2013 REPORT - Apetito

Meeting the wider funding challengeThe real value of community meals on wheels

2013 REPORT

ContentsExecutive summary 1

Introduction 2

The challenge for care homes 4

Easing the strain on the NHS 6

The impact of malnutrition 8

The impact of dementia 10

Maintaining a healthy lifestyle at home 12

Demonstrating the importance of community meals on wheels 16

Conclusion 18

Appendix 20

Source data 27

Appendix source data 28

This report uses data from a variety of sources to identify that by 2020, the UK economy could achieve savings of £1.7 billion simply by keeping 10% of over 65’s in their own homes – rather than being admitted to longer term care institutions.

These significant savings would be realised through reducing the requirement to provide new beds and appropriate care in hospitals and care homes in line with forecasts for the huge growth in the population of over 65s in the forthcoming years.

In addition, the report also addresses other growing social issues such as the increasing prevalence of dementia, and the causes and effects of malnutrition in the community – a £7.3 billion problem in the over 65s alone.

Provision of services that enable the elderly to stay in their own homes, such as community meals on wheels, are an absolute necessity if the savings identified are to be achieved. The report concludes that between now and 2020, the investment in additional meals on wheels services of just £275 million, represents extremely good value when viewed in the context of the £1.7 billion overall savings available.

In support of the government’s pledge to ensure people have the capabilities to live at home for longer, we firmly believe that people should be able to remain in their homes for as long as they possibly can. This is important, not only because it is a fundamental human right, but also because it is ultimately where our older population would choose to be; rather than being forced to live far less independently in a care institution.

apetito are the market leaders in the provision of community meals on wheels across the UK and as such are in a unique position to lead this debate. Our products and services make a real difference to some of the most elderly and vulnerable people in our society, every day.

Executive summary

1

With Britain’s ageing population continuing to grow at a rapid pace, the country’s overstretched health and social care system is struggling to cope with increased demand for services at a time of ever-tightening public sector budgets.

Introduction

This report outlines how greater investment in frontline community services, such as community meals on wheels, would play a critical role in helping to meet the wider funding challenge by keeping elderly people living well, for longer in their own homes. Not only would this have wider socio-economic benefits such as tackling loneliness among the elderly, the fact of the matter is it would also save money through:

• The reduced use of residential care

• Fewer hospital admissions

• Additional social issues such as the reduced prevalence of malnutrition in the elderly

A full return on investment analysis in the conclusion of this report provides a detailed breakdown of the financial impact that safeguarding community meals on wheels could have by the end of the current decade. Now the Government

has pledged to examine future funding for elderly care in the 2014 Spending Review, there is a real opportunity to kick-start the fundamental overhaul of Britain’s health and social care system that is needed if society is to continue to meet the needs of an ageing population. As Sarah Pickup said in her inaugural speech as president of the Association of Directors of Social Services (ADASS) in April 2012:

“We are at a moment of opportunity, a change point with the potential to initiate and drive forward new approaches… there is some clarity about what we would all like the answer to be – more people living independently and healthier for longer, adding life to years and years to life, reduced demand for high end services whether acute hospitals or care homes…”.

This report concludes that if just 10% of the projected future elderly population remained in their homes between now and 2020, it could potentially save Britain as much as £1.7 billion

£1.7bn

2

Demographic Pressure

As highlighted in the Daily Telegraph (Bingham, July 2012 1), figures from the 2011 UK Census show there are now over 900,000 (10%) more over 65s than there were a decade ago, representing around 16.4% of the population. Research from the BBC (July 2012) concludes that three quarters of the elderly population will

develop a social care need. According to the Institute for Public Policy Research, ‘The Long View’, the number of people aged over 85 – currently 1.5 million (BBC, 2012 2) – is set to more than double in the next 25 years, sparking fresh warnings over the sustainability of public spending (Muir, 2012, p. 3 3).

Current 2020 Projected

Population of United Kingdom 63,100,000 67,400,000

UK population aged 65+ 10,348,400 12,667,000

Number of UK residents aged 65+ with dementia 783,000 958,892

Percentage of population aged 65+ 16.4% 18.6%

0 20m 40m 60m 80m

0 10m 20m 30m 40m 50m 60m 70m 80000000 0

Current

Dementia suffers

2020Projected

Current

2020Projected

0 200K 400K 600K 800K 1M

UK Population65+

65+ UK Population

3

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The challenge for care homesAn ageing population will undoubtedly place enormous pressure on the already strained resources of care homes, as they struggle to meet demand from this growing demographic while operating within stricter budgets.

“Failure to reform now will only lead to more major failure just a short way down the line in terms of the system collapsing”– Submission to the United Kingdom Parliament Committee on Public Service and Demographic Change by the Association of Directors of Adult Social Services, the Local Government Association and the Society of Local Authority Chief Executives and Senior Managers, 3rd September 2012

As the figures opposite demonstrate, an additional 130,000 new care home beds will be required to meet demand by 2020 (BUPA, 2011 4 and apetito, 2012). Out of these new care home beds, 88,000 would be needed for the over 65s alone. Current care provision to the 400,000 elderly people who occupy care home beds costs over £11 billion. We could be looking at an extra £11 billion spend on top of this over the next 8 years – including the cost of new beds – just to cope with the rising demand.

