Estimating demand pressures arising from need for social services for older people

The twelve years preceding the introduction of the community care reforms in 1993/4 saw an increased demand for health and social services generated by the increase in numbers of older people (particularly the over 85s) and reflected in the rapid growth of residential and nursing home places over a twelve year period (from 224,000 in 1983 to 427,000 in 1994). While the move into the residential and nursing home sector was partly driven by the perverse incentives offered by social security in the early 1980s, it may also have reflected a real increase in the levels of dependency experienced by older people coming into contact with the services during the period. This has fuelled concern about rising costs. However, there are competing forecasts of how big a burden the costs of care will be. One of the difficulties is in determining how far the burden will fall on statutory services or formal services (provided by either the statutory or independent sectors) and how far the pool of informal carers will be large enough to maintain the level of care which it provides currently. The Institute of Actuaries published an influential paper in 1993 (Nuttall et al, 1993) suggesting that the current cost of informal caring based on a rate of £7 per hour could be estimated at £33.9 billion. The House of Commons Health Committee (1996) took evidence during 1995 and 1996 and concluded that the gloomiest forecasts were unfounded and that radical action was not needed in the immediate future. Nevertheless, whatever the predictions for the medium and long term, concerns have been raised with regard to current capacities to meet demand. The community care changes resulting from the Act were funded by a transfer, Special Transitional Grant (STG), to the local authorities with which to meet their new responsibilities. There has been a continuing debate as to whether the STG and the SSA allocations have been sufficient to enable them to do this. The Association of Directors of Social Services and the Association of Metropolitan Authorities (now subsumed into the Association of Local Government) have repeatedly called for a review of the current funding of community care saying they are unable to meet the full needs of dependent people (Community Care, 1996, 1997a).