A lost decade? A renewed case for adult social care reform in England

Glasby, Jon; Zhang, Yanan; Bennett, Matthew; Hall, Patrick

doi:10.1017/s0047279420000288

Cited by 37 publications

(35 citation statements)

References 10 publications

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“…The COVID-19 pandemic has tested the capability of not only individual social care providers, but also the commissioning system in which they operate. It is known that funding for adult social care has been characterised by years of austerity 15 at the expense of staffing, quality, and support, which may have been detrimental to the ability of care homes to cope with the pandemic 16 . As such, the experiences of the adult social care sector during the pandemic must not be forgotten, and the growing body of research on ownership variation across COVID-19 outcomes offers an important opportunity to revisit the impact of outsourcing social care services to FP providers.…”

Section: Introductionmentioning

confidence: 99%

Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities

Bach-Mortensen

Verboom

Esposti

2021

Preprint

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BackgroundThe adult social care sector is being increasingly outsourced to for-profit providers, but the impacts of privatisation on service quality and resident outcomes are unclear. During the COVID-19 pandemic, for-profit providers have been accused of failing their residents by prioritising profits over care, prevention, and caution, which has been reported to result in a higher prevalence of COVID-19 infections and deaths in for-profit care homes. Although many of these reports are anecdotal or based on news reports, there is a growing body of academic research investigating ownership variation across COVID-19 outcomes, which has not been systematically appraised and synthesised.ObjectivesTo identify, appraise, and synthesise the available research on ownership variation in COVID-19 outcomes (outbreaks, infections, deaths, shortage of personal protective equipment (PPE) and staff) across for-profit, public, and non-profit care homes for older people, and to update our findings as new research becomes available.DesignLiving systematic review.MethodsThis review was prospectively registered with Prospero (CRD42020218673). We searched 17 databases and performed forward and backward citation tracking of all included studies. Search results were screened and reviewed in duplicate. Risk of bias (RoB) was assessed in duplicate according to the COSMOS-E guidance. The results were synthesised according to RoB, model adjustment, and country context and visualised using harvest plots.ResultsTwenty-eight studies across five countries were included, with 75% of included studies conducted in the Unites States. For-profit ownership was not consistently associated with a higher probability of COVID-19 outbreaks across included studies. However, there was compelling evidence of worse COVID-19 outcomes following an outbreak; with for-profit care homes having higher rates of accumulative infections and deaths. For-profit providers were also associated with shortages in PPE, which may have contributed to the higher incidence of infections and deaths.Chain affiliation was often found to be correlated with higher risk of outbreaks, but not consistently associated with an elevated number of deaths and infections. Private equity ownership was not consistently associated with worse COVID-19 outcomes.ConclusionFor-profit status was a consistent risk factor for higher cumulative COVID-19 infections and deaths. Thus, ownership among providers may be a key modifiable factor which can be regulated to improve health outcomes in vulnerable populations and reduce health disparities. This review will be updated as new research becomes published, which may change the conclusion of our synthesis.

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Section: Introductionmentioning

confidence: 99%

Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities

Bach-Mortensen

Verboom

Esposti

2021

Preprint

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“…Emerging research also reports how needs assessments fail to translate into outcomes for people with intellectual disabilities and their carers Forrester-Jones (2021). This all weakens our trust that the theoretically laudable Care Act 2014 -premised on promoting a person's 'well-being' and enabling individuals to realise 'normal' life goals (e.g., employment; living in a home of one's own choosing; friendships; and intimate relationships) has had any tangible impact on the lives of people with intellectual disabilities due to poor implementation (see Forrester-Jones, 2021;Glasby et al, 2021). The fact that there has been no government national intellectual disability strategy since Valuing People Now finished in 2012 adds weight to Glasby et al's lament that we have experienced a 'lost decade' of adult social care in the UK (Glasby et al, 2021, p. 406).…”