The cost breakdown shows that by supporting just 10% of elderly people to avoid entering residential care by remaining in their own homes, a saving of £824 million can be made between now and 2020. These figures are based on current levels of inflation and are likely to be considerably higher by 2020 – making this a conservative estimate.

The need for investment

BUPA’s research predicts that over the next 10 years, several thousand more people will need care home places, but as local authorities are likely to reduce the fees paid to homes, tens of thousands of older people who need specialist help will be unable to access places. There is also much debate around the increasing potential for a poverty crisis among this age group, due to factors such as a lack of private pension provision and high levels of mortgage and personal debt. At present, 25% of care is privately funded by individuals (Institute of Public Care, 2011, p. 10 5) – a significant reduction in this figure would place an enormous strain on local authority budgets. If the elderly population continues to grow at anticipated levels, the case for greater investment in frontline community services that help the elderly remain at home for as long as possible is therefore stronger than ever.

£824mValue of savings

5

Care home provision – Current

Facts

Number of available beds in UK care homes 545,863

Estimated number of care home beds in United Kingdom occupied by people aged 65+ 404,000

Figures

Average UK annual cost (including extras) of residential care for people aged 65+ £28,496

Estimated 2012 annual cost of care home provision to UK (total) £11,512,384,000 (Bn)

Care home provision – 2020

Facts

Total Number of available beds in UK care homes 680,000

Estimated number of care home beds in UK occupied by people aged 65+ 492,880

New care home beds required to keep occupancy at max 75% (essentially the current rate) 134,137

Extra number of beds required for those aged 65+ between now and 2020 88,880

Figures

Estimated 2020 annual cost (including extras) of residential care for people aged 65+ £30,500

Cost per new bed £62,203

Total cost of new beds £8,343,723,811

Estimated 2020 cost of additional care home provision (88,880) in UK total now-2020 £2,710,840,000

Estimated total cost of care home provision to UK between now and 2020 £11,054,563,811 (Bn)

Total Savings between now and 2020

Saving (now – 2020) keeping 10% of potential 65+ care home admissions (8,888) at home £271,084,000

By keeping 10% of care home admissions at home, thus negating 8,888 new beds being built £552,860,264

Totals

Total saving £824 million

According to The King’s Fund (Imison, Thompson & Poteliakhoff, August 2012, p. 2 6), those aged over 65 make up 16% of the population, but occupy around 65% of general and acute hospital beds. As outlined by Age UK, almost half the NHS budget is spent on this age group (Harrop, 2011, p. 15 7).

As the following figures outline, those aged 65 and over currently account for 79,000 of the total 122,000 occupied hospital beds in the UK.

By 2020, as the population continues to age, this demographic is expected to require nearly 97,000 beds – over 17,000 more than today, at a cost of an additional £8.6 billion to the NHS (apetito, 2012). To keep the level of admissions at a manageable level, and to enable the healthcare system to cope comfortably without significant overcrowding and bed blocking, new hospitals will have to be built. This is a substantial cost to the UK, with new beds costing, on average, a huge £400,000* each.

Through negating the need to build as many new hospital beds as anticipated and thus preventing the requirement to provide expensive care for 10% of potential future hospital admissions, Britain stands to save a total of £861 million.

Evidence of further savings (not included in our findings)

The King’s Fund’s research also finds that 2.3 million overnight stays in hospital could be prevented if all Primary Care Trusts in the country performed as well as the top 25 in providing good community care; this is the equivalent of 7,000 hospital beds, or several medium-sized hospitals full of elderly emergency cases every night of the year (Imison, August 2012 8). The researchers advised that savings of £462 million could be made, which could be reinvested in community services to keep the elderly well at home.

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Easing the strain on the NHSCare homes are not the only care setting which will suffer from overcrowding and spiralling costs. Hospitals too are struggling to meet the increasing demand – particularly from the growing elderly population.

“Our own work shows how pressures on social care services are feeding through into high levels of hospital bed occupancy, contributing to an eight-year high in the proportion of patients spending more than four hours in A&E…Using NHS funding as a sticking plaster does not address the pressures facing social care” – Richard Humphries, Senior Fellow at The King’s Fund, 14th June 2012

£861mValue of savings

*Data taken across 9 brand new state-of-the-art hospitals – see appendix for more.

7

Hospital provision – Current

Facts

Estimated number of hospital beds in UK 140,449

Estimated number of hospital beds occupied by 65+ (any given day) (at 65% total occupancy) 79,370

Number of occupied beds 122,108

Figures

Cost of providing a hospital bed per day £255

Cost of providing a hospital bed per year (based on day cost x 365) £93,075

Estimated current cost of those aged 65+ to UK per year £7,387,362,750 (Bn)

Hospital provision – 2020

Facts

Estimated number of hospital beds required to keep occupancy at 2012 rate (86.9%) 171,250


Number of extra beds required for population aged 65+ 17,461

Figures

Cost of providing a hospital bed per day £25,517


Cost per new hospital bed £400,000

Total Costs

Cost of building new hospital beds for additional population aged 65+ (17,461) £6,984,400,000

Projected additional cost providing beds to additional population aged 65+ to UK (now-2020) £1,625,182,575

Total cost of additional 17,461 to UK £8,609,582,575 (Bn)

Keeping 10% at Home

Saving – negating need to build 1,746 new beds (10% of total hospital admissions) £698,400,000

Saving (between now and 2020) by keeping 10% of hospital admissions (1,746) at home £162,508,950

Totals

Total saving £861 million

8

As well as the aforementioned £1.7 billion savings which can be made by preventing admissions to care homes and hospitals, there is significant evidence that other socio-economic savings could also be made by helping to monitor and prevent the increasing prevalence of malnutrition and dementia in the community.

