Many thanks to great co-authors @andersb-m.bsky.social @catherineneedham.bsky.social and Michelle Degli Esposti

And many thanks to our funders @nuffieldfoundation.org

All feedback welcome :)

Our case for change is quite simple: the system doesn't function well for anyone.

A different funding model can simultaneously provide more equitable outcomes whilst preventing extortionate costs for people self-funding.

We argue that

"Beyond these statistics lies a profound human impact: those who cannot afford to self-fund from the outset will have often have no choice but to live in struggling homes simply because they cannot afford to pay."

We also show that state-funded residents live in worse quality care homes across the board - with largest inequalities in the richest areas.

We show that in England the best homes open in the richest places...

... It's almost exactly the opposite for the worst quality homes.

And happy to share my experiences working with Anders for anyone thinking of applying.

Full paper available open access here: academic.oup.com/ageing/artic...

cc: @weownit.org.uk

With many thanks to @nuffieldfoundation.org for funding the study.

You can read more of our studies on our previous project page:

www.nuffieldfoundation.org/project/evid...

Published with @andersb-m.bsky.social + Michelle Degli Esposti + Christine Corlet Walker

At @blavatnikschool.bsky.social + @lse-sticerd-case.bsky.social

cc: @camille-oung.bsky.social , @gerisoc.bsky.social , @nataliegreenpeer.bsky.social , @skinnock.bsky.social

We conclude that the combined system of:

1) Two-tiered funding
2) Under resourcing of state-funded services
3) Outsourcing of care provision

Means that care is unequally provided between people and areas with wealth vs without.

The Casey Commission should consider all three of these features.

Secondly, we show that the "ownership gap" in care quality - a widely shown phenomenon of for-profit care homes being worse quality than other kinds - is only true in England when care homes are providing care for state-funded residents.

Firstly, our research reveals that a problem area for care quality might be for-profit care homes serving state-funded residents.

These are the homes most likely to be rated poorly by inspectors - a potential big concern for Local Authorities paying for these services, and the residents.

We find that the probability of a care home being rated as good or outstanding is dependent on the number of self-funded residents they care for (x axis in figure = % self-funders).

This is particularly true in for-profit care homes.

This has several large implications...

We analyse over 350,000 care home residents in England, their funding status, and what that means for the quality of care homes they live in.

We show that self-funded residents live in the richest areas, and are disproportionately in for-profit care homes in the richest areas.

You can read our press release from @blavatnikschool.bsky.social here:

www.bsg.ox.ac.uk/news/outsour...