title: Unpaid carers and unmet need for social care services in England
Creators: name: Brimblecombe, Nicola
Publisher: name: London School of Economics and Political Science (LSE)
Year: 2024

description: My study investigated inequalities in outcomes of providing care and unmet need for social care services in England from the perspective of unpaid carers. There are an estimated 5 million carers in England and Wales, many millions more worldwide. There are inequalities in who provides care by gender, ethnicity, and socio-economic status. Unmet need for social care services affects a substantial proportion of people in England and can constrain the lives of disabled and older people and the people providing care for them. However, carers are often missing from theory research on unmet need for care. Across four papers, my thesis addresses the following research questions: (i) How do the effects of higher intensity care provision vary among unpaid carers? (ii) What is the extent and nature of unmet need for social care services for disabled adults or older people and their co-resident unpaid carers? (iii) What are the consequences of unmet need for social care services for unpaid carers? (iv) What factors additionally contribute to unpaid carers having better or worse outcomes? My study takes an individual-structural and dyadic conceptual approach to studying unmet need for services. As such it recognises both the context of care provision and receipt, and the dyadic and inter-related nature of the caring relationship. The study design is mixed methods, although some analyses used one method only. Methods comprised secondary analysis of data from several waves of the United Kingdom Household Longitudinal Study and semi-structured in-depth interviews with unpaid carers. My research found that female carers caring for 10 or more hours a week or within the household have worse mental and physical health and lower earnings than male carers. Asian carers have lower earnings from paid employment than White carers. Carers with lower educational qualifications (a measure of social class) have worse mental and physical health than carers with higher qualifications, are less likely to be in paid employment, and have lower earnings when they are in paid employment (Paper 1). Male care recipients are less likely to receive services than female care recipients. Ethnic minority care recipients are less likely to receive any services or to receive services they perceive to be fully appropriate to their care needs. Care recipient-carer pairs living in lower income households or in more deprived areas are more likely to experience unmet need for services than higher income households or people living in less deprived areas respectively. Reasons for unmet need for services include perceived or actual ineligibility; lack of availability either overall or of appropriate services; low financial resources and unaffordability; and constrained and unconstrained choice (Paper 2). Unmet need for care services – services not being received at all or not adequately meeting care needs – is associated with negative outcomes for carers in a number of life domains: paid and voluntary employment, health, relationships, social and community participation, and leisure activities. These findings are reported in Paper 3. Lack of choice over whether or not services are received is associated with carers having poorer mental health, more difficult relationships with the people they care for, and less social connectedness. Other factors also impact carers. Lack of material resources and concerns about current and future financial situation are associated with poorer mental health and wellbeing for carers. Living conditions – high neighbourhood deprivation, low neighbourhood cohesion and living in rented accommodation – are also associated with poorer mental health and wellbeing for carers (Paper 4). In sum, my research shows that there are inequalities in the effects of providing care, inequalities in who receives support in the form of social care services, and variations in the effects of unmet need for services on carers. My research also shows that the nature of unmet need for care is nuanced and that this nuance matters; that the individual and structural context in which someone provides or receives care is important; and that including the presence, perspectives, and experiences of carers in conceptualisations and research on unmet need is crucial to fully understanding and addressing it. My research also shows that considering inequalities is fundamental to the study of social care and considering social care is fundamental to the study of inequalities.