Importantly, malnutrition is a major factor in driving admissions to care homes and hospitals. Figures from BAPEN reveal that 37% of care home residents are malnourished on admission (Russell & Elia, 2011, p. 4 9). It follows that eating well can help to delay entry by providing people with the nutrients they need to stay healthy for longer.Further research also reveals:

• More than three million people in the UK are malnourished (Brotherton, Simmonds, Stroud, 2010, p. i 10)

• A third of people with malnutrition in the UK are aged over 65 (Russell & Elia, 2011, p. 1 11)

• Over a half of what is spent on malnutrition is treating people over 65 (BAPEN, 2012 12)

• Malnutrition costs the NHS double what obesity costs (PR Newswire, September 2012 13)

• Malnutrition costs the UK £7.3 billion on the over 65s alone (BAPEN, June 2012 14)

The impact of malnutrition

Community meals on wheels are an effective way of helping to prevent, monitor and potentially reduce cases of malnutrition in the elderly. The five years between 2003 and 2008 provide a useful snapshot for this argument. Over this period, the number of community meals on wheels delivered was reduced by 35% (apetito and NACC market intelligence), whereas the number of people admitted to hospital with malnutrition in England rose by 90%. (hospital Episode Statistics, n. d. 15)

While it is difficult to accurately measure the direct impact of one versus the other, it is fairly safe to assume that the relatively small investment in a community meals on wheels subsidy by local authorities has the potential to deliver significant cost and health benefits by making a small but positive impact on the prevalence of malnutrition in the over 65s.

Community meals on wheels delivered

Admissions to hospital with malnutrition (England)

2003 34 million 1,667

2008 22 million 3,161

£13bnCost of malnutrition in UK

“Over half of what is spent on malnutrition is spent on the over 65s”– BAPEN, June 2012 14

9

Estimated annual cost of malnutrition in the over 65s to the United Kingdom

£7.3bn

The impact of dementiaAs demonstrated by the figures highlighted in this report, as well as increasing numbers of people suffering from malnutrition, it is also anticipated that the growing elderly population will have a huge impact on the prevalence of dementia. Over the next decade, the number of dementia sufferers in the UK is expected to grow by 34% (Based on Alzheimer’s Society, 2012 projections 16).

The Alzheimer’s Society also reports that two-thirds of care home residents currently have some form of dementia, but only 28% of beds are registered to provide specialist dementia care (Alzheimer’s Society, May 2012 17).

As the number of people entering care homes with the condition increases, staff training will be needed to ensure that those providing care for sufferers understand their particular needs and challenges – adding further pressure to the financial burden already placed on care homes.

According to the National Dementia Strategy, early provision of support at home can decrease care home admissions for sufferers by 22% (Department of Health, February 2009, p. 34 18). The benefits of a daily or regular visit from a trained community meals on wheels driver can be very useful, providing a cost effective mechanism for proactively monitoring the wellbeing of those vulnerable members of the community and helping to prevent their entry into a care home for as long as possible.

Cancer £5,999 £129,269

Stroke £4,770 £8,745

Heart Disease £3,455 £73,153

Dementia £27,647 £4,882

Average annual cost per patient

£ invested in research per £ million spent on treatment

Cancer

Stroke

Heart Disease

Dementia

Dementia is just one of several other potential social costs

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Dementia currently costs the UK economy £23 billion each year

£23bn

Maintaining a healthy lifestyle at homeAt a time when investment in frontline community services such as community meals on wheels are under increased threat, the financial benefits of helping the elderly to remain at home for as long as possible are compelling.

Our figures show that by 2020, an additional 106,000 elderly people will require some form of residential or hospital care which could be avoidable if they are instead able to receive preventative support services such as community meals on wheels in their own home, as part of a social care assessment. Keeping just 10% of this number at home (10,634) would result in significant financial savings.

By investing just an additional £4.1 million over the next 8 years to meet the projected 2.7 million additional meals required to meet the needs of Britain’s ageing population,

the UK could prevent significant costs having to be invested in more expensive residential or hospital care. This equates to an annual subsidy of between £29 million and £33 million, to be able to keep these elderly people at home for longer.

Even bearing in mind that this results in a total spend of £275 million on community meals on wheels over the next 8 years, it pales into insignificance when compared to the huge cost of caring for people outside of their own home (£1.7 billion in total or £211 million annually over the next 8 years.)

£275mThe potential total cost to the UK of providing community meals on wheels to the over 65s between now and 2020

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13

UK community meals on wheels market

Current

Existing number of meals delivered per annum 19,000,000

Current, proposed or target subsidy per meal £1.50

Current cost of meals on wheels (MOW) to UK £28,500,000

Additional

Additional people requiring MOW 10,634

Additional meals required per annum (additional requirement x 5 x 52) 2,764,840

Estimated 2020 total meals delivered yearly 21,764,840

Estimated now-2020 additional MOW subsidy cost to United Kingdom £4,147,260

Total UK MOW subsidy (including current + additional) 2020 £32,647,260

Total cost (now-2020) including annual increases £275 million

Keeping people in their homes: the financial benefits

Earlier this year, Age UK found that more than 80% of English councils only provide home care – including community meals on wheels services – to those with ‘substantial’ or ‘critical’ health needs (2012, p. 2 19). By comparison, just 57% of councils restricted care to these groups in 2005/06 (Martin, November 2011 20). Even those who are classified as ‘low’ or ‘moderate’ may still be disabled or housebound and the less that is spent on supporting them now will result in considerably more needing to be spent when their needs become substantial and they are forced to enter the care system.

