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Unmet social care needs in England: a scoping study for evaluating support models for older people with low and moderate needs
- Authors:
- FERNANDEZ Jose-Luis, et al
- Publisher:
- London School of Economics and Political Science, Care Policy and Evaluation Centre
- Publication year:
- 2020
- Pagination:
- 105
- Place of publication:
- London
- Edition:
- 6
The aim of this scoping study was to consider how to design a possible “main study” that would evaluate the consequences on outcomes for older people with social care needs, their carers and the wider care system of recent changes in the support offered by councils, focusing on older people at the edges of current eligibility criteria (referred to in the report as older people with low/moderate needs). The analysis has found that it would not be possible to base the main study on data from existing national surveys or on administrative data records, because of data shortfalls. This scoping study has focussed therefore on the methodology for conducting a survey of older people and their carers, collecting data prospectively. We have explored the potential for examining the impact of recent changes in social care support by exploiting the local variability in the type and intensity of support provided. As a result, the objective of this report became how to evaluate the consequences on costs and outcomes of different models for supporting older people with low/moderate needs in England. Expected outcomes from the main study include: a detailed picture of the characteristics of people with low/moderate care needs approaching their local council for support and their carers; a detailed understanding of the nature of different care models for supporting individuals with low/moderate social care needs; a comparative analysis of the costs and outcomes of alternative care models; an analysis of differences in the cost-effectiveness of specific services for different individuals with low/moderate care needs; an analysis of the likely effects of recent changes in social care provision; evidence to support the development of recommendations about the most cost-effective strategy for supporting older people with low/moderate care needs. (Edited publisher abstract)
Supporting carers following the implementation of the Care Act 2014: eligibility, support and prevention. The Carers in Adult Social Care (CASC) study
- Authors:
- FERNANDEZ Jose-Luis, et al
- Publisher:
- London School of Economics and Political Science
- Publication year:
- 2020
- Pagination:
- 40
- Place of publication:
- London
The primary aims of this study were to understand local authority processes and approaches for assessing and meeting the care needs of carers in England, and to examine the extent to which they changed following the implementation of the Care Act 2014; and to evaluate the support provided to carers post-Care Act 2014. The study adopted a mixed-methods approach, combining quantitative and qualitative analyses and individual and area-level data to carry-out the research activities summarised in this report. The evaluation suggests that the impact of the 2014 Care Act on carers in England could be described as a combination of conceptual achievements and practical challenges. The improved clarity about the roles and responsibilities of the state towards carers was notable and widely welcomed by social care stakeholders. However, the impact of strengthened carer rights appears to have been limited by the requirement for local authorities to keep within budget, and as a result these rights have not led to greater access to support for carers. (Edited publisher abstract)
Exploring the use of micro data for estimating a relative needs formula for older people’s additional assessments following the introduction of a universal cap on social care expenditure
- Authors:
- FERNANDEZ Jose-Luis, SNELL Tom
- Publisher:
- University of Kent. Personal Social Services Research Unit
- Publication year:
- 2018
- Pagination:
- 32
- Place of publication:
- Canterbury
The cap on social care costs described in the Care Act 2014 will mean that all individuals with lifetime social care needs exceeding £72,000 will become eligible for state-supported care. It is expected that as a result the number of individuals requiring a needs-assessment by local authorities will increase significantly. Relative needs formulae (RNFs) are used to determine the allocation of central government funding for social care. This report summarises the methods used for developing an RNF that measures the additional assessments for people aged 65 needed across local authorities in England following the introduction of a care cap. The study used individual-level data to divide local authority populations into groups with different needs and income/wealth characteristics. It estimates the numbers of individuals with social care needs in the community and in residential care separately and then aggregates the two figures into an estimate of total local social care need. (Edited publisher abstract)
