Project objectives

There is increasing emphasis in social policy on helping people who become carers during their working lives to combine paid work and unpaid care. However, many carers face barriers to remaining in employment. A key barrier is the difficulty many carers face in obtaining support and services for the person they care for. Revised eligibility criteria mean that there is a relatively new onus on local authorities in England to support carers in employment by providing social care services to the cared-for person.

However, little is known about the social care interventions that enable working carers to remain in employment. Moreover, it is not clear what the cost implications would be if local authorities were to intervene systematically to sustain carers in employment by providing services to the cared-for person. Considerable resources might be required, but the costs might be offset by gains elsewhere in the public sector, for example from reduced benefits claims and improved carers’ health.

This project sought to identify social care interventions by local authorities which would support working carers to remain in employment, and evaluate the costs of these interventions and their potential savings to the wider public sector.

Brief summary

Unpaid care and employment is a key policy issue in England. There has been growing emphasis on supporting people of working age with caring responsibilities to remain in work, if they wish to do so, and on ‘replacement care’ for the cared-for person. Obligatory guidance for local authorities in England on the eligibility criteria for adult social care states that, if a carer’s employment is, or will be, at risk, the local authority is likely to be required to provide services. This is consistent with the Law Commission’s report on Adult Social Care, which shows that local authorities are already required to provide services to meet the needs of carers under certain circumstances, one of which is when a carer’s employment is at risk.

The Overcoming Barriers (I) study was concerned with exploring the barriers faced by unpaid carers to remaining in employment. A key barrier is the problem many carers face in accessing social care for the person they care for. The emphasis of the study was on support for the cared-for person that would enable working carers to remain in employment and the potential economic benefits of providing that support.

Methods

The project was a 12-month scoping study which included a literature review, review of practice, consultation with key stakeholders, analysis of ELSA and the 2009/10 Survey of Carers in Households in England, and initial economic analysis.

Findings

The literature showed that there is a negative relationship between unpaid care and employment in Britain. There has long been uncertainty over the direction of this relationship, but there is now evidence that provision of unpaid care for 20 or more hours a week or on a co-resident basis negatively affects employment. The policy implication is that, since “caring keeps people from working, policy should focus on the provision of formal care” (Heitmueller 2007). However, the literature review also showed that access to services by people cared for by working carers in England was low. Services were likely to be accessed through Local Authority assessments of carers needs. However, in the 2009/10 Survey of Carers in Households in England, only 4% of carers working full-time, and 6% working part-time, had been offered an assessment or review. Moreover, when carers do receive an assessment, most are not asked if they wish to do paid work.

The study’s review of local authority practice, which drew on the Care Quality Commission’s Annual Performance Assessments, showed little evidence that councils systematically used services for the cared-for person as a means of supporting carers whose paid work was at risk. Potentially due to lack of support, many working carers leave employment. Based on secondary analysis of the 2009/10 Carers Survey and 2010 Office for National Statistics (ONS) population estimates, around 315,000 carers aged 16 to 64 in England have left employment to provide unpaid care and remain out of work (120,000 are men and 195,000 are women). These figures relate to the time when the Carers Survey was carried out in 2009/10. Since then, reductions in social care expenditure are likely to have reduced council support for working carers and may have increased the numbers leaving employment.

Moreover, the study found that the thresholds at which carers leave the labour market in England are lower than previously thought. Earlier studies have shown that care provided for 20 or more hours a week has an impact on employment (Carmichael et al. 2010). In this study, it was found that a key threshold at which carers aged 50 and over were at risk of losing their employment can occur when care is provided for 10 or more hours a week. Using the English Longitudinal Study of Ageing (ELSA) analyses looked at women and men, aged between 50 years and State Pension Age, who were initially employed and examined their employment status two years later. Caring is defined in terms of provision of care for 10 or more hours a week. Respondents were divided into three groups: ‘carers’ who were caring in the initial period; ‘new carers’ who did not provide care initially but did so two years later; and ‘continuing non-carers’ who were not caring initially or two years later. The results show that the employment rates of ‘carers’ and ‘new carers’ were lower after two years than those of ‘continuing non-carers’. These results were statistically significant for women who are ‘new carers’ and men who are ‘carers’. The differences between women and men carers are likely to be attributable to underlying gender differences in employment patterns.