Just as important as the financial benefits of maintaining frontline community services, are the wider socio-economic benefits. These include regular human contact and the reassurance provided to friends and family of elderly people that their health and wellbeing are being monitored on a regular basis. More than just a meal, one of the major advantages of a community meals on wheels service is the safety and

social contact provided by a regular visit from a meal delivery driver who gets to know each service user and is trained to spot any signs that might raise a concern. Research from the NACC (Wilson, March 2010, p. 5 21) found that community meals on wheels drivers often have more regular contact with people than home care workers and often fulfil a number of roles. These include providing social contact, prompting about medication, bringing in doorstep items, reminding people about the need to drink more fluids and providing a visual check on health and appetite. This proactive strategy might trigger the early intervention of other services and has the potential to deliver both individual wellbeing and financial benefits. In fact, the human contact that services such as community meals on wheels provide, can be vital in maintaining the health and wellbeing of service users.

Not only did a 2012 report by think-tank Demos – commissioned by older people’s charity WRVS – find that far higher proportions of British elderly people are living in poverty than in

...pto

“Social care is not a nice to have extra – it is the support that helps older people get out of bed, feed themselves, have a wash, live a life that is more than just an existence” – Michelle Mitchell, Charity Director of Age UK

“With rises in heating costs, rents, day care/home care costs, and community meal costs where would you draw the line and what would you give up? Would it be one of your meals a day or even two?” – NACC Spokesperson

other Northern European countries surveyed (WRVS, May 2012, p. 5 22), it also reported that a third of them did not see their close family or friends even once a month (WRVS, May 2012, p. 44 23).

According to the Campaign to End Loneliness (2012 24), over half (51%) of people aged 75 and over live alone. The campaign claims that loneliness has a similar impact on mortality as smoking and has significant links to depression and the risk of developing Alzheimer’s disease. Similarly, a recent survey by Age UK reported that five million elderly people considered the television to be their only source of company (Brooks, November 2012 25). The charity is calling for loneliness to be recognised as a major health issue and for it to be treated as a public health priority on a par with obesity and smoking addiction.

An emerging pattern in the provision of community meals on wheels is a move by local authorities towards personalisation, whereby services would be delivered on a wholly private, self-managed basis. However, there is little evidence to suggest that such a move would reduce incidences of malnourishment. Furthermore, the use of specialist food companies that are able to cater to the individual needs of recipients – including dietary requirements, any health conditions, personal tastes

and cultural influences – will help ensure that recipients receive meals they enjoy eating and which meet their nutritional requirements. This is particularly relevant when bearing in mind that the average service user receiving community meals on wheels is in the 75-85 age bracket (apetito, 2012), and a large percentage will also be suffering from some form of dementia and/or diabetes and are therefore less able to manage their own care provision.

There is considerable evidence that providing a community meals on wheels service has significant socio-economic benefits to the service user. In Hertfordshire, a recent Social Return on Investment (SROI) report compiled by Hertfordshire Community Meals (2012 26) outlines how every £1 spent on the service is worth a social return of £5.28 to the service user. A further study from the NACC (November 2011 27) backs up the claim that a meals on wheels provision is beneficial to local authorities and their residents, outlining how, in Australia £1 spent on good nutrition is likely to save £5 as care packages are reduced.

Good nutrition is a vital part of keeping as many people as possible in their own homes. Providing a daily, nutritious meal with a guaranteed intake of calories and nutrients is a sure way of being able to do this.

£4mThe additional MOW subsidy required between now and 2020 (£500k annualised)

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To this end, community meals on wheels can provide access to meals for a wide range of dietary requirements that would otherwise be extremely difficult to cater for as a local authority or family member. For example, a range of descriptor specific texture-modified meals for people with varying degrees of swallowing difficulties may not be accessible through other means. These meals are puréed, but moulded to appear like normal meals – retaining their shape after cooking. Designed to not only enable people with dysphagia to potentially enjoy food

for the first time in years, they also help to promote dining with dignity, allowing those who eat them to enjoy meal times with a friend or relative in a comfortable environment. This has further social benefits – helping to prevent loneliness, depression, malnutrition and general ill health. There is no question that these products, with their dedicated focus on elderly care would be very difficult to access away from a specialist market provider, yet they are absolutely vital to the health and wellbeing of those who consume them.

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Demonstrating the importance of community meals on wheelsIn recent years, to further highlight the continued importance of a community meals on wheels service in a society with a growing elderly population, a number of high profile celebrity supporters have come out in support of the social, economic and nutritional benefits of the service.

