The relationship between social care resources and healthcare utilisation by older people in England: an exploratory investigation

Since 2010, spending on adult social care has fallen substantially at a time when demand has been rising. Reductions in local authority (council) budgets also have had an impact on people’s use of healthcare services in the English NHS. Older people, including those with dementia, are a group who are likely to have been affected. 

We linked data on spending, staffing and use of health care for 150 councils. We then tested the impact of changes in spending on older people, and changes in social care staff numbers, on five outcomes. 

1. Emergency hospital admissions for falls in people with dementia aged 65 and over.
2. Emergency hospital admissions for fractured neck of femur in people 65 and over.
3. Cases where people with dementia stayed in hospital 7 days or longer.
4. Cases where people with dementia stayed in hospital 21 days or longer.
5. Cases of NHS Continuing Health Care.

We used standard statistical methods to investigate impacts, but also tried some special statistical techniques – known as ‘instrumental variables’. These techniques are designed to reflect the fact that social care spending decisions may be based on long-standing problems in the local NHS. For example, councils may choose to spend more on social care if lots of local people with dementia stay in hospital for over a week. 

The study found no conclusive proof that reductions in social care budgets have led to the expected rises in hospital admissions, hospital stays or uptake of NHS Continuing Health Care. However, we found some evidence that councils who employ more front-line social care staff, particularly professional staff, may be more successful in helping their clients to access NHS Continuing Health Care. We also identified two factors that seemed to be linked to fewer long hospital stays: higher social care staffing by the independent sector; and more unpaid carers providing intensive care (35 hours a week or more). To test whether these findings are right, future research should use more detailed data on how much health and social care each individual uses. 

Full Report: CHE Research Paper 174

Other papers in the CHE Research paper series can be found at: CHE Research Papers