Census Microdata: findings and futures - 2008

Geography of Unpaid Caring in

England & Wales

Paul Norman1 and Kingsley Purdam2

(1.) School of Geography, University of Leeds; (2.) CCSR, University of Manchester

Unpaid Caring

• A person is a provider of “unpaid care” if they give any help or support to family members, friends, neighbours or others because of long-term physical or mental health or disability, or problems related to old age

• It is estimated that there are over 6 million unpaid carers in the UK of whom 1.7 million provide over 20 hours of care per week (2001 Census)

• Economic Value of unpaid care. £87 billion, equivalent to £15,200 for every carer - (Buckner and Yeandle 2007)

• The UK is increasingly becoming on older society as a consequence of declining birth and death rates. The number of unpaid carers may need to double within a generation.

• The primary statutory responsibility for caring for people with care needs lies with the LA and specifically the social services department which has to assess a person’s needs and ensure that services are put in place. This is supported by central government funding including the annual Carers Grant.

• Every LA in England uses a national framework from the Department of Health to decide the eligibility criteria for the adult social care services it provides. At present LAs assess care according to four eligibility bands - Critical, Substantial, Moderate and Low - under review.

• Within an LA decisions on eligibility and services to people with similar care needs should be made in order to achieve similar outcomes, but this is not a requirement across different LAs. Different LAs have to take account of the resources locally allocated to adult social care (DH 2003)!

• The actual care is provided through a LA social services department in partnership with PCTs, GPs, the voluntary sector and private sector providers.

• Our focus is on the question of who is doing the caring in terms of age, gender, social class, household composition and by LA/PCT. The findings inform the debates about access to services and the nature and recognition of caring.

Recent Government Policy in Relation to Carers and Caring

• Government’s new ten year plan for carers - 'Carers at the heart of 21st Century families and communities'. (DH June 2008).

• New Deal for Carers (2006)

Emergency cover if carer ill; training for carers

• Review of entitlement criteria for those in need of care (2008)

• Work and Families Act 2006. Extended the right to request flexible working to employees who care for an adult. 2010 -National Insurance credit for carers.

Shift to the individual

Individual care plans and control over budget for those in need of care -

Independent Living Strategy (2007) and Putting People First (2007)

(i) Shift of emphasis to home care:

“the best environment for the person being looked after is very often their own home. The strategy aims to support people and their carers in their own homes and communities wherever possible” (DH 2008).

Public Service Agreement - target to increase the proportion of older

people treated at home

(ii) Introduction of Personal Budgets

Allocation of social care resources to individuals who may choose to spend it as they wish rather than decisions being taken by their social worker (Putting People First 2007).

Individuals are still means tested prior to being allocated funds in relation

personal budgets. Currently, in England the state will only provide

assistance with residential care bills for people with assets worth less than

£12,000. Though this is under review.

(iii) Mental Capacity Act 2005 protects individuals right to decide their

own care. People should be given as much help as possible to make their own

decisions.

Care questions in large scale surveys and

administrative data

SurveysCensus, General Household Survey (2000 Carers Module), British Household Panel Survey, Family Resources Survey, National Survey of Voluntary Activity (1997), Younger Carers in the UK (1995, 1997, 2004), Time Use Survey.

Other surveys - local authorities, Princess Royal Trust for Carers, Carers UK.

Administration dataCarers Allowance Benefit - claimant rates Work and Pensions Longitudinal Study (100% data); Carers Addition to Pension Credit

NHS Returns hours of care provided by Councils with Social Services Responsibilities - HH1 - Adult Social Services Statistics

Referrals, Assessments and Packages of Care (RAP) - compares money spent on different types of provision and different client groups by each local authority.

Best Value

Care question in 2001 Census

• Area tables enable small area geographical analysis

• SARs allow covariates

• SAM enables medium level geography and covariates

Current Knowledge

• Overall women are more likely to be unpaid carers than males. 1/5th of women aged between 60 and 64 are unpaid carers. However, amongst the older old (75+) this changes round and men are more likely to be carers (Buckner and Yeandle 2005; Young, Grundy and Kalogirou 2005)

• Many young people are carers. Over half of young carers live in one parent families (Dearden and Becker 2004).

• As age increases so does the amount of care unpaid carers provide (Buckner and Yeandle 2005)

• One in five carers gives up work to care (EOC 2005).

• Carers providing high levels of unpaid care are more likely to be in poor health and have a LLTI than non carers of the same age. Poor health is independently associated with care provision, after control for socio-economic factors. (Young, Grundy and Kalogirou 2005). Care giving can lead to deteriorating health

Current Knowledge

• Correlation of unpaid caring with deprivation (Hutton 2002; Young, Grundy and Kalogirou 2005; Shaw and Dorling 2004)

• Inverse care law - fewer medical practitioners in areas where LLTI is higher and where unpaid (and untrained) caring is higher (Shaw and Dorling 2004)

• Variations in caring by ethnicity. After control for age, sex and socio-economic variables, strong differences by ethnic group in propensity to provide care. Bangladeshi, Pakistani and Indian ethnic groups significantly more likely to provide care than the majority White ethnic group (Young, Grundy and Kalogirou 2005)