Findings also suggest that the lower threshold at which caring affects employment applied to carers more widely. Using the 2009/10 Carers Survey, the study found that over 95 per cent of adult men and women, who have left work due to caring, provided care for 10 or more hours a week. Carers who leave the labour market are significantly more likely to care for 10 or more hours a week than either those in employment or other carers who are out of the labour market.

The public expenditure costs of carers leaving employment are substantial. Analysis of the2009/10 Carers Survey has shown that over a third of carers who have left employment to care were in households where Carers’ Allowance is claimed. This suggested that there are around 115,000 carers who have left work to care and were claiming Carers’ Allowance, at a cost of around £0.3 billion a year. Moreover, the research team estimated that lost tax revenues, based on foregone income and an average percentage of income that goes on tax of 17.8%, would be approximately £1.0 billion a year. This estimate was based on median weekly full-time earnings of £538 for men and £439 for women and part-time earnings of £142 for men and £157 for women (ONS 2010). It also assumed, based on the 2009/10 Carers Survey, that the full-time employment rate was the same for carers leaving employment as for carers currently in employment (82% of men, 39% of women).

If there was greater public investment in social care, such as `replacement care' to support working carers, and fewer carers left the labour market, then public spending on benefits would be lower and revenues from taxation would be higher. £1.3 billion constitutes 9 per cent of current public spending on adult social care in England (currently around £14.5 billion).

Gaps in evidence

Despite the increasing policy emphasis on ‘replacement care’, and the evidence to support it, this scoping study did not found any scientific (published, peer-reviewed) papers on theeffectiveness of services for the cared-for person as a means of supporting carers in employment in England. There was international literature on this issue, primarily from the US and Europe, but this literature is inconclusive and not necessarily applicable to England, owing to differences in labour market and community care conditions.

An underlying reason for this gap in evidence was that it reflected a gap in practice. As indicated earlier, the study’s findings showed that carers are at risk of leaving employment when care is provided for only 10 or more hours a week. However, the 2009/10 Personal Social Services Survey of Adult Carers in England suggested that the majority of carers known to councils care for 35 or more hours a week. Therefore councils were not generally in contact with large numbers of carers whose employment is at risk. This was consistent with the evidence of surveys showing unmet need for social care support among employed carers at the time of writing.

Conclusion

A key implication of the study was that there is a need for more evidence to support the development of policies around ‘replacement care’ for working carers in England. The study therefore suggested the need for further research.

References

1. Carmichael et al. (2010) Who will care? Journal of Health Economics, 29, 1, 182–90.
2. Heitmueller A (2007) The chicken or the egg? Journal of Health Economics, 26, 3, 536–59.
3. ONS (2010) Annual Survey of Hours and Earnings, Statistical Bulletin, London.

Plain English summary

The Overcoming Barriers (I) study was concerned with exploring the barriers faced by unpaid carers to remaining in employment. The emphasis of the study was on support for the cared-for person that would enable working carers to remain in employment and the potential economic benefits of providing that support.

The project was a 12-month scoping study which included a literature review, review of practice, consultation with key stakeholders, analysis of ELSA and the 2009/10 Survey of Carers in Households in England, and initial economic analysis.

This study identified several strands of evidence to support a policy emphasis on social care support for the cared-for person (‘replacement care’) as a means of supporting carers in employment. However, it has also identified some important gaps in evidence.