Journalist John Sergeant is a keen supporter of community meals on wheels, his mother having been a volunteer in Oxford while he was a child. He describes his interest in helping to keep the service running: “Meals on wheels goes back to the time of the Blitz. It’s an extremely useful service and as relevant today as it used to be all those years ago. As our elderly population grows, services like these give vulnerable people the help they need to remain in their own homes, delaying their move into a care home for as long as possible.” (National Community Meals Week, 2012 28).

House of Commons speaker John Bercow has supported National Community Meals Week for the last two years. He is a staunch advocate of community meals on wheels, fully appreciating the enormous value of the service to the people who receive it. He says: “Meals in the community are really important to keep people healthy, nourished and in their own homes. But it goes further than the food itself – socialisation is a very important aspect and many of the people receiving community meals on wheels have no other point of personal contact. It’s hard to imagine how isolated those individuals can sometimes feel and the service

being delivered is outstanding and reaches to people in need.” (National Community Meals Week, 2011).

War veteran Simon Weston is now a respected public speaker and champion of the elderly. He supported National Community Meals Week for two years between 2010 and 2011 and understands the impact the service can make on some of the most elderly and vulnerable people in our society. “Community meals does an unbelievable amount of good. It’s such an important service and allows people to stay in their homes and live independently. Any cuts to the service would result in a huge long-term loss for the sake of just a short-term gain. Plus, anything that keeps people in their own homes for as long as possible will save the public money needed to support them through the care system.” (National Community Meals Week, 2011).

Esther Rantzen and Christine Hamilton are just a couple of other big names who have recently dedicated time out of their schedules to showcase the importance of the community meals on wheels service. The service has also seen political support from advocates including the MP for Housing and

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“Meals on wheels go back to the time of the Blitz. It’s an extremely useful service and as relevant today as it used to be all those years ago.” – John Sergeant, Journalist

Local Government Mark Prisk, and even royalty in the form of HRH the Duchess of Cornwall who is an honorary member of the National Association of Care Catering. This immense support promotes the benefits of community meals on

wheels socially and also economically as relatively inexpensive yet highly valuable. This is particularly relevant when compared to the comparatively vast expense of residential or hospital care.

ConclusionAs the government prepares to embark on a much-needed overhaul of Britain’s health and social care system, what is clear from the research gathered in this report is that the role of frontline services – and in particular community meals on wheels – are an integral part of addressing the significant demand on resources that will be needed to accommodate the country’s ageing population for years to come.

“The latest [figures] show that councils continue to strive to protect frontline services through re-designing services to focus on prevention and recovery and reducing ongoing costs, and by reviewing processes, services and contracts to ensure value for money. Yet despite this and the use of transferred resources from the NHS to protect services and fund rising demographic pressures, some councils have had to resort to reductions in services to balance their budgets. We are particularly concerned at the impact this might have on preventative and voluntary sector services.” – Sarah Pickup, president of ADASS, 12th June 2012

We have calculated that the UK could make savings of at least £1.7 billion, just by keeping 10% of elderly people in their own homes by 2020; with savings of £824 million coming from the prevention of care home admissions, and £861 million from the cost of hospital care. There is also substantial evidence to suggest that other significant socio-economic savings could be made by helping to prevent and monitor the increasing prevalence of malnutrition and dementia in the community.

Additionally we have highlighted that in order to make these savings, a relatively small investment of around £275 million would be required to retain the provision of community meals on wheels – a vital service which not only helps to keep people in their homes for longer but could help towards dramatically decreasing hospital and care home admissions over the coming years. The full Return On Investment

analysis in this report illustrates that an additional £500,000 annual subsidy for community meals on wheels over the next 8 years would result in a £33 million cost by 2020; only £4 million more than it potentially ‘costs’ the UK today. The outcome is the possibility to make huge annual savings against a comparatively minor spend.

Though keeping people at home for as long as possible is a vital government objective, we firmly believe that it is also a human right for people to stay at home as it is where they want to be, rather than having the distress of living far less independently in a care institution. What is clear is that the retention of community meals on wheels can play a significant role in allowing this to happen.

Please see overleaf for detailed breakdown of spend vs. savings.

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could be saved by keeping 10% of the over 65s in their own home.

£1.7bn19

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AppendixCare home provision – Current

Population of United Kingdom 63,100,0001

UK population aged 65+ 10,348,4001

Percentage of population aged 65+ 16.4%8

Number of UK residents aged 65+ with dementia 783,0005

Facts

Number of available beds in UK care homes 545,863

Total occupied number of beds 420,0003

Occupancy rate 77%


Percentage of over 65s who occupy care beds 96.2%3

Number of population aged 65+ per available bed 194

Number of homes (residential and nursing) available for the over 65s in the UK 14,2817

Current UK average % of care home provision funded by Local Authorities 65%20

Figures

Average UK weekly cost (including extras) of residential care for people aged 65+ £5482

Average UK annual cost (including extras) of residential care for people aged 65+ £28,496

Estimated 2012 annual cost of care home provision to UK (total)

= Total Number of occupied beds (65+) (404,000) x cost of care provision (£28,496) £11,512,384,000

Total Directly related to Local Authorities (65% Funding)

Estimated 2012 annual cost of care home provision to UK (65% funding)

= *65% of number of occupied beds (262,600) x cost of care provision (£28,496) £7,483,049,600

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Care home provision 2020 – Based on anticipated 22% growth

