Background Across the UK today, an estimated 6.8 million people are carers, supporting friends and family who are older, disabled or seriously ill. The economic value of informal carers contributions is an estimated £132 billion a year. This is calculated by multiplying the total hours of care provided by carers (using responses from the ‘Personal Social Services Survey of Adult Carers in England 2014–15’ to determine numbers of carers and average hours of care provided) by the unit cost of an hour of replacement homecare for an adult (£17.20). This assumes informal carers provide substitution for formal care. Reliance on carers appears to be increasing, with fewer people getting access to formal support as a result of local authority budget cuts.

This study aimed to understand if people with a carer have different levels of service use across different settings of care when compared to those who do not have a carer but have similar characteristics.

Methods A quantitative study using person-level data in Barking and Dagenham (B&D), a London borough, to assess the impact of having a carer in terms of the differences in cost-weighted utilisation relative to a matched control group. Nearest neighbour matching was used, matching on age, gender, ethnicity, deprivation, BMI category, smoking status, the number of long-term conditions, the prevalence of 16 conditions, housing tenure, benefits received and housing occupancy.

Results For the adult residents of B&D between 1st April 2016 and 31st March 2017, health and care costs were £2,662 (CI £1,595, £3,729) higher for people registered in their primary care records to have a carer (n=1,295) compared to a matched cohort of adults who were not registered as having a carer. Social care accounted for the majority of this difference (39%).

Conclusion The increased costs across all settings of care suggest that informal carers do not provide care substitution or, at least, that additional service use induced by the carer may dominate any substitution effect. There is an opportunity to provide bespoke training and education to informal carers and identify interventions that could support more care substitution.

For people who have a carer, such support may be a key element in enabling them to access services and, as such, there may be wider inequalities in access to services for people without a carer. In a society that is ageing with projections suggesting that there will be more people without carers in the future, these inequalities need to be addressed.