• Geographic variations have been identified after standardising for age, gender and health and socio-economic status (Young, Grundy and Kalogirou 2005; Shaw and Dorling 2004)

• Strong relationship between level of caring and level of limiting long-term illness (Young, Grundy and Kalogirou 2005)

Methodological approach2001 Census SAMs aggregated to Primary Care Trust

Approach - Differentiate between whether:• People are caring when somebody ill within the household• People caring when nobody ill within the household

Health-relevant geography• Primary Care Trusts in England & Health Boards in Wales• One-to-one or aggregated LAs• (Birmingham as a whole & City of London with Westminster)

2001 HH1 Returns - aggregate number of hours of care provided in one week at LA level.

Qualitative interviews with key agencies and care providers

Unpaid Caring: all

Correlation= 0.53

Modelled odds of unpaid caringOutcome variable:

• Did / Did not care for somebody

Explanatory variables:

• Age, Sex, Ethnic group, Religion

• NS-SEC, Qualifications, House type, Area type

Models for:

• Caring within the household

• Caring outside the household

Whether:

a.) Cares or b.) Cares 20+ hours per week

Modelled odds of unpaid caring

0.50

0.75

1.00

1.25

1.50

Within the household Outside the household

Od

ds

ra

tio

Males Females

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Within the household Outside the household

Od

ds

ra

tio

16-29 30-39 40-49 50-59 60-74 75+

Modelled odds of unpaid caring

0.00

1.00

2.00

3.00

4.00

5.00

Within the household Outside the household

Od

ds

ra

tio

Large employers & higherprofessonal occupations

Lower managerial andprofessional occupations

Intermediate occupations

Small employers and ownaccount workers

Lower supervisory andtechnical occupations

Semi-routine

Routine occupations

Never worked, LT unem &N/A

0.50

0.75

1.00

1.25

1.50

Within the household Outside the household

Od

ds

ra

tio

No & other qualifications Level 1 Level 2 Level 3 Level 4/5

Modelled odds of unpaid caring

0.00

0.50

1.00

1.50

2.00

Within the household Outside the household

Od

ds

ra

tio

White

Indian

Pakistani & other South Asian

Chinese

Black groups

Mixed & Other

0.50

0.75

1.00

1.25

1.50

Within the household Outside the household

Od

ds

ra

tio

Detached or Semi-detached Terraced house Flats & others

Modelled odds of unpaid caring

0.50

0.75

1.00

1.25

1.50

Within the household Outside the household

Od

ds

ra

tio

Cities and Services London Suburbs London Centre

London Cosmopolitan Prospering UK Coastal and Countryside

Mining and Manufacturing

Unpaid Caring: IN households

Correlation= 0.77

Unpaid Caring: OUTSIDE household

Correlation= -0.43

Conclusions

Modelled odds of unpaid caring (& similar for 20+ hours)

Despite similarities in models, very different geography

Care falls to

• Females

• Aged 40-75

• Tendency towards lower NS-SECs & less qualified

• South Asian groups more than others

• House type influential

• Area type relates to levels of LLTI

Different geographies of care within & outside household

Policy Implications and Further ResearchCaring increasingly important issue in relation to the UK’s ageing population. Not only for those who may need care but for family members and society as a whole.

For those who don’t live close to their relatives concerns about governments shift to individual care and independent living

Different demands on LAs and other service providers from carers and those they are caring for

Research challenges: Measurement issues - people who do not recognise what they do as caring; people who don’t take up care even if they need it; people who state they need care but are not given access to it as a result of a care entitlement decision or means testing; people who don’t have family or relatives able/willing to help

Next steps combine admin (HH1 over time) and SAM data. Qualitative work with key agencies.

2011 census - Care question will go ahead! It was under threat due to proposed reduction in length of questionnaire. “Keep Counting Carers” campaign - Carers UK

% Individuals (aged 40+) providing care who don’t have LLTI but where there is a household member with LLTI

(2001 SAM, England)

Top and bottom five LAs

Rank LA % providing care % providing 1-19 hrs % providing 20-49 hrs % providing 50+ hrs1 Blyth Valley 41.50% 13.20% 7.00% 21.30%2 Cannock Chase 41.20% 18.30% 6.70% 16.20%3 Kerrier 41.10% 16.40% 7.00% 17.80%4 Hartlepool 41.00% 14.20% 8.30% 18.50%5 Staffordshire Moorlands 40.70% 20.10% 3.70% 16.90%

348 Hackney 26.70% 11.00% 3.70% 12.00%349 Richmondshire 26.00% 8.90% 6.20% 11.00%350 Haringey 25.20% 11.30% 3.80% 10.20%351 Kensington & Chelsea 23.40% 12.60% 1.80% 8.90%352 Alnwick 19.80% 7.90% 4.80% 7.10%

Why differences - individual preferences? Carers and/or LAs provision?

HH1 return 2001. Average hours of care provided by LA in one week: Hartlepool - 7,580 hrs (850 households); Kensington & Chelsea 11,810 hrs (1,470 households). Both below average hrs provided by an LA in a week- 19,439 hrs. (147 LA’s).