Population of United Kingdom 67,400,0001

UK population aged 65+ 12,667,00018*

*22% growth – other calculations based on this

Percentage of population aged 65+ 18.8%8

Number of UK residents aged 65+ with dementia 958,89214

New CH beds required to keep occupancy at max 75% (the current rate) 134,13718

Facts

Total number of available beds in UK care homes 680,000

Projected total occupied number of beds (at 22% growth) 512,40018

Occupancy rate 75%


2012 Figure * 22%

Percentage of over 65s who occupy Care Beds 96.2%

Extra number of beds required for those aged 65+ between now and 2020 88,88018

Number of age 65+ population per available bed 194

Figures

Cost per new bed £62,2036

Total cost of new beds £8,343,723,811

= Number of new beds required (134,137) x cost of each new bed (£62,203)

Estimated 2020 annual cost (including extras) of residential care for people aged 65+ £30,5009

Estimated 2020 cost of additional care home provision (88,880) in UK total now-2020 £2,710,840,000

= Total Number of additional beds (88,880) x cost of care provision (£30,500)

Keeping 10% at home (8,888) £271,084,000

= Number to keep at home (8,888) x cost of care provision (£30,500)

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Final Figures

Estimated total cost of care home provision to UK between now and 2020 £11,054,563,811

= Additional funding (£2,710,840,000) + cost of new beds (£8,343,723,811)

Current £22,566,947,811

= (£11,054,563,811) + (11,512,384,000)

Total Savings between Now and 2020

Saving (now – 2020) keeping 10% of potential 65+ care home admissions (8,888) at home £271,084,000

= 10% of admissions (8,888) x cost of care (£30,500)

By keeping 10% of care home admissions at home, thus negating 8,888 new beds being built £552,860,264

= 10% of admissions (8,888) x cost of new beds (£62,203)

Totals

Estimated total saving by keeping 10% of potential care home admissions (8,888) at home £823,944,264

= Saving on bed building (£552,860,264) + saving on cost of care in those beds (£271,084,000)

Annual Savings between now and 2020

Annualised Saving (10%) £102,933,033

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Hospital provision – Current

Facts

Number of people aged 65+ in the UK 10,348,400

Estimated number of hospital beds in UK 140,44915

Total number of occupied beds 122,10821

Percentage of beds occupied 86.9%


Estimated percentage of hospital beds occupied by 65+ in UK 65%16

Figures



Estimated current cost of those aged 65+ to UK per year £7,387,362,750

(Total number of 65+ (79,370) x yearly cost of providing a bed (£93,075)

Hospital provision 2020 – Based on anticipated 22% growth

Facts

Projected population of people aged 65+ in UK 12,667,00018

Estimated number of hospital beds required to keep occupancy at 2012 rate (86.9%) 171,250

Projected total number of occupied beds 148,97223

Percentage of beds occupied 86.9%

(Based on 65+ occupying 65% of all occupied beds)

Estimated number of hospital beds occupied by 65+ (any given day) (at 65% total occupancy) 96,83118 22

Estimated percentage of hospital beds occupied by 65+ in UK 65%

(According to population growth statistics (22% growth between now-2020))

Number of extra beds required for population aged 65+ 17,461

Total number of new beds required 30,801

= Difference between 2020 and current

24

Figures



Cost per new hospital bed £400,00019

Projected total cost of building new beds required (30,801) £12,320,400,000

= Cost of building new beds (£400,000) x total new beds required (30,801)

Cost of providing hospital bed per year to additional beds (30,801) £2,866,803,075

= Cost of hospital bed per year (£93,075) x additional number of new beds required (30,801)

Total cost to above £15,187,203,075

Total Costs

Cost of building new hospital beds for additional 65+ (17,461) £6,984,400,000

= Cost of building new beds (400,000 x 17,461)

Projected additional cost providing beds to additional 65+ to UK (now-2020) £1,625,182,575

= Total number of additional beds required (17,461) x yearly cost of providing a bed (£93,075)

Total cost of additional 17,461 to UK £8,609,582,575

Keeping 10% at Home

Saving – negating need to build 1,746 new beds (10% of total hospital admissions) £698,400,000

= Cost of building new beds (£400,000 x 1,746)

Saving (between now and 2020) by keeping 10% of hospital admissions (1,746) at home £162,508,950

= Yearly cost of care (93,075) x 10% of admissions (1,746)

Total Saving £860,908,950

Annual Savings between Now and 2020

Annualised Saving (10%) £107,613,619

25

Community meals on wheels – The costs

Keeping People in their Homes: The Financial Benefits

Number of people to keep at home (10% of all hospital & LA care home admissions (now-2020)) 10,63412

UK Community Meals on Wheels Market

Existing number of meals delivered per annum (if known) 19,000,000

Current, proposed or target subsidy per meal £1.50

Additional people requiring MOW 86,130

Estimated number of meals per week 5

Additional meals required per annum 22,393,800

Estimated 2020 total meals per annum 41,393,800

Estimated additional 2020 annual MOW subsidy cost to United Kingdom £33,590,700

UK Community Meals on Wheels Market (Keeping Projected 10% at Home)

MOW subsidy current £28,500,000

MOW subsidy including current (by 2020) £32,647,260

Additional only MOW subsidy £4,147,260

Additional only MOW subsidy annualised £518,408

Total cost (now-2020) £275,162,68824

(MOW subsidy now (£28,500,000) + cumulative yearly additional subsidy (£518,408) for 8 years)