Section: Discussionmentioning

confidence: 99%

“…Continuous annual spending data for intellectual disabilities is unavailable but annual data on long-term (residential, nursing and community) social care spending provide a similar picture on trends in expenditure. For example, in 2016/17 gross current expenditure on long term care for adults (aged 18-64 years) with intellectual disabilities was 4,733 million, rising only to 5 million in 2018/19 despite the steady increase in the number of people with intellectual disabilities needing support for a longer time period due to greater life expectancy (see Glasby, Zhang, Bennett & Hall, 2021) and concomitant complex care needs. Year-on-year budget reductions left local authorities (LAs) in England struggling to provide adult social care, exacerbated by a history of inconsistently applied assessments for eligibility across the country (Charles & Manthorpe 2007;Fernández & Snell 2012) with practitioners using their own professional judgement (rationing by discretion or what Lipsky [2010] termed 'street level bureaucracy') of client need and fairness (see Henwood 2015).…”

Section: Introductionmentioning

confidence: 99%

The Impact of Austerity Measures on People with Intellectual Disabilities in England

Forrester‐Jones¹,

Beecham²,

Randall³

et al. 2021

Journal of Long Term Care

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Context: UK austerity measures following the 2008 financial crisis included budget reductions for health and social care. We aimed to investigate the extent to which austerity-measures had impacted the lives of people with intellectual disabilities in England, and whether their support costs were associated with their characteristics, needs and outcomes. Objectives: We report on what services people with intellectual disabilities were using, whether they had lost care, the costs of their support, and what impact any loss of benefits and services had on individuals' lives. Methods: 150 participants with intellectual disabilities across England were interviewed about their services and their well-being. Service and individual support costs were calculated. Statistical and thematic analyses were employed. Results: The largest proportion (42%) of our sample had lost care. 14% had experienced changed care, and care had remained the same for 36%. Only 7% said their care had improved. No associations were found between costs and characteristics and needs except for whether the person had mild or severe intellectual disabilities. Those who had lost care engaged in fewer activities and had significantly lower self-esteem and quality-of-life scores compared with those who had not lost care. Loss of care impacted on individuals' independence and future aspirations. Limitations: A comparative study of austerity impacts across the whole of England was not possible. Our costs data may be underestimated because full information on support from home, key, or support workers was unavailable. Implications: In attempting to mitigate against COVID-19 impacts on people with intellectual disabilities, policy-decisions will need to consider the backlog of a decade of cuts.

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“…A further issue is public funding for those unable to fully afford their own care. In concurrence with the ageing population, the last ten years has seen public funding austerity, where funds to LAs from central government have been cut, and LTC budgets have fallen in real terms in consequence (Glasby et al, 2020). This is then exacerbated by LAs' strong market position as dominant purchasers where they can push down the price paid for services (Allan and Nizalova, 2020;.…”

Section: Discussionmentioning

confidence: 99%

Incentives and Deterrents to the Supply of Long-term Care for the Elderly in England: Evidence and Experience in Two Local Authorities

Allan¹,

Darton²

2021

Social Policy and Society

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This article reports on a study assessing the incentives and deterrents to long-term care (LTC) supply in two local markets in England. The supply of LTC in many countries is facing the issues of rising demand, (lack of) workforce and the interaction of the public and private sectors. Findings from qualitative interviews of local council and provider stakeholders exploring barriers and enablers faced by LTC providers in two local authorities (LAs) are presented and discussed. The interviews provided insight in three main areas: staffing, demand and stakeholder relationships. Staffing, in particular, is crucial and we found that there are many difficulties for providers in maintaining their workforce. Consistent with previous research, we also found that public spending levels on LTC puts pressure on providers striving to maintain a good quality service, including improved remuneration of staff.

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A lost decade? A renewed case for adult social care reform in England

Cited by 37 publications

References 10 publications

Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities

Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities

The Impact of Austerity Measures on People with Intellectual Disabilities in England

Incentives and Deterrents to the Supply of Long-term Care for the Elderly in England: Evidence and Experience in Two Local Authorities

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