Estimating local relative expenditure needs of changes in social care means-testing arrangements: a microsimulation approach
- Authors:
- FERNANDEZ Jose-Luis, SNELL Tom
- Publishers:
- University of Kent. Personal Social Services Research Unit, London School of Economics. Personal Social Services Research Unit
- Publication year:
- 2018
- Pagination:
- 28
- Place of publication:
- Canterbury
In the English social care system, adults with eligible social care needs undergo a means-test to determine the relative contributions of the individual and their local authority to care costs according to the national minimum eligibility criteria set out in the Care Act 2014. This report summarises the methodology and results of a formula for estimating relative spending needs across English local authorities associated with proposed changes in the social care means-testing arrangements. The methods follow a microsimulation-based approach, and focus exclusively on the impact of changes in means-testing arrangements on older people. According to the proposed rules modelled in this analysis, the upper capital threshold would be raised from £23,250 to £27,000 for individuals in the community or for individuals in a care home whose property is disregarded. For individuals in care homes without a property or whose property was taken into account when calculating assessable income, the upper capital limit would increase to £118,000. The lower limit (disregarded assets) would increase from £14,250 to £17,000. (Edited publisher abstract)
Using a 'wellbeing' cost-effectiveness approach to improve resource allocation in social care
- Authors:
- FORDER Julien, FERNANDEZ Jose-Luis
- Publisher:
- Quality and Outcomes of Person-centred Care Policy Research Unit
- Publication year:
- 2015
- Pagination:
- 22
- Place of publication:
- Canterbury
The main aim of this paper is to contrast a needs-led social care resource allocation system with one using a maximising wellbeing approach; that is, one based on: measuring the wellbeing consequences of using services and applying the principles of cost-effectiveness and opportunity cost. The promotion of wellbeing is the newly-stated guiding principle for the long-term care (social care) system in England. It signals a shift away from a focus on care need ‘deficits’ approach. Such a change in perspective has the potential to substantially alter how public care systems operate. The practical challenges are significant, both in the interpretation of wellbeing goals and in determining how the care system might be configured to achieve them. The paper describes how a maximising wellbeing approach might be applied in the case of long-term care. It argues that in theory a maximising wellbeing approach with full information will produce greater total wellbeing improvement for the same budget than a needs-based system. In practice, the comparison will depend on: (a) whether it is possible to actually measure wellbeing in a way that is consistent with the policy goals; (b) the availability of cost-effectiveness information; and (c) the decision rules used to implement a maximising wellbeing approach. (Edited publisher abstract)
Implications of setting eligibility criteria for adult social care services in England at the moderate needs level
- Authors:
- FERNANDEZ Jose-Luis, et al
- Publisher:
- London School of Economics. Personal Social Services Research Unit
- Publication year:
- 2013
- Pagination:
- 38
- Place of publication:
- London
The introduction of Fair Access to Care Services (FACS) guidelines in 2003 provided local authorities with a common framework against which to assess needs and set local eligibly thresholds for the provision of supported care. Since their introduction, many authorities have tightened eligibility thresholds such that only those with critical or substantial levels of need are entitled to receive publicly-funded care across much of the country. Using national statistics and data from a PSSRU national survey of local authorities in England, this report describes estimates of the likely impact at present and up to 2020 on client numbers and expenditure of introducing a national eligibility threshold at the ‘moderate’ FACS level. According to a central set of assumptions, it is estimated that overall client numbers would increase at the 2010 baseline by 23 per cent nationally (26 per cent among older people, 28 per cent among younger adults with physical disabilities, 11 per cent among younger adults with learning disabilities and 17 per cent among younger adults with mental health needs). Gross expenditure corresponding to these figures is estimated to increase by approximately 17 per cent for older people, 19 per cent for adults with physical disabilities, 9 per cent for adults with learning disabilities and 13 per cent for adults with mental health needs. (Publisher abstract)
Survey of fair access to care services (FACS) assessment criteria among local authorities in England: final report
- Authors:
- FERNANDEZ Jose-Luis, SNELL Tom
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2012
- Pagination:
- 72p.