Key findings included:

• An estimated 315,000 unpaid carers aged 16 to 64 in England, predominantly women, have left full-time or part-time employment to provide care;
• A key threshold at which carers in England were at risk of leaving employment occurred when care is provided for 10 or more hours a week, a lower threshold than previously thought;
• The public expenditure costs of carers leaving employment were estimated at £1.3 billion a year, based on the costs of Carers Allowance and lost tax revenues on foregone incomes alone;
• Access to publicly-funded services by working carers is low, with only 4% of carers working full-time, and 6% working part-time, offered an assessment or review;
• There was little evidence that councils systematically used services for the cared-for person as a means of supporting carers whose employment was at risk;
• Councils targeted their support at people providing care for 35 hours a week or more and were therefore not in contact with large numbers of carers whose employment was at risk;
• Despite an increasing emphasis in government policy on ‘replacement care’, the study did not found any scientific papers on the effectiveness of services for the cared-for person (‘replacement care’) as a means of supporting working carers in England at the time of writing.

The study concluded that there was a need for further evidence to support the development of policies around ‘replacement care’ for working carers in England.

Dissemination

Published articles

1. King D,Pickard L (2013) When is a carer's employment at risk?: Longitudinal analysis of unpaid care and employment in midlife in England, Health and Social Care in the Community, 21, 3, 303-314.
   http://onlinelibrary.wiley.com/doi/10.1111/hsc.12018/full
2. Pickard L (2012) Public expenditure costs of carers leaving employment,LSE Health and Social Care Blog (25 April 2012).
   http://blogs.lse.ac.uk/healthandsocialcare/2012/04/25/dr-linda-pickard-public-expenditure-costs-of-carers-leaving-employment/
3. NIHR School for Social Care Research (2012) Overcoming barriers: Unpaid care and employment in England, Research Findings 10,NIHR School for Social Care Research, London.
   http://www.sscr.nihr.ac.uk/PDF/Findings/Findings_10_carers-employment_web.pdf

Presentations

1. LindaPickard, Overcoming barriers: unpaid care and employment. Findings from the scoping study,SSCR Annual Conference 2012, London, May 2012.
   http://www.lse.ac.uk/LSEHealthAndSocialCare/pdf/SSCRAnnualConfPresentations/Linda-Pickard.pdf
2. LindaPickard, Overcoming barriers: unpaid care and employment in England - the Scoping Study,SSCR Carers Research Workshop, London School of Economics, 7 November 2012.
   http://sscr.nihr.ac.uk/PDF/7NovWorkshop/7NovWorkshop-Linda-Pickard-scoping.pdf
3. Linda Pickard, Unpaid care and employment: overcoming barriers, ESRC Seminar series on Carers in the 21st Century: Developing the Evidence Base, University of York, 11 February 2013.

Public involvement

Carers and professionals were members of the project Advisory Group.

Impact

The research has contributed to the development of policy around unpaid care and employment. Some results from this study were posted by the research team on their organisational blog and almost immediately cited in more than 20 outlets, including the BBC news, the Guardian and Community Care, as well as in a policy document by Carers UK. Findings were shared by Treasury officials with their analysts, have been used extensively in policy and practice documents by HMG and Employers for Carers (2013), the Alzheimer’s Society (2013), King’s Fund (2013), West Sussex Public Health Research Unit (2013) and Carers UK (2012), and cited in the House of Commons during the second reading of the Care Bill. The work was utilised by Carers UK to demonstrate the costs of caring to the government  and has informed a number of their reports (such as their response to the King's Fund's Commission on the Future of Health and Social Care in England, a report on the case for care leave and the report of the Employers for Carers and Department of Health Task and Finish Group in 2012 on supporting working carers).

A key output of the scoping study was a further study funded by the NIHR School for Social Care Research with the objective of filling gaps in evidence by looking at, first, the effectiveness of formal social care in supporting working carers and, second, the needs of working carers for 'replacement care' and the costs of meeting them.

This project was funded by the National Institute for Health Research School for Social Care Research (project number T976/EM/LSE1).

Department of Health Disclaimer

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR School for Social Care Research, NIHR, NHS or the Department of Health.