Do informal carers reduce adult health and social care utilisation?

17 Jan 2023

An ageing population means that reliance on informal carers is increasing. There were an estimated 6.8 million informal carers in the UK in 2015 – people who are not paid to provide care, but provide some form of support to relatives, friends or neighbours who require it. A new study led by ARC North Thames' Jenny Shand indicates wider health inequalities for those without informal care.

One might assume that those with an informal carer are less likely to use formal health or social care, because some of their needs are met by the informal arrangement. However, there is mixed evidence as to whether carers are substitutes for formal health and social care utilisation. Some studies suggest that carers may actually lead to an increase service utilisation. Why? And what can policy learn from these findings?

These questions were central to a study led by Jenny Shand, ARC NT Implementation Lead, which set out to investigate the association between having a carer and patterns in formal service use across five settings:

  • Hospital
  • Primary care
  • Community
  • Mental health
  • Social care

By comparing the primary care records of matched individuals with a carer and those without a carer, the authors were able to calculate the difference in service costs between the two groups. Their analysis reveals that individuals with a carer had a 27% increased total cost of service use when compared with those without a carer. This increase was found across all five care settings but the most significant was social care, accounting for 39% of the overall cost difference.  

If there was care substitution, we would have expected to see reduced service use in social care, and community care settings, where some tasks were completed by an unpaid informal carer. However, the study suggests the opposite - that having an informal carer may induce additional service use. Informal carers may in fact be filling unmet needs, such as coordinating care, advocating for the care recipient, providing emotional and social support, all of which may have a positive impact on the quality of life of the person being cared for. This indicates there may be wider inequalities in service access for people without a carer, whose unmet needs continue to go unmet. For an ageing society with projections suggesting there will be more people without carers in the future, these inequalities need to be addressed.

The findings of this research raise questions about the relationship between informal care and the formal care system. In the UK, policy relies on the economic assumption that carers are a substitute for formal care, with an hour of their time directly comparable to an hour of a paid carer. This means that policy priorities are to identify carers, provide them with information, and support them to continue their care giving role by addressing their own health and wellbeing needs. However, supporting carers to continue to deliver caregiving may not be cost-effective and reduce the burden on the care system, if individuals with carers have higher health and social care costs.

Find out more in the paper here.

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