- Place of publication:
- London
Fair Access to Care Services (FACS) guidelines were introduced by the Government in 2003 as a means of providing local authorities with a common framework for determining individuals’ eligibility for social care services. The Personal Social Services Research Unit (PSSRU) were asked by the Department of Health to conduct a survey of local authorities in England to understand the way in which local authorities in England assess eligibility for services in terms of the processes used for assessing and classifying need for services, the relationship between combinations of need-characteristics and FACS groups and the targeting of resources across need groups. In particular, the survey aimed to shed light on the following questions: the targeting of resources across FACS need groups; the processes used for assessing, classifying and storing information on need for services; and the relationship between combinations of need-characteristics and FACS groups. Two thirds of those surveyed (67%) have set their eligibility policy to cover clients in the top two FACS groups (critical and substantial) only. Nearly all of the remainder (32% of all participating authorities) provide services to clients with critical, substantial and moderate needs.
What works abroad?: evaluating the funding if long-term care: international perspectives: report commissioned by BUPA Care Services
- Authors:
- FORDER Julien, FERNANDEZ Jose-Luis
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2011
- Pagination:
- 46p., bibliog.
- Place of publication:
- Canterbury
This paper explores the most appropriate way to reform the funding system in England, learning from the international experience, and in particular from the recent reforms in Germany, Japan, France and Australia. The experience of these countries is relevant because their starting point for reform was similar to the current situation in England. In its first section, the paper argues that achieving efficiency, equity and sustainability should constitute the main objectives of any reforms. It then provides an overview of the funding systems in the four countries examined. Germany, Japan and France have all implemented state-run social insurance arrangements for long-term care. Under these long-term care insurance arrangements all people covered by the system are required to pay regular contributions either as taxes or mandatory insurance premiums. In return, should the insured person develop a care need they become entitled to support from the system – either as services or cash allowances – regardless of their income. The Australian system is characterised, by a means-tested, tax-funded long-term care programme which targets help on poorer people. These are non-universal systems because wealthier people are not covered by the public system and generally have to make their own arrangements for any care cost.
Ageing societies: challenges and opportunities: evidence from the BUPA health pulse 2010 international healthcare survey
- Authors:
- FERNANDEZ Jose-Luis, FORDER Julien
- Publisher:
- Bupa
- Publication year:
- 2010
- Pagination:
- 27p., bibliog.
- Place of publication:
- London
This report presents the findings of the Bupa Health Pulse 2010 international healthcare survey around the theme of 'ageing societies'. It summarises some of the most important evidence about the ageing process across the world, and discusses some of the key policy challenges that ageing presents, looking particularly at the capacity for societies to provide high quality support for their older people in the future. The study surveyed 12,262 people across 12 countries (Australia, Brazil, China, France, Germany, India, Italy, Mexico, Russia, Spain, UK, USA), but the patterns described are common to a much larger number of countries. The report is structured around 3 parts. The first examines the question of the ageing process in different societies and what it means in terms of: increases in the older population; changes in the balance between young and old; and increases in the number of people with health problems and in the level of demand for care services. The second part examines the support system required to look after older people in need of care including: the sharing of caring and funding responsibilities between the state and private individuals; the need to ensure that resources are in place to look after the growing number of older people; and the levels of support provided to older people in need. The last section summarises the key policy implications.
Impact of changes in length of stay on the demand for residential care services in England: estimates from a dynamic microsimulation model
- Authors:
- FERNANDEZ Jose-Luis, FORDER Julien
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2011
- Pagination:
- 13p.
- Place of publication:
- Canterbury
Residential care services constitute the largest component (approximately 60%) of social care expenditure in England. Understanding the level of demand for residential care services in the future, and the associated costs, is paramount to planning for an efficient and equitable social care system. This paper explores the impact of changes in the length of time that individuals spend in residential care once admitted, in order to gauge the impact of likely improvements in the survival of residents in the future. This analysis uses a dynamic microsimulation model to estimates future changes in demand and levels of use of residential care services in England. The central assumptions of the model include a constant age and gender specific prevalence of disability, gains in life expectancy, and real-terms increases in unit costs. Care home unit costs are assumed to start at £550 per week on average and grow by 1.5% until 2016/7 and by 2% thereafter. The implications of length of stay and costs are made in terms of their impact on the projected level of funding required to support future numbers of older people with care needs. The analysis highlights how relatively modest changes in survival in residential care will lead a higher levels of demand and expenditure. It also shows the significant impact of changes in the growth of the weekly person costs of care home services.