Investigating the relationship between social care supply and healthcare utilisation by older people in England

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Since 2010, adult social care spending in England has fallen significantly in real terms whilst demand has risen. Reductions in social care supply may also have impacted demand for NHS services, particularly for those whose care is provided at the interface of the health and care systems.
We analysed a panel dataset of 150 local authorities (councils) to test potential impacts on hospital utilisation by people aged 65 and over: emergency admission rates for falls and hip fractures (‘front-door’ measures); and extended stays of 7 days or longer; and 21 days or longer (‘back-door’ measures).
Changes in social care supply were assessed in two ways: gross current expenditure (per capita 65 and over) adjusted by local labour costs; and social care workforce (per capita 18 and over). We ran negative binomial models, controlling for deprivation, ethnicity, age, unpaid care, council class and year effects. To account for potential endogeneity, we ran instrumental variable regressions and dynamic panel models. Sensitivity analysis explored potential effects of funding for integrated care (the Better Care Fund).
There was no consistent evidence that councils with higher per capita spend or higher social care staffing rates had lower hospital admission rates or shorter hospital stays.
Original languageEnglish
Pages (from-to)36–54
Number of pages19
JournalHealth Economics
Issue number1
Early online date24 Oct 2020
Publication statusPublished - 1 Jan 2021

Bibliographical note

© 2020 The Authors. Health Economics published by John Wiley & Sons Ltd.


  • Social care
  • Healthcare
  • Dementia
  • Local Government Expenditures

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