Abstract
Since 2010, adult social care spending in England has fallen significantly in real terms whilst demand has risen. Reductions in social care supply may also have impacted demand for NHS services, particularly for those whose care is provided at the interface of the health and care systems. We analyzed a panel dataset of 150 local authorities (councils) to test potential impacts on hospital utilization by people aged 65 and over: emergency admission rates for falls and hip fractures ("front-door" measures); and extended stays of 7 days or longer; and 21 days or longer ("back-door" measures). Changes in social care supply were assessed in two ways: gross current expenditure (per capita 65 and over) adjusted by local labor costs and social care workforce (per capita 18 and over). We ran negative binomial models, controlling for deprivation, ethnicity, age, unpaid care, council class, and year effects. To account for potential endogeneity, we ran instrumental variable regressions and dynamic panel models. Sensitivity analysis explored potential effects of funding for integrated care (the Better Care Fund). There was no consistent evidence that councils with higher per capita spend or higher social care staffing rates had lower hospital admission rates or shorter hospital stays.
Highlights
In England, social care is funded from a combination of central government grants, local taxation, transfers from the NHS and user charges
Our analyses mainly focus on a group of patients—older people with dementia—whose care pathway involves the provision of both health and social care services and in principle, could be affected by reductions in social care spending
The aim of this study was to test whether recent changes in the supply of social care in England have had spillover effects on the use of healthcare
Summary
In England, social care is funded from a combination of central government grants, local taxation, transfers from the NHS and user charges. Notes: BCF: Better Care Fund; BME: black and minority ethnic; CA: Carers Allowance; CCG: Clinical Commissioning Group; CFAS II: Cognitive Function and Aging Study II; DLA, Disability Living Allowance; FNF: Fractured Neck of Femur; GMS: General and Personal Medical Services dataset; HES: Hospital Episode Statistics; IMD: Index of Multiple Deprivation; IV, instrumental variable; NMDS‐SC: National Minimum Data Set for Social Care; ONS: Office for National Statistics; PHOF, Public Health Outcomes Framework; PIP: Personal Independence Payment; WTE: whole time equivalent. There is often more than one reason for extended stays, the availability of adequate social care support is a major factor, especially for older people (Oliver, 2019) Both measures of extended stay include emergency and elective admissions for patients aged 65þ who were coded as having a diagnosis of dementia (Kasteridis et al, 2015). We tested two alternative measures of falls; and tested the robustness of our findings for the count data models using fixed effects Poisson models instead of random effects negative binomial models (RENB)
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