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PROJECTIONS OF FUTURE EXPENDITURE ON LONG-TERM CARE FOR OLDER PEOPLE IN ENGLAND

This study examines the sustainability of long-term care expenditure in England and the balance between public and private funding. It projects the numbers of disabled older people, volumes of care services, expenditure, and social care workforce.

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PROJECTIONS OF FUTURE EXPENDITURE ON LONG-TERM CARE FOR OLDER PEOPLE IN ENGLAND

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  1. PROJECTIONS OF FUTURE EXPENDITURE ON LONG-TERM CARE FOR OLDER PEOPLE IN ENGLAND Raphael Wittenberg, Adelina Comas-Herrera, Derek King, Linda Pickard and Juliette Malley

  2. AIMS OF THE STUDY PSSRU study, funded by the Department of Health, on two related issues: • Whether expenditure on long-term care will remain sustainable in the face of demographic and other pressures; • What should be the balance between public and private expenditure on long-term care. G:\SRC\OUTPUTS\BSG2000.PPT

  3. MIXED ECONOMY OF SUPPLY • INFORMAL UNPAID CARERS • PUBLIC SECTOR • PRIVATE FOR-PROFIT SECTOR • VOLUNTARY SECTOR G:\SRC\OUTPUTS\BSG2000.PPT

  4. MIXED ECONOMY OF FINANCE • HEALTH SERVICES – NATIONAL HEALTH SERVICE - TAXATION • SOCIAL SERVICES – CENTRAL AND LOCAL TAXATION AND USER CHARGES • DISABILITY BENEFITS - SOCIAL SECURITY SYSTEM - TAXATION G:\SRC\OUTPUTS\BSG2000.PPT

  5. ROYAL COMMISSION • COMMISSION RECOMMENDED FREE NURSING AND PERSONAL CARE • ENGLAND IMPLEMENTED FREE NURSING CARE ONLY • SCOTLAND IMPLEMENTED FREE NURSING AND PERSONAL CARE • WALES IMPLEMENTING FREE NURSING CARE AND HOME CARE G:\SRC\OUTPUTS\BSG2000.PPT

  6. AIMS OF THE MODEL The PSSRU model aims to make projections of: • Numbers of disabled older people • Volumes of long-term care services • Long-term care expenditure: public and private • Social care workforce G:\SRC\OUTPUTS\BSG2000.PPT

  7. MODEL STRUCTURE: FIVE MODULES • Numbers of older people by age, gender, functional disability, household type/informal care and housing tenure • Residential and non-residential services • Health and social services long-term care expenditure • Expenditure by source of finance • Social care workforce G:\SRC\OUTPUTS\BSG2000.PPT

  8. NUMBERS OF DEPENDENT OLDER PEOPLE • Age (five bands) and gender • Disability (six groups- IADLs and ADLs) • Household type (five categories) • Housing tenure (two categories) • Informal care (by spouse, children, others) G:\SRC\OUTPUTS\BSG2000.PPT

  9. Disabled Older People by Disability, England, 2002 G:\SRC\OUTPUTS\BSG2000.PPT

  10. Disabled Older People by Source of Informal Care, 2002 G:\SRC\OUTPUTS\BSG2000.PPT

  11. SERVICES AND BENEFITS • Residential care – in residential homes, nursing homes and hospitals • Home care, day care, meals • Day hospital, community nursing, chiropody • Assessment and care management • Disability benefits G:\SRC\OUTPUTS\BSG2000.PPT

  12. SOURCES OF FUNDING • Service recipients divided between NHS, social care and privately funded clients • Gross costs of social services divided between user charge and net public cost G:\SRC\OUTPUTS\BSG2000.PPT

  13. KEY BASE ASSUMPTIONS Older population changes in line with latest official population projections Prevalence rates of disability remain unchanged Supply of informal care: by spouses reflects marital status projections, by children unchanged Patterns of care remain unchanged: no allowance for rising expectations Real unit costs and GDP rise in line with official projections: supply increases to match projected demand on this basis G:\SRC\OUTPUTS\BSG2000.PPT

  14. PROJECTED LONG-TERM CARE EXPENDITURE AS PERCENTAGE OF GDP, 2002 TO 2041 G:\SRC\OUTPUTS\BSG2000.PPT

  15. PROPORTION OF PROJECTED EXPENDITURE THAT IS PRIVATE G:\SRC\OUTPUTS\BSG2000.PPT

  16. PROJECTED EXPENDITURE (£M) BY SOURCE OF FUNDING, 2002-2041 G:\SRC\OUTPUTS\BSG2000.PPT

  17. PROJECTED NUMBERS OF SOCIAL CARE STAFF, 2002 TO 2041 G:\SRC\OUTPUTS\BSG2000.PPT

  18. SCOPE OF SCENARIOS • Mortality rates – official variant projections • Disability rates – falling rates • Informal care – less care by children • Rises in real unit costs • Patterns of care – shift to home care, carer-blind services • Funding arrangements – free personal care G:\SRC\OUTPUTS\BSG2000.PPT

  19. PROJECTED EXPENDITURE, 2041, UNDER ALTERNATIVE ASSUMPTIONS ABOUT LIFE EXPECTANCY G:\SRC\OUTPUTS\BSG2000.PPT

  20. PROJECTED EXPENDITURE, 2041, UNDER ALTERNATIVE ASSUMPTIONS ABOUT FUNCTIONAL DISABILITY G:\SRC\OUTPUTS\BSG2000.PPT

  21. CONCLUSION • Expenditure on long-term care will need to increase significantly over the next 40 years to keep pace with demographic pressures and real rises in the unit costs of care • Expenditure projections are sensitive to assumptions about future mortality and disability rates and real rises in the unit costs of care G:\SRC\OUTPUTS\BSG2000.PPT

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