Response to the Dilnot Commission

Sam Barker, our Head of Family Policy, was on BBC Radio Cambridgeshire this morning talking about a relational view of the Dilnot Commission and its background.

Commenting on the Dilnot Commission, Michael Trend, Executive Director of the Relationships Foundation said:

“Dilnot’s clarity on the financial implications of social care reform is welcome, as is his focus on individuals and their families throughout the report.

“But it is disappointing that he makes no mention of the unique pressures the UK faces because of our high level of family breakdown. Older people, fathers particularly, who separate from the spouse are less likely to receive informal care, and less likely to have the assets to pay for care.”

“David Cameron has rightly talked about the need to strengthen couple relationships in society: all departments, not least the Department of health, need to take this aspiration seriously if they want to deliver on their goals.

At the launch of the recent OECD report Help Wanted? Providing and Paying for Long-Term Care, Edward Whitehouse, the OECD’s head of pensions policy analysis, made the point that the UK has unique pressures compared with other European Countries because smaller and more complex families meant there would be fewer people to provide informal care to frail relatives in future. He pointed out that more than 12% of British children live in step families, compared with an OECD average of 8%, and there are more single parents.

The Dilnot consultation expected informal caring to continue to play a significant role in the future of social care, but made no mention of the implications of family breakdown.

A reduction in the number of couples living together has some implications for the ability to care, large implications for the ability to pay for care, and some implications for morbidity. Relationships Foundation contends that family breakdown is not inevitable, and that action to reduce the pressures on families, and to strengthen relationships, will reap dividends for a variety of social and economic outcomes, not least in long term care.

Key Questions

What assumptions do the Dilnot recommendations make about the stability of families in the future?

(Why) does Dilnot (not) recommend actions to strengthen families?

Key Facts

· 59% of the population was married or cohabiting in 2008: by 2033 this will drop to 56%, and more beyond.

· 8% of care home admissions are due to family breakdown

· 20% of people have neither a ‘satisfactory friendship network’ nor a ‘satisfactory relatives network’, and 17 per cent of the older population living alone are lonely and lack opportunities for social participation.

· British Families are the third most pressured in Europe

· More than 40% of single people have no housing wealth to release, compared with only 10% of couples. The median non-housing and non-pension wealth of couples is 3 to 4 times greater than that of single people, and weekly income more than double.

· Stable relationships may deliver a health dividend of similar size to giving up smoking. It seems they also delay dementia.

· Family Breakdown is not inevitable. Reducing macro pressures would help families stick together, as would developing preventative and crisis relationships education.

Briefing

The scale of breakdown in the UK

Nearly 48% of children born today will see their parents split by their 16th birthday. (CSJ)

Britain has one of the highest divorce rates in Europe and the largest percentage of people in any European nation who have been divorced (around one in six adults).(i)

According to ONS projections:

59% of the population was married or cohabiting in 2008: by 2033 this will drop to 56%.
There is a particular problem for men: in 2008, 72% of men over 65 were in a partnership, by 2033 this is projected to drop to 67%.
Divorced fathers also fare particularly badly when it comes to being cared for by their children: their children are less likely to give financial assistance to them (ii) and less willing to let a sick or ageing father live with them.(iii)
Whilst the proportion over 65 in a partnership will rise slightly, from 57% in 2008 to 58% in 2033, the real worry is in the generation behind this (45-64: the current 22-42 bracket), where partnerships will fall from 76% to 69%. Not only does this reduce spousal care, it will potentially reduce the number of children who can care for their parents, and certainly reduce the number of parents able to care for adult children with social care needs.(iv)

Derek Wanless’ magisterial 2006 review of social care found that 8% of care home admissions are due to family breakdown (it also found 38% of care home admissions are due to stress on carers). (v)

Implications for ability to care

Most informal care for older people in England is provided either by partners or adult children. (vi) Relationship breakdown removes partners from the picture. It can damage relationships between parents (notably fathers) and children who might care. Relationships breakdown amongst carers is also an issue: the OECD has pointed out that carers are more likely to be home makers, and less likely to be employed.

