PROJECT NIHR206126.05
Geographic variation in access to social care
BACKGROUND
Social care policy in England is aimed at prevention and living well in the community, receiving care support locally or in an individual’s home, with greater health and social care integration. Unlike health care, social care is not free at the point of use, and publicly-funded support is based on wealth and level of needs. Nonetheless, local authorities and government have a responsibility to ensure that diverse provider capacity is available, including for self-payers, and at the best possible quality.
The availability of social care varies within regions across England. This variation is due to various economic factors that influence local markets such as: demand, workforce, local market competition, health care provision, local policy decisions, etc. It is therefore likely that the demand for health care varies not only according to local population need but also because of access to local social care. Whilst there is some recent analysis of care home availability, home care and the interrelationship between health care utilisation and social care, there is generally little known about social care availability at local levels (e.g. urban/rural locations), how social care availability varies with NHS provision, and whether the availability of social care differs according to socio-economic and personal characteristics (e.g. deprivation, ethnicity).
AIMS
The primary objective is to assess whether there are disparities in the availability of social care in England. The project will aim to:
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Assess whether there are differences in potential access to care (by quality level) based on (a) socio-economic and personal characteristics (e.g. deprivation, ethnicity, etc.) and (b) institutional and policy factors, such as local capacity and expenditure/funding of NHS/health services (e.g. including measures set out as part of the Better Care Fund (BCF), and Integrated Care System (ICS) development).
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Analyse how far quality and viability of social care providers are influenced by the socio-economic and demographic characteristics of local populations.
METHODS
The project would build on previous analyses of market dynamics in care home and home care markets. We will utilise and extend existing time series datasets we have developed which use Care Quality Commission (CQC) data for both care homes and home care. We will link to this data with local area information on socio-economic (e.g. deprivation, benefit uptake) and personal characteristics (ethnicity, religion, age).
We will spatially analyse the availability of social care at small-area level utilising available data on care homes and home care provision. We will assess changes over time, between areas differing by socio-economic and personal characteristics (i.e. high/low deprivation, ethnicity, religion), and considering care quality (CQC quality ratings) differences.
Using the local area supply and provider-level data, we will quantitatively analyse whether local contextual factors such as deprivation and ethnicity/religion of the population influence supply, quality ratings and likelihood of closure of social care providers, when controlling for other drivers of supply (e.g. competition, supply, demand and need factors).
Building on Covid-19 responsive work in ASCRU and previous research in this area, we will use spatial analysis to assess how social care varies with NHS provision and policy factors locally.