This research was led by Barshana Goswami as part of her PhD Fellowship. For more information about Barshana, please check our PhD Fellowships pages

 

What were we trying to do?

The aim of this research was to understand how the use, determinants (factors that influence) and entry requirements of community-based formal social care have changed over time for older adults, especially in the context of austerity measures in England. The aim was to understand if and how factors affecting formal care receipt in general, and state-commissioned care in particular, had progressed, and if entering the system had become more restrictive over time. We wanted to deliver a clear picture of care pathways at a time when social care systems faced intense strain due to harsh cuts, growing demand and evolving family structures, and to offer evidence-based recommendations for policymakers and providers.

 

 

Why was this important?

Since care in England is means-tested, understanding whether and how wealth and socio-demographics could influence who receives this care was vital in ensuring fair access and addressing equity concerns. There were gaps in up-to-date scientific research examining such trends and how these related to the existing social care policy in the country. 

 

From a policy standpoint, this research provided evidence to evaluate whether legislation and ways of funding aligned with the evolving needs of an ageing population with complex health and care needs. Local authorities needed to anticipate where and how demand for formal care would grow - the findings from this study on need, affordability and socio-demographic variations could inform this and help refine long-term planning and organisation in the sector.  
 

 

How did we do it?

The research answered three main questions:

 

 

1. The first aim was to look at predictors of who can access formal care using the most recent available data (2018-19) from the English Longitudinal Study of Ageing (ELSA). We also looked at publicly-funded care to see if and how the predictors had changed. 
2. We used the findings from the first study to see how the relationships between identified predictors and formal social care, including state-commissioned care, had changed over time using a repeated cross-sections approach: essentially answering the question by looking at what used to be an important determinant in the past and what is become increasingly important now. 
3. In the final stage, the research built on previous findings to look at how specific factors affect people receiving care for the first time. We looked at the social care modules of ELSA to identify different patterns that individuals could be classified into, such as: a. when someone started care for the first time, did they have their needs not met in previous years? b. did they continue or discontinue using care? c. did people have needs but never receive the care? This approach helped us answer crucial questions - for example, had the “bar” or threshold for accessing care risen, remained stable or lowered? And, what could that tell us about the responsiveness and effectiveness of the care system to growing demand? 
    

 

Findings

Findings will be available in due course.
 

 

Who we worked with:

• Northern Care Alliance Group
• Salford Royal NHS Foundation Trust 

 

More information
 

Senior Programme Lead
Mike Spence
michael.spence@manchester.ac.uk