The previous government recognised the value of spousal care in their care and support green paper: ‘We could look at providing a lower rate for couples because the costs for two people can be very high and many couples support each other and provide care for each other. However, if we did this, we would need to make the contributions higher for single people. This is an issue we would like to explore during the debate.’ (vii)

According to a 2008 NOP poll, two thirds of adults (63 per cent) – excluding those who are already receiving social care – think they will seek help from family or friends, if they find themselves in need of social care when they are older. (viii) But our wider and intergenerational family relationships, and broader community relationships are also breaking down. The General Household Survey reports that 20% of people have neither a ‘satisfactory friendship network’ nor a ‘satisfactory relatives network’, and the ESRC Growing Older programme found that up to 17 per cent of the older population living alone could be described as lonely and lacking opportunities for social participation. (ix) This is not just a human tragedy, it is crucial to providing the very low level care that is most effective. As far back as 1963, Peter Townsend, in his seminal study of ‘working-class Bethnal Green’ The Family Life of Old People argued that: ‘The poorest people, not only financially, were those without an active family life. They had fewest resources in time of need’. (x)

As Relationships Foundation’s Family Pressure Gauge found, British Families are the third most pressured in Europe. Lengthening working hours, rising debt levels, and very high housing costs will all reduce the ability of people to provide informal care – they will have to seek paid work instead. Finally, a mobile labour force and less rooted society is likely to see children moving too far away from parents to care for them.(xi) The Government has said little about co-location – families living near one another: this is in contrast to, for example, Singapore where married children or elderly parents in the social housing sector, who apply to live near each other, receive increased housing grants and a reduced waiting time for social housing. (xii)

Pickard 2008 does find on General Household Survey data that ‘Married people were significantly less likely to provide intergenerational care than single people in all years except 1995, with the likelihood of married people providing care being only around half that of single people,’ however, it is unclear whether this accurately predicts the future, given the likely expansion in demand and the increase of women in the labour market.

Pickard et al 2007 note “An increase in numbers of married/cohabiting people, therefore, whilst not changing projected demand for informal care as a whole, reduces demand for informal care from sources other than partners and, in particular, reduces demand for care from children.” She does go on to note that “very large increases in numbers of married/cohabiting older people are needed to effect comparatively modest reductions in demand for care by children,” suggesting that nearly a million more people would need to be in couples by 2031 to reduce demand on children by 130,000. (xiii)

Unsustainable levels of informal care can also take their toll on relationships. A survey of 3,500 carers undertaken by the Princess Royal Trust for Carers in 2007 found that one of the most difficult challenges carers have to cope with is the impact on their relationships. Two thirds (66%) of those surveyed said their relationships had suffered as a result of their caring responsibilities. These effects are both emotional and physical, with six in ten reporting that they had little quality time with their partners and a similar number saying that their sex lives had taken a back seat directly as a result of their caring role. When carers did get time to relax, more than a fifth used it to catch up on their sleep.

Implications for ability to pay.

The Wanless review notes, using data from the IFS’s English Longditudinal Study of Aging that ‘more than 40 per cent approximately of single people have no housing wealth to release’ compared with only 10% of couples and ‘couples have significantly more housing wealth than single people’ (pp. 107-115 & 243). (xiv) The median non-housing and non-pension wealth of couples is 3 to 4 times greater than that of single people (IFS tables 16-18), and weekly income more than double (IFS Table 9).

Age	50-59		60-74		75+
Housing Wealth	Mean	Median	Mean	Median	Mean	Median
Single Man	67.7	38.0	67.7	40.0	67.2	35.0
Single Woman	74.0	42.5	87.4	65.0	74.7	43.0
Couple	148.5	120.0	143.9	140.0	117.7	100.0

Adapted from IFS adaption of ELSA data for Wanless here pp. 45-46

Implications for morbidity

Stable families can deliver health gains. Controlling for selection, people in stable relationships tend to be healthier: In 2005, researchers at UEA, Warwick and Harvard suggested ‘The size of the health gain from marriage is remarkable. It may be as large as the benefit from giving up smoking.’ (xv)

A 2009 study published in the BMJ found that stable couples experience delay in the onset of dementia: it said ‘People cohabiting with a partner in mid-life (mean age 50.4) were less likely than all other categories (single, separated, or widowed) to show cognitive impairment later in life at ages 65-79) (xvi)

Family breakdown is not inevitable

Research evidence shows that couple relationships can be strengthened and breakdown can be prevented. (xvii)

Relationships Education, like marriage preparation courses, or Let’s Stick Together, a programme delivered to new mums in Bristol, can help couples go the distance. The evidence is nascent, but positive. For example, a recent study from the University of Denver found that one year after receiving relationships education, couples had 1/3 the rate of divorce of a control group (1102 couples approached, 248 were given the intervention, with 228 in the control group)

The latest Growing up in Scotland report goes so far as to recommend that relationships support be available on the NHS there (p.56).

