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Changes in the Patterns of Social Care Provision in England: 2005/6 to 2012/13

In recent years, public concern has increased about the potential impact of reductions in public spending on the social care system and on its capacity to support older people and adults with mental and physical disabilities in England. In addition, the close interdependence between social care and NHS provision has raised questions about the impact of the significant cuts in local authority expenditure on patient flows and outcomes, notwithstanding the commitment to provide real growth in health resources.

In previous papers, we have explored the nature of the criteria used for determining social care eligibility in England, differences in their implementation at the local level and recent changes in minimum eligibility thresholds (Fernandez, Snell, Forder, & Wittenberg, 2013; Fernandez & Snell, 2012). The aim of the present paper is to quantify the changes in levels of social care service provision that have taken place in recent years, focusing on two indicators: the number of adults receiving local authority brokered social care support and the levels of net local authority adult social care expenditure.

When comparing trends in social care activity through time, it is important to take into account possible changes in the underlying need for services. The ageing of the population, for instance, has been generally predicted to increase the level of need for social care services amongst older people. In such cases, constant levels of service provision through time would imply a reduction in the level of support per person or unit of need". Analysing whether service levels increase or decrease through time in the sense of changes in the likelihood that individuals with a given level of care needs have of receiving local authority brokered support and in the intensity of the support they receive requires us therefore to "control for" possible changes through time in need-related factors. In this report, we deal with this issue by presenting two sets of estimates. First, we present the ‘raw’ data on local authority provision as collected and aggregated annually by the Health and Social Care Information Centre. In addition, we have used multivariate regression methods in order to produce a set of standardised estimates of social care provision. This second set of estimates enables us to take into account socio demographic changes which potentially impact on the level and pattern of need. Throughout the report, we refer to these data as the ‘standardised’ estimates of levels of provision.

Overall, the findings suggest that in the recent past significant reductions in raw and standardised levels of service provision have taken place across all user groups with the exception (albeit very limited) of provision for people with a learning disability. The extent of these reductions in service provision varies significantly across local authorities, but appears to be concentrated on social care clients living in the community, typically those with the lowest levels of need. These reductions are particularly significant when consideration is taken of inflation and of increases in the levels of need linked to, amongst other things, demographic patterns.