Does public adult social care expenditure improve care-related quality of life in England?

Abstract: This study investigates the marginal productivity of changes in public adult social care (ASC) and long-term care (LTC) expenditure on care-related quality of life (CRQoL). Formal ASC in England is provided to support people experiencing difficulties with their activities of daily living and it is funded through a mix of public and private expenditure. We collect data on outcomes and characteristics of public ASC users, and on public ASC expenditure and characteristics of local authorities across England in 2017/18. We employ an instrumental variable approach using exogenous elements of the public funding system to estimate the effect of public ASC and LTC expenditure on users’ CRQoL. Our findings show that increasing public ASC or LTC expenditure by £1,000 per user generates 0.0031 or 0.0044 additional CRQoL, respectively. These results suggest that public ASC is effective in increasing users’ quality of life but only to a relatively small extent. Combined with other findings on the effect of ASC expenditure on mortality, this study can inform policy makers in the UK and around the world about whether social care provides good value for money. Moreover, our marginal productivity estimates will inform an assessment of opportunity costs in the social care sector to aid judgement about the cost-effectiveness of alternative services.