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The Progressive Policy Think Tank

Home care postcode lottery: 80,000 care home residents could be receiving social care in their own homes

  • New IPPR and CF analysis uncovers unequal access to care at home, meaning many are going without preferable and cheaper care 
  • Fewer people would need to sell homes to pay for care if government makes big push to level up home care capacity across England 
  • Government reform needs to go beyond funding and explain how social care can enable people to live flourishing lives, including through £5bn investment in community care capacity, think tank argues 

New analysis by the Institute for Public Policy Research (IPPR) and CF – the consulting and data science company - has uncovered a postcode lottery in home-based social care services throughout England.  

The proportion of care provided at home varies considerably across different councils - from as low as 46 per cent in Barnsley to as high as 84 per cent in Hammersmith and Fulham.  

Where medically possible, home care is preferable to care in residential care homes or hospitals. Research has shown people strongly prefer care in their home - and that home care increases independence, enabling people to lead more fulfilling lives. Where there is a lack of home care options, patients are more likely to end up occupying hospital beds without clinical justification. In some cases, this can lead to ‘non-beneficial treatments’, which impact quality of life. Alternatively, they may be forced into residential or nursing homes earlier than necessary. 

Failing to deliver equal access to home care constitutes a missed opportunity to maximise independence and quality of life, according to IPPR.  

The IPPR and CF analysis shows that if every local authority provided home care equal to better-performing similar councils, 80,000 more people over 65 in England could be receiving care at home. Levelling up home care across the country would also save English local authorities £1.1 billion per year from their social care budgets, with new analysis showing community care is around one third of the cost of more institutional residential and nursing home options. 

No matter the social care funding solution the prime minister decides on, the risk of people having to sell their home to pay for care will be significantly reduced by providing more care in people’s homes, according to the report. IPPR’s preferred funding plan - free personal care funded by general taxation – alongside a levelled-up home care system would prevent an estimated 80,000 people from facing the catastrophic care costs that force people to sell their homes. 

The report explains that while some of this local variation in home care access can be explained by differing demographics, much of it cannot be reasonably explained. The unequal provision of home care in unfair and must be addressed, according to the think tank.  

The report says that the drivers of this inequality is unfair distribution of budget cuts, local workforce shortages, cuts to local government commissioning expertise, and a lack of community care infrastructure in some parts of the country. 

Community-first social care 

IPPR calls for a guaranteed right to care at home where clinically appropriate. Receiving care in the most suitable setting shouldn’t depend on where you happen to live in the country, according to the researchers. 

To enable all who want it to access home care, the authors argue that the UK government should implement a bold new 'community-first’ model of social care. This will help ensure that social care reform looks beyond the funding issue to the question of how to empower more people to live flourishing lives while receiving care.  

IPPR proposes: 

  • Building capacity – Mirroring moves being made by the Biden administration, the UK needs to make a £5 billion upfront investment in boosting home care infrastructure, including rapid response teams, 24-hour support lines, home care packages and new technology to support patients and carers.
  • Supercharging the workforce - Delivering high quality outcomes relies on well-paid, motivated and well-trained social care staff with time to care. The government should introduce minimum pay standards, a new social care royal college to coordinate sectoral bargaining, and provide more training and progression opportunities. 
  • Increasing commissioning firepower - The government should increase local commissioning capacity and expertise, by bringing more skilled staff into local authorities and introducing rigorous training in outcome-based social care commissioning. 

The paper suggests these reforms will be most effective if combined with free personal care – which is the fairest, most popular and most practical funding reform option. There is growing cross-party support for free personal care from politicians ranging from Jacob Rees-Mogg MP to Manchester mayor Andy Burnham, and organisations including Policy Exchange and the House of Lords’ Economic Affairs Committee. 

Chris Thomas, IPPR senior research fellow, said: 

“The government needs to think through not only how social care is funded, but also how care is delivered to ensure people can lead flourishing lives, regardless of arbitrary factors like where they live.  

“Anchoring care in places people call home is an important way to achieve that. Everyone should have the opportunity to receive care at home, if clinically appropriate, from the first moment they need support. The care options available to you shouldn’t depend on where you happen to reside.  

“We urge ministers to deliver a funded and ambitious programme to enable care in the places people call home. A community first model of social care can save money, improve care quality, and align social care support with what people who use care want.” 

ENDS 

Chris Thomas, the report’s author, is available for interview  

A case study is also available on request

CONTACT 

David Wastell, Head of News and Communications: 07921 403651 [email protected]  

Robin Harvey, Digital and Media Officer: 07779 204798 [email protected]  

NOTES TO EDITORS 

  1. The IPPR paper, Community First Social Care by Chris Thomas, is published at 0001 on Sunday August 22. It will be available for download at: http://www.ippr.org/research/publications/community-first-social-care
     
  2. Full local authority breakdown of the proportion of care provided at home is available on request.
     
  3. IPPR has proposed free personal care as a preferred funding reform option for adult social care. https://www.ippr.org/research/publications/social-care-free-at-the-point-of-need
     
  4. The UK has a higher proportion of people in care homes and hospital settings than other, comparable countries (Figure 2).  

Figure 2: Location of death, selected European countries against UK 

Home 

Hospital 

Care home 

European average 

33% 

44% 

18% 

UK  

23% 

47% 

28% 

Difference 

-10% 

3% 

10% 

 6. CF analysis shows that community care is around one third of the price of residential and nursing options – both per episode of care and per day of care delivered. 

Figure 5: Care in community settings is about a third of the cost of  residential or nursing home  

  

Residential 

Nursing 

Community 

Average length of stay (Weeks) 

140.1 

108.9 

84.1 

Total Cost (per episode) 

£92,354 

£92,202 

£24,755 

Total cost (per day) 

£94.14 

£121.00 

£42.06 

 7. The postcode lottery in community social care provision was calculated by grouping local authorities together, based on population demographics and using ONS official classifications. Analysts then explored what improvements would be possible if every local authority provided a proportion of social care in the community equal to the top quartile of similar local authorities. This indicated 80,000 more people receiving community social care – at a saving of £1.1 billion.  

8. A further £1.6 billion in savings is attributed to reduction in hospital days used by patients who could be better cared for in their homes. This figure was ascertained by extrapolating a weighted average of hospital bed days that could be saved by increasing access to home care (9.6 per cent), from a review of 7 publications, and applying that to the country as a whole. Bed days were costed using standard unit costs. 

9. One in three people in residential care experience lifetime catastrophic costs. Free personal care would reduce that to 1 in 5 people. The estimate of up to 16,000 people avoiding catastrophic costs is derived from applying this figure to the finding that reducing avoidable variation in community social care provision will reduce the residential care home population by an estimated 80,000 people. This relies on an assumption that the shift to greater community care provision will not change the proportion of people in residential settings experiencing catastrophic costs. The figure also assumes free personal care will eliminate catastrophic costs for those receiving domiciliary care in their home. 

10. 143,000 people are thought to experience catastrophic care costs in England, meaning a 16,000 reduction is over 10 per cent. That means a combination of free personal care and greater community care would see a 50 per cent fall in people selling their home, if implemented in tandem.  

11. CF is a bespoke healthcare management consultancy and analytics company dedicated to improving health and care. 

12. IPPR is the UK’s pre-eminent progressive think tank. With more than 40 staff in offices in London, Manchester, Newcastle and Edinburgh, IPPR is Britain’s only national think tank with a truly national presence. www.ippr.org