In his book, The Hidden Wealth of Nations, David Halpern, now head of the Government’s ‘Nudge Unit’ said: ‘More active policies to support stable family formation must be a high priority for future policymakers’. He went on to note (pp.168-169):

‘research shows that relationship failure can often be highly accurately predicted’

‘There are a myriad of practical and political problems about the state getting involved in such personal relationships, but if you are interested in equitable outcomes for kids, someone will have to. Free, evidence-based advice (we should all take the negative-to-positive test if we had any sense!); parenting classes; and intensive support programmes such as the nurse family partnership for the most at risk are all strong candidates.’

Additionally, as Relationships Foundation’s Family Pressure Gauge found, British Families are the third most pressured in Europe. This is despite a commitment from the Government to make us the most family friendly country in the world. (xviii) The greatest pressures are financial, with household debt (excluding mortgages), childcare costs and living costs pushing us to the very top of the table. 1.5 million families (20.9%) experience “difficulty” of “great difficulty” in making ends meet make up 20.9% of the total population. 14% experience ‘highly critical’ debt burdens, the highest in Europe, and compared with 1% of Swedish, Finnish and Norwegian households. Childcare costs represent 23.5% of family income, twice the percentage for French families, three times that for German families and four times the percentage for families in Sweden. We also work some of the longest and most unsocial hours in Europe.

Money worries are a major source of argument and relationship conflict. A 2006 survey for the FSA found that over a third (35%) of British couples are kept awake at night worrying about their money situation and over a quarter (27%) of couples regularly argue when they try to discuss their finances. (xix) One in twelve households have experienced relationship problems as a result of financial difficulties. (xx) The Government’s Foresight Report into mental wellbeing suggested that debt is a much stronger risk factor for mental disorder than low income (p. 19).

There is much that could be done to reduce pressure on families.

N.B. Relationships Foundation is not a provider of relationships support, and has no financial interest in it.

For further information, please contact John Ashcroft, Research Director: 01223 909 408 j.ashcroft@relationshipsfoundation-org.stackstaging.com

The Relationships Foundation, established in 1993, is a Cambridge-based independent think tank seeking a better connected society. It studies the effect that culture, business and government have on relationships. It proposes new ideas for strengthening social connections, campaigns on issues where relationships are being undermined, and trains and equips people to think relationally for themselves. It is a company limited by guarantee registered in England and Wales (no. 5191052) and a registered charity (no. 1106460).

Appendix 1: Wider implications of family breakdown for the health service

The Relationships Foundation’s Cost of Family Failure report puts the cost of family breakdown to the Health and Social Care sector at £10.65 billion p.a. (equivalent to nearly 10% of the NHS bill), comprising £5.30bn on physical health, £1.56bn on Mental health and £3.79 on social services and care.

Divorced men and women are about 35% more likely to consult their GPs than those who are married. (xxi)

Divorcees of both sexes are more likely to smoke than married people. (xxii)

Over three times as many divorced men as married men reported drinking in excess of 50 units of alcohol per week. (xxiii)

Divorced men report the highest rate of unsafe sex, as measured by multiple partnerships and the lack of condom use. (xxiv) Surprisingly cohabiting men engage in slightly higher rates of unsafe sex than single men. Both have much higher rates than married men. (xxv)

Relationship breakdown is associated with poor mental health: and both impact child outcomes. (xxvi)

The Children’s Society’s The Good Childhood Inquiry found the primary cause of mental health problems in children to be family breakdown. (xxvii) Accounting for demographic factors, children from single parent households are twice as likely to be unhappy, have low self-esteem or mental health problems. (xxviii) A survey for the Office for National Statistics carried out in 1999 found that children of lone parents were approximately twice as likely to have a mental disorder as the children of married or cohabiting parents, at 16% and 8% respectively. (xxix)

Children of divorced parents are 50% more likely to be admitted to hospital (xxx) or to suffer accidental injury or poisoning than children whose parents are not divorced. (xxxi)

The Exeter Family Study compared 76 intact families with 76 families reordered by separation or divorce, matching them for age and gender and socio-economic background. There were 27 children with three or more current health problems in the reordered families compared with only nine for those in intact families. Those who had experienced multiple family disruptions reported the most problems.

[i] European Social Survey (2006) Scope: all persons aged 15 and over resident within private households.

[ii] Furstenberg, F., Hoffman, S. And Shrestha, L. (1995), “The effect of divorce on intergenerational transfers: New evidence”, Demography, 32(3): 319-33.

[iii] Goldscheider, F.K. and Lawton, L. (1998), “Family experiences and the erosion of support for intergenerational coresidence”, Journal of Marriage and the Family, 60(3): 623-32.