26

Totals

Savings

Care homes £860,908,950

Hospitals £823,944,264

Total £1,684,853,214

Costs

Community meals on wheels £275,162,688

Total £275,162,688

Net Saving £1,409,690,526 (Billion)(£1,684,853,214 – £275,162,688)

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Source data1. BINGHAM, J., 16th July 2012. Census 2011: one in six people in Britain now over 65 (online)

(viewed September 2012) Available from: http://www.telegraph.co.uk/earth/greenpolitics/population/9403470/Census-2011-one-in-six-people-in-Britain-now-over-65.html

2. BBC, 10th July 2012. Social Care – how the system works (online) (viewed September 2012) Available from: http://www.bbc.co.uk/news/health-18610954

3. MUIR, R., June 2012. The Long View – Public Services and Public Spending in 2030, Page 3. (online) (viewed July/August 2012) Available from: http://www.ippr.org/images/media/files/publication/2012/05/long-view-publicservices-spending-2030_June2012_9209.pdf

4. BUPA, February 2011. New report predicts shortfall of 100,000 care home beds by 2020 (online) (viewed January to September 2012) Available from: http://www.bupa.co.uk/individuals/care-homes/care-homes-news-2011/february-2011/new-report-predicts-shortfall-of-one-hundred-thousand-care-home-beds-by-twenty-twenty

5. INSTITUTE OF PUBLIC CARE, January 2011. People who pay for care: quantitative and qualitative analysis of self-funders in the social care market, Page 10 (online) (viewed 2012) Available from: http://ipc.brookes.ac.uk/publications/pdf/People_who_pay_for_care_- _report_12_1_11_final.pdf

6. IMISON, C., THOMPSON, J. & POTELIAKHOFF, E. August, 2012. Older people and emergency bed use – Exploring Variation, Page 2 (online) (Last viewed September 2012) Available from: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/older-people-and-emergency-bed-use-aug-2012.pdf http://www.kcl.ac.uk/sspp/departments/sshm/geront/study/ibsc.aspx

7. HARROP, A. 2011. Agenda for Later Life 2011 – Public Policy and an Ageing Society, Page 15 (online) (viewed August 2012) Available from: http://www.5050vision.com/images/pictures/documents/agenda-for-later-life-rep-ageuk-may-2011.pdf

8. IMISON C., August 2012. 2.3 million fewer overnight hospital stays needed if all areas perform as well as top 25% (online) (September 2012) Available from: http://www.kingsfund.org.uk/press/press-releases/23-million-fewer-overnight-hospital-stays-needed-if-all-areas-perform-well-top

9. RUSSELL, C. A., & ELIA, M., February 2011. Nutrition Screening Survey in the UK and Republic of Ireland in 2010 (A Report by the British Association for Parenteral and Enteral Nutrition (BAPEN)), Page 4 (online) (viewed August 2012) Available from: http://www.bapen.org.uk/pdfs/nsw/nsw10/nsw10-report.pdf

10. BROTHERTON, A., SIMMONDS N., & STROUD M., May 2010, Malnutrition Matters – Meeting Quality Standards in Nutritional Care, Page (i), (online) (September 2012) Available from: http://www.bapen.org.uk/pdfs/toolkit-for-commissioners.pdf

11. RUSSELL, C. A., & ELIA, M., February 2011. Nutrition Screening Survey in the UK and Republic of Ireland in 2010 (A Report by the British Association for Parenteral and Enteral Nutrition (BAPEN)), Page 1 (online) (viewed August 2012) Available from: http://www.bapen.org.uk/pdfs/nsw/nsw10/nsw10-report.pdf

12. BAPEN, 3rd June 2012. Malnutrition among Older People in the Community, (online) (September 2012) Available from: http://www.bapen.org.uk/professionals/publications-and-resources/bapen-reports/malnutrition-among-older-people-in-the-community

13. PR NEWSWIRE, September 14th 2012. Cost Relating to Malnutrition in Europe Exceed Those Associated with Obesity (online) (September 2012) Available from: http://www.prnewswire.co.uk/news-releases/costs-relating-to-malnutrition-in-europe-exceed-those-associated-with-obesity-169756846.html

14. BAPEN, 3rd June 2012. Combating Malnutrition: Recommendations for Action (online) (September 2012) Available from: http://www.bapen.org.uk/professionals/publications-and-resources/bapen-reports/combating-malnutrition-recommendations-for-action

15. HOSPITAL EPISODE STATISTICS, n.d. ‘Malnutrition data’ (online) (July 2012) Available from: http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=970

16. ALZHEIMER’S SOCIETY, 2012. Statistics (about Dementia) (online) (viewed September 2012) Available from: http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=341

17. ALZHEIMER’S SOCIETY, May 2012. Response to Nurse Education Commission, n. p. (online) (viewed September 2012) Available from: www.alzheimers.org.uk/site/scripts/download.php?fileID=1438

18. DEPARTMENT OF HEALTH, 3rd February 2009. Living well with dementia: A National Dementia Strategy, Page 34 (online) (Last viewed September 2012) Available from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_094051.pdf

19. AGE UK, 2012. Care in Crisis, Seven building blocks for reform, Page 2. (online) (viewed July 2012) Available from: http://www.ageuk.org.uk/Documents/EN-GB/Campaigns/Care_In_Crisis_Report_2012_pro.pdf?dtrk=true

