Association for Public Policy Analysis & Management

The increasing demands for healthcare and pension provision generated by growing older populations worldwide are a familiar story. Corresponding increases in needs for personal care – help with activities of daily living – are less widely discussed. At the same time, additional pressures are being exerted by the increasing complexity of the needs of the working age disabled population: a greater proportion have recognised mental health needs, and a larger proportion of children with complex needs including learning disability are surviving into adulthood. Needs for help with personal care among both older and working age people may be met by a combination of formal services (public and private), and unpaid (or ‘informal’) family care, but this patchwork can leave a significant proportion of needs unmet. This paper investigates who is at risk of having unmet needs for personal care, in the context of retrenchment in publicly provided services.  It begins by mapping differences between OECD countries in the balance between formal and informal care, before giving a more detailed breakdown of the provision of public and private services and unpaid care in England. Analysis of data from three years of the Family Resources Survey between 2007/8 and 2013/14 reveals reductions in formal services especially for people with moderate need, increasing pressure on unpaid carers, and high levels of unmet need. We also investigate risk of unmet need by gender, age, household composition, type of disability and household income. The paper concludes that while unpaid care can to some extent expand to fill some of the gap left by cuts in public services, not all older or working age disabled people are protected in this way, and the twin pressures of a growing population with personal care needs and reductions in public services are likely to produce an increasing mismatch between needs and provision.