[iv] A PRSSU paper makes the point that ‘A decline in marriage/partnerships among people in this age-group is particularly important because people in mid-life have a higher probability of providing care than those in other age-groups.’ Pickard L (2008), Informal Care for Younger Adults in England: Current Provision and Issues in Future Supply, England 2005-2041

[v] Data from the Wanless Review of Social Care, p.33:

TABLE 2: REASONS FOR ADMISSION OF OLDER PEOPLE TO CARE HOMES AS GIVEN BY SOCIAL WORKER, 1996

Reason for admission	Percentage
Physical health problems	69
Mental health problems	43
Functional disablement	42
Stress on carers	38
Lack of motivation	22
Present home physically unsuitable	15
Family breakdown (including loss of carer)	8
Need for rehabilitation	6
Fear of being the victim of crime	4
Abuse	2
Loneliness or isolation	2
Homelessness	1
Number of individuals	2573

Source: Bebbington A, Darton R, Netten A (2001). Care Homes for Older People: Volume 2 admissions, needs and outcomes. The 1995/96 National Longitudinal Survey of Publicly-Funded Admissions. London: Personal Social Services Research Unit.

Note: Multiple answers possible so percentages add to more than 100 per cent.

[vi] Arber, S. and Ginn, J. (1991), Gender and Later Life: A Sociological Analysis of Resources and Constraints, London: Sage., cited by Pickard 2008. The OECD breaks this down:

Table 3.1. Unpaid care is mostly directed towards parents and spouses
Percentage of carers by relation to the care recipient by country

Country		Carers (%)
	Spouse	Parent	Relative	Friend
Australia	26.3	41.0	9.7	8.8
Austria	36.3	34.7	14.7	16.8
Belgium	33.7	40.4	16.6	23.4
Czech Republic	27.5	11.2	33.0	16.2
Denmark	39.7	41.3	15.9	20.9
France	31.8	40.5	19.6	13.7
Germany	34.9	44.2	13.0	21.5
Greece	33.2	35.2	14.9	14.7
Ireland	28.5	35.2	22.4	18.8
Italy	23.1	36.2	22.6	24.1
Korea	43.2	33.5	9.6	–
Netherlands	27.4	46.9	17.2	24.7
Poland	33.8	10.6	27.9	8.0
Spain	28.0	39.9	20.6	10.9
Sweden	26.5	48.5	19.0	18.1
Switzerland	30.1	42.8	17.2	24.1
United Kingdom	34.1	32.2	5.4	27.4
OECD (16)	31.6	36.1	17.6	18.2

[vii] For academic treatments, see:

Glaser K, Grundy E and Lynch K (2003) ‘Transitions to supported environments in England and Wales among elderly widowed and divorced women: The changing balance between co-residence with family and institutional care‘. Journal of Women and Aging.15: 107-126

Pickard L, Wittenberg R, King D, Malley J and Comas-Herrera A (2009) Informal Care for Older People by their Adult Children: Projections of Supply and Demand to 2041 in England. Poster presentation at 19th World Congress of Gerontology and Geriatrics, Paris, France, 5-9th July 2009.

· The key conclusion of this paper is that, on the assumptions used here, the supply of intense informal care to disabled older people by their adult children in England is unlikely to keep pace with demand in future years

Pickard, Linda, Raphael Wittenberg, Adelina Comas-Herrera, Derek King and Juliette Malley. Care by Spouses, Care by Children: Projections of Informal Care for Older People in England to 2031. Social Policy and Society (2007), 6: 353-366

Grundy, E, and Murphy, M (2006) ‘Marital status and family support for the oldest-old in Great Britain’ pp 415-436 in J-M Robine et al (eds) Human Longevity: Individual Life Duration and the Growth of the Oldest-Old Population. Springer.

Kalogirou Stamatis, Michael Murphy (2006) Marital status of people aged 75 and over in nine EU countries in the period 2000-2030. European Journal of Ageing 3(2): 74-81

[viii] http://www.gfknop.com/pressinfo/releases/singlearticles/002721/index.en.html

[ix] Victor C, Bowling A, Bond J, Scambler S (2003). Loneliness, Social Isolation and Living Alone in Later Life. ESRC Growing Older Programme, Research Findings 17. Sheffield: University of Sheffield.

[x] Townsend, Peter. The Family Life of Old People Pp. 227-228

[xi] Pickard et al 2009 (Op.Cit). note that care by children is likely to reduce in the future: ‘First, there has been a long-term decline in co-residence of older people with their children in Great Britain, with the proportion co-resident falling from 42 per cent in 1962 to 12 per cent in 2001 (Grundy, 1995; authors’ analysis of 2001/02 GHS) and this is likely to continue in future years. Second, although the proportion of older people with a surviving child is likely to increase over the next 20 years (Murphy and Grundy, 2003) beyond 2025 there will be a rise in childlessness among older people in Britain (Evandrou and Falkingham, 2000). Finally, there may be a decline in the propensity of children to provide care to older parents in future years, particularly associated with the projected rise in labour market participation rates of mid-life women (Henz, 2004)’.

