence from FRS  Solving the puzzle

4. Table 1: Summary of ASCOF outcome measure values: by measure and year, England Units2010-11 2011-12 2012-132013-14p 1ASocial care-related quality of life 1 / 2418.718.7 ▲ 18.8 ▲ 19.0 1BProportion of people who use services who have control over their daily life 1 %75.075.176.1 ▲ 76.7 1CiProportion of people using social care who receive self-directed support%29.243.056.262.1 1CiiProportion of people using social care who receive direct payments%11.713.716.819.1 1DCarer-reported quality of life 2 / 12.. 8.1.. 1EProportion of adults with learning disabilities in paid employment 3 %6.67.17.06.8 1FProportion of adults in contact with secondary mental health services in paid employment 4 %9.58.98.87.1 1GProportion of adults with learning disabilities who live in their own home or with their family 3 %59.070.073.574.8 1H Proportion of adults in contact with secondary mental health services who live independently, with or without support 4 %66.854.658.560.9 1I(1) Proportion of people who use services who reported that they have as much social contact as they would like %41.942.343.244.2 1I(2)Proportion of carers who reported that they have as much social contact as they would like%.. 41.3.. 2Ai Permanent admissions to residential and nursing care homes for younger adults, per 100,000 population 5,6 15.0 19.1 (14.0) 15.014.4 2Aii Permanent admissions to residential and nursing care homes for older adults, per 100,000 population 5,6 686.6 695.9 (694.2) 697.2668.4 2Bi Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services (effectiveness of the service) 7 %82.082.781.481.9 2Bii Proportion of older people (65 and over) who were offered reablement services following discharge from hospital 7 %3.03.2 3.3 2CiDelayed transfers of care from hospital per 100,000 population 6 10.69.79.49.7 2Cii Delayed transfers of care from hospital, and those which are attributable to adult social care per 100,000 population 6 4.13.73.23.1 3AOverall satisfaction of people who use services with their care and support 1 %62.162.864.1 ▲ 64.9 3BOverall satisfaction of carers with social services 2 %.. 42.7.. 3C Proportion of carers who report that they have been included or consulted in discussion about the person they care for 2 %.. 72.9.. 3DProportion of people who use services and carers who find it easy to find information about services 1,8 ASCS component only%74.273.874.174.7 Carers’ Survey component only%.. 68.7.. Total%74.273.871.4.. 4AProportion of people who use services who feel safe 1 %62.463.8 ▲ 65.1 ▲ 66.0 4B Proportion of people who use services who say that those services have made them feel safe and secure 1 %..75.578.1 ▲ 79.2

5. PSSRU: expenditure peaked in 2010/11 and has fallen by 6.2% Net current expenditure including spending funded by other sources £m 20012/13 prices (England)

6. PSSRU: standardised expenditure peaked in 2009/10 and has fallen by 11.9% Net current expenditure including spending funded by other sources £m 20012/13 prices (England)

7. Number of clients peaked in 2008/9 and has fallen by 29%... Number of clients receiving community based services, residential or nursing care provided or commissioned by CASSR, on 31 March each year

8. ...accompanied by intensification Average hours per client (per year) 2006-07 308 2007-08 326 2008-09 344 2009-10 2010-11 369 2011-12 364 2012-13 387 Average hours of home care provided per client per year Distribution of clients by planned contact hours of home care per week

9. Unmet need: what do we know Forder and Fernandez (2010) microsimulation model predicting levels of unmet need under various scenarios Vlachantoni et al (2011) use GHS 2001/2 and ELSA 2008 to estimate unmet need among age 65+ – 39% to 61% of those needing help with bathing, dressing and/or getting in/out bed receive no help in 2001/2 – 32% to 62% of those needing help with bathing and/or dressing receive no help in 2008 Whalley (2012) use HSfE 2012 for age 65+ – 22% of men and 30% of women who needed help with at least one ‘activity of daily living’ received none – 14% of men and 15% of women who needed help with at least one ‘instrumental activity of daily living’ received none Life Opportunities Survey... watch this space!

10. Family Resources Survey For 2002/03, 2009/10 and 2011/12 Age 16 plus, household population, UK 8000 plus in each year with ‘substantial difficulties’ Need = has a longstanding illness or disability and experiences substantial difficulties in one or more areas of life as a result of health problems or disability Formal care = local authority home help or home care worker; private domestic help; district nurse, health visitor or other kind of nurse; other outside helpers Informal care = household members; relatives; friends or neighbours Unmet need = in need but has no formal or informal care

18. The ‘solution’ to the puzzle Why do surveys of adult social care users in England show high levels of satisfaction with services, despite significant spending cuts and revelations about poor quality care? Cuts have been implemented by withdrawing services from people with low/mid intensity need, especially older people Downwards trend in provision of informal care has been stemmed for some groups but not all, eg over-75s These would-be users and have-been-users are not included in user surveys Users themselves may be afraid of losing services and grateful to be receiving any form of support? Older people especially likely to have ‘conditioned expectations’?

19. The puzzle may be solved but multiple problems remain  care quality  abuse  lack of entitlement to services  increasing demand  decreasing availability of informal care