20. MARTIN D., November 2011. Thousands of vulnerable elderly lose help they need to stay at home because of town hall cuts (online) (viewed December 2011-August 2012) Available from: http://www.dailymail.co.uk/news/article-2064066/Thousands-vulnerable-elderly-lose-help-need-stay-home.html

21. WILSON, L., March 2010. A report from a round table discussion on Personalisation and Community Meals Chaired by Baroness Greengross, Page 5 (online) (October 2012) Available from: http://www.ilcuk.org.uk/files/pdf_pdf_123.pdf

22. WRVS, May 2012. Ageing Across Europe, Page 5 (online) (viewed September 2012) Available from: http://www.wrvs.org.uk/Uploads/Documents/Reports%20and%20Reviews/ageing_across_europe_may24_2012.pdf

23. WRVS, May 2012. Ageing Across Europe, Page 44 (online) (viewed September 2012) Available from: http://www.wrvs.org.uk/Uploads/Documents/Reports%20and%20Reviews/ageing_across_europe_may24_2012.pdf

24. CAMPAIGN TO END LONELINESS, 2012. Loneliness Research (online) (viewed September 2012) Available from: http://www.campaigntoendloneliness.org.uk/information-on-loneliness/loneliness-research/

25. BROOKS, R., 15th November 2012. 3.5m older people don’t get help from neighbours (online) (November 2012) Available from: http://www.ageuk.org.uk/Latest-news/Archive/3-million-older-people-dont-get-help-or-company-from-their-neighbours/

26. HERTFORDSHIRE COMMUNITY MEALS, 2012. ‘Other Services’. *Full report available on request (online), (November 2012) Available from: http://hertscommunitymeals.co.uk/other-services.html

27. NATIONAL ASSOCIATION OF CARE CATERING, October 2012. NACC Launched Nutrition Standard To Help Older People Receive The Meals Service They Deserve – Press Release (online) (October 2012) Available from: http://www.thenacc.co.uk/assets/downloads/229/Nutrition%20Standards%20reminder%20release.pdf

28. Quotes taken from celebrity support of National Community Meals Week (October 2011 & October 2012)

Appendix source data 1. Population data taken from UK census 2011. UK population aged 65+ calculated from

these figures.

2. Weekly cost residential care provision taken from Dilnot Commission report on Commission on Funding of Care and Support.

3. Total number of care home beds in UK taken from BUPA Care Homes Annual report 2011.

4. Care home bed numbers based on dividing United Kingdom population aged 65+ by total number of UK beds available.

5. Data taken from Dementia 2012 – A report from the Alzheimer’s Society. N.B. This estimate (55%) is conservative as it is widely stipulated that over 68% of care home Residents live in care homes.

6. Construction cost of care home beds based on cost of recent developments divided by number of beds.

7. Malnutrition data taken from Age UK report on social care spending 2012.

8. Cost of malnutrition in United Kingdom taken from ‘Mind the Hunger Gap report’ by British Dietetic Association.

9. Average UK cost per hour and number of hours provision of Dom Care data taken from UK Home Care Association (UKHCA) summary paper July 2010.

10. Current meal volumes and subsidy data provided by existing MOW provider – where available.

11. A £1.50 Local Authority subsidy per meal is assumed where current data is not known.

12. For the purpose of this calculation it has been assumed that a MOW service, in conjunction with a Dom Care package, can play an integral role in reducing the number of care home and NHS admissions (for malnutrition) by 10%.

13. Growth figures taken from projected rate of Dementia to 2020 (from Dementia 2012 report.) Also based on population projections from ONS of 12,667,000 older people by 2020 compared with current population 10,348,400 (22% increase).

14. Estimated number of Dementia sufferers taken from percentage of older people over 65 currently (7.57%) vs. projected number of older people in 2020 as predicted by the ONS (12,667,000) thus 958,892. This number is backed up by Dementia UK predictions of 1,000,000 Dementia sufferers by 2021 at current growth rates – see above.

15. Number of hospital beds taken from Department of Health ‘Average daily number of available and occupied beds open overnight’ report.

16. Percentage of over 65s who occupy hospital beds taken from report by King’s College London on gerontology.

17. Taken from BBC Health study 2011 on bed blocking (http://www.bbc.co.uk/news/health-15198431). Weekly cost (£255x7) = £1,785. That figure multiplied by 52 to obtain yearly figure.

18. Population statistics 2020 based on projected 22% growth. 22% growth also used for: future care home admissions and new bed requirements and Future hospital admissions and new bed requirements (according to various projections.)

19. Cost of hospital Beds taken from cross section of 9 state of the art hospitals built over last five years – mean, median and average new bed cost across all hospitals was circa £400,000.

20. LA care provision taken from various sources including carehome.co.uk. Figure not directly relevant to savings

21. Source = Department of Health publication on number of beds v number of occupied beds 2011-12 ‘Average Daily Available and Occupied Beds Timeseries’ Accessed from: www.wp.dh.gov.uk

22. 65% of occupied number of beds (now & 2020)

23. Number of occupied beds 2020 based on current number of occupied beds + growth projections (22%)

24. Total MOW provision based on current spend (£28.5m) + additional meal subsidy per year (£518,408) cumulatively up to 2020 (28.5m + £518,408 + £518,408 + £518,408... etc)

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