[xii] Yap Mui Teng Living Arrangements among the Elderly in Southeast Asia UN Economic and Social Commission for Asia and the Pacific http://bit.ly/mabNoY. Research by Lloyds TSB Insurance has found that 500,000 homes in Britain are occupied by several generations. It also found that, when questioned, nearly two thirds (62 per cent) of multi-generational dwellers say that they were forced into it by circumstances, but four in five (77 per cent) say that they are happy with the situation and even more (83 per cent) feel it has brought their family closer together.

[xiii] Pickard et al 2009 (Op.Cit)

[xiv] Wanless data is drawn from a background note by the IFS here pp. 45-46. For further academic treatments, see:

Zagorsky, Jay L. Marriage and divorce’s impact on wealth. Journal of Sociology December 2005 vol. 41 no. 4 406-424.

Chun, H. and Lee, I. (2001). Why Do Married Men Earn More: Productivity or Marriage Selection? Economic Inquiry, 39(2):307-319.

Daniel, K., ‘The Marriage Premium,’ in Tommasi, M. and Ierullli, K. (eds.), The New Economics of Human Behavior, Cambridge: Cambridge University Press, 1995, pp. 113-25.

Reed, W. Robert, and Kathleen Harford. The marriage premium and compensating wage differentials Journal of Population Economics Volume 2, Number 4, 237-265.

Loh, Eng Seng. Productivity Differences and the Marriage Wage Premium for White Males. The Journal of Human Resources. Vol. 31, No. 3 (Summer, 1996), pp. 566-589.

Becker Gary S., Altruism in the Family and Selfishness in the Market Place. Economica. New Series Vol. 48, No. 189 (Feb., 1981), pp. 1-15.

[xv] For Health,

· For comparisons with smoking, see How Does Marriage Affect Physical and Psychological Health? A Survey of the Longitudinal Evidence Chris M. Wilson (University of East Anglia UK), Andrew J. Oswald (University of Warwick UK and Harvard University USA). May 2005.

· See also

o Phillips, A.C., Carroll, D., Burns, V.E., Ring, C. & Drayson, M. (2006). Bereavement and Marriage are Associated with Antibody Response to Influenza Vaccination in the Elderly. Brain, Behavior and Immunity, 20, 279-289. and

o Murphy M, Grundy E, and Kalogirou S (2007) ‘The increase in marital status differences in mortality up to the oldest age in seven European countries, 1990-99’ Population Studies 61(3): 287-98.

· Interestingly, adults who live together (cohabiters) are more similar to singles than to married couples in terms of physical health and emotional well-being and mental health as well as in assets and earnings. The Early Findings report on the latest wave of the Understanding Society survey (formerly British Household Panel Survey) says: “after controlling for a range of characteristics, cohabiting people are significantly less happy in their relationships than married people.” See also:

o Pienta, A.M. et al., ‘Health Consequences of Marriage for the Retirement Years’, Journal of Family Issues 21(5), 2000, pp. 559-586. Brown, S.L., ‘The Effect of Union Type on Psychological Well-Being: Depression Among Cohabitors versus Marrieds’, Journal of Health and Social Behavior 41, 2000, pp. 241-255;

o Stack, S. and Eshleman, J.R., ‘Marital Status and Happiness: A 17-Nation Study,’ Journal of Marriage and the Family 60, 1998, pp. 527-536;

o Mastekaasa, A., ‘The Subjective Well-Being of the Previously Married: The Importance of Unmarried Cohabitation and Time Since Widowhood or Divorce’, Social Forces 73, 1994, pp. 665-692.

[xvi] See Hakansson, K., Rovio, S., Helkala, E., Vilska, A., Winblad, B., et al. (2009). Association between mid-life marital status and cognitive function in later life : population based cohort study.. British Medical Journal. 339. b2462. This found ‘People cohabiting with a partner in mid-life (mean age 50.4) were less likely than all other categories (single, separated, or widowed) to show cognitive impairment later in life at ages 65-79).

[xvii] Useful surveys of the research literature on this point are:

Clark, M., R. Lynas and D. Percival. (2007) Building Strong Foundations: The Case for Couple Relationship Education. Relationships Foundation.

Coleman, L. and F. Glenn. (2010) When Couples part: Understanding the consequences for adults and children. One Plus One – which says ‘couple relationships can be strengthened and breakdown, in some cases, can be prevented’ (p22ff).

Newsletter June 2011

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