Disabled children's health and social care: The funding gap widens

Families of disabled children face daily challenges that make life harder, and coronavirus has made this worse. Over 70% of disabled children are not able to access the same level of health and social care, as they did before the pandemic.

With support from the Disabled Children’s Partnership (DCP), we commissioned economic research to identify the funding gap for disabled children’s health and social care.

We want to add to existing evidence, showing why disabled children’s health and social care needs urgent investment.

• The projected funding gap for disabled children’s health and social care in 2019 to 2020 was between £1.86 and £2.26 billion.
• This is a minimum increase of £299 million from £1.6 billion in 2016 to 2017.
• Investing in disabled children’s health and social care now, will lead to improved community engagement, educational outcomes and employment opportunities for them in the longer term.
• Targeted investment would allow disabled children and their families to access services and support that are not currently being delivered consistently across local areas, such as respite care, therapies, rehabilitation support, provision of medicines and in-home support.
• Investment to address gaps in service delivery would also create the potential for net positive gains for public finances in the medium and longer term.
• Filling the funding gap in its entirety would generate even more value for money, particularly through tax revenues but also in terms of future savings in health and social care costs.
• Government must act now and invest in disabled children’s health and social care. If it doesn’t, it is likely that the funding gap will continue to grow.

The disabled children’s health and social care funding gap is the difference between the current expenditure on health and social care, and the level of expenditure needed to meet gaps in the provision of services.

In 2019 to 2020 the funding gap was projected to be £1.8 to £2.3 billion. At least a £299 million increase from 2016 to 17.

Disabled children and their families’ need for support has grown during the pandemic. And it is worrying that this has remained after lockdown has eased.

While many see a return to ‘normal’, families of disabled children are being left behind with delays to therapies, treatment, and respite. Leading to more acute needs in future.

The Government needs to improve its understanding of the impact of the pandemic on disabled children and their families. It can do this by better tracking and evaluation. It’s important the government acts on these findings to improve support. This should be included in the ‘Build Back Better’ agenda.

Scope and the DCP’s primary focus is to make sure disabled children and their families get the support they need when they need it. But there is also an economic reason too.

Surveys conducted by the DCP, confirmed that the coronavirus pandemic has made many of the challenges faced by disabled children and their families worse.

• 71% of disabled children have seen progress managing their condition. But overall development declined.
• 70% of disabled children are still unable to access the same level of service as before the pandemic.
• 9 in 10 disabled children and 6 in 10 parents remain socially isolated.

Freedom of information requests to local authorities and health service providers found:

• 7 in 10 NHS Trusts are failing to meet their targets for providing services such as physiotherapy.
• Over half of local authorities have failed to meet their targets for providing Education, Health and Care Plans (EHCP) assessments.
• 40% of local authorities have cut respite care for families. Despite the prevalence of relationship breakdown and social isolation in parents.

Analysis found that targeted investment to address the gaps in service delivery, would create the potential for net positive gains for public finances.

Filling the funding gap entirely would generate even more value for money, both through tax revenue and reducing future health and social care costs.

If the trends of 2019 to 2020 continue and the pandemic continues to have an impact, then this funding gap will continue to grow year on year.

Meeting disabled children’s health and social care needs

The economic analysis estimated a spend range that is required to meet the service needs of disabled children’s health and social care needs in England.

• An additional £465 million to £680 million yearly spend is required for social care services by local authorities.
• An additional £1.40 billion to £1.69 billion yearly spend is required by the NHS.
• A total of £1.86 billion to £2.36 billion yearly spend required for health and social care.

Local authority and healthcare service expenditure

To calculate these figures, both local authority expenditure and healthcare services expenditure on disabled children have been produced, using the best available data.

Local authorities

Total spending by local authorities on children’s social care services amounted to:

• £9.11 billion in 2019 to 2020
• £9.50 billion in 2020 to 2021

9.5% of the total spend on Children’s social care was for disabled children, amounting to:

• £954 million in 2019 to 2020
• £995 million in 2020 to 2021

Healthcare services

Health care services are defined as prescribed drugs, inpatient care, doctor (GP) contacts, Accident and Emergency visits and outpatient attendances.

Current health care services spend on disabled children is estimated at:

• £2.54 billion in 2019 to 2020
• £2.65 billion in 2020 to 2021

The total health and social care spend is:

• £3.5 billion in 2019 to 2020
• £3.64 billion in 2020 to 2021

Source: DCP survey design with Development Economics. Part of funding gap research in 2017 and a survey in August 2021.

We quantified the economic impact of investing in health and social care for families of disabled children, using a discounted cash flow model.

Our assessment is compliant with Her Majesty’s Treasury Green Book. This provides guidance on how to appraise and evaluate the impact of government policies, projects, and programmes.

We have assessed 2 scenarios over a 20-year period from 2021 to 2040:

1. Maintaining current levels of provision by person , for disabled children’s services.
2. Increasing service provision address the current gap in disabled children’s service, in full.

Scenario 1

Maintaining current provision would see a 6.78 billion cost. This is based on 2021 prices for health and social care.

Scenario 2

Increasing spending on disabled children’s services to address the current gap would amount to a cost of £15.43 billion. £8.64 billion more compared to scenario 1.

Scenario analysis results

The results of Scenario 2 demonstrate that addressing the funding gap for disabled children’s health and social care, would generate much greater levels of value for money.

The analysis reveals that the greatest share of value is associated with the link between support for health and social care services and the release of economic potential. This is through raised levels of disabled people in work.

This covers disabled children, as they enter adulthood and the workplace. And parent carers, particularly female parent carers.

The assessment is somewhat conservative, as it does not account for other costs such as:

• The cost of entering care, or
• family breakdown

We are not devaluing these issues and suggest that this means the figures are an under-estimate.

The 2019 to 2020 funding gap analysis was completed along similar lines to the method used in the 2017 study. Part of the DCP’s #GiveItBack campaign. This update involved the following.

A thorough literature and data review

This review established the current health and social care services spend on disabled children. This included gathering up to date estimates of the number of disabled children across 6 conditions.

• Mental health
• Autistic spectrum disorder
• Life-limiting or life-threatening conditions
• Learning disabilities
• Vision and Health impairments

And the most up to date spend data across these conditions, including government published data and data from University and independent research papers.

Analysis of DCP survey 2017 and short questionnaire 2021

This assessed current Council and Clinical Commissioning Group (CCG) spend on health and social care services in England. And the proportional decrease or increase in spend required by local authorities and the NHS to meet the need.

The short questionnaire took place in August of 2021 and was sent to DCP members.