Written evidence submitted by Dr Angeliki Papadaki (Associate Professor in Public Health Nutrition at University of Bristol) (ASC0069)
The Role of Preventative Services like Meals on Wheels in Addressing the Cost of Inaction on Adult Social Care Reform
Health and Social Care Select Committee: Adult Social Care Reform: The Cost of Inaction
Evidence from:
Dr Angeliki Papadaki (Associate Profession in Public Health Nutrition), School for Policy Studies, University of Bristol
I am an academic with expertise in the evaluation of community nutrition programmes, at the intersection of nutrition, social care and gerontology. I am based in the School for Policy Studies at the University of Bristol, which has an international reputation for research excellence within the field of social policy and social work. Ninety-seven per cent of our research was rated as 'world-leading' or 'internationally excellent' in the 2021 Research Excellence Framework, and the School was rated 2nd in the UK for research excellence in these disciplines.
I am submitting evidence to inform the Health and Social Care Committee’s inquiry into the Cost of Inaction on Adult Social Care Reform, focusing on the critical role of preventative services like Meals on Wheels. Drawing on my research at the University of Bristol and expertise, I highlight how these services address malnutrition, social isolation, and delayed hospital discharges, while promoting independence and reducing financial pressures on the NHS and local authorities. My evidence underscores the urgent need for national action to support and expand Meals on Wheels services, which are vital for enabling adults with care and support needs to live independently and improving health and social care outcomes.
1. How much is inaction on adult social care reform costing the NHS and local authorities, and what impact does this have on patients and the public?
1.1. Inaction on adult social care reform places significant pressure on both the NHS and local authorities, by contributing to delays in hospital discharges, avoidable readmissions, and premature transitions to residential care. For example, one of the main reasons people experience lengthy hospital stays is the lack of social care support in the community, or the limited signposting to this support (1).
1.2. Preventative services like Meals on Wheels could help mitigate these challenges (2). Meals on Wheels services are crucial in addressing malnutrition, social isolation, and daily living challenges, while enabling individuals to recover at home and avoid unnecessary hospital readmissions (3). Meals on Wheels provides much more than a daily meal. It promotes independence, welfare checks, and social interaction (3) - key factors in supporting adults with care needs to remain in their homes and communities for longer, therefore alleviating pressures on healthcare systems (2).
1.3. For example, a U.S. study found that increasing Meals on Wheels coverage by just 1% among adults aged 65+ was projected to save Medicaid over $109 million annually by reducing the need for nursing home care (4). Applying such preventative measures in the UK could yield similar cost reductions, while improving outcomes for patients and the public. Yet, due to funding cuts and inconsistent signposting in England and the UK, accessing Meals on Wheels is difficult, contributing to delays in hospital discharges and avoidable re-admissions.
2. What NHS and local authority service reforms are not happening as a result of adult social care pressures, and what benefits are patients and the public missing out on?
2.1. Resource constraints have hindered the integration of preventative services, like Meals on Wheels, into local authority care pathways and NHS hospital discharge planning.
2.2. Currently, Meals on Wheels is not a statutory entitlement, and in recent years, there has been a dramatic reduction in local authority-provided Meals on Wheels services; only 18% of councils in England currently provide this service (5). This gap in provision is challenging for communities to fill. Other types of Meals on Wheels providers, such as charities and private providers, also face financial challenges, resulting in service closures (6). As a result, adults with care and support needs miss out on accessible meal services that could address malnutrition and social isolation (7). It is vital for Adult Social Care Reform policies to position Meals on Wheels as a critical service for adults with care and support needs. The service should be included in the Care and Support Statutory Guidance (8), to ensure consistent provision of Meals on Wheels across English local authorities, reducing regional disparities.
2.3. Our research also highlights significant gaps in the visibility of essential services, such as Meals on Wheels (9). Despite the importance, under the Care Act 2014 (10), of easily accessible information that ‘helps prevent people developing needs for care and support, or delay people deteriorating such that they would need ongoing care and support’, accessible information about Meals on Wheels remains limited, contributing to delays in care delivery.
2.4. To address this, we developed the Meals on Wheels UK website (https://mealsonwheelsuk.org/), which features a user-friendly map of approximately 280 Meals on Wheels providers across the UK. This pioneering national resource fills a critical gap, connecting individuals, carers, and health and social care professionals with Meals on Wheels services delivering to their area, while providing key information on each provider to empower informed decision-making. In less than a month since its launch, the website has attracted over 5,200 unique visitors, demonstrating its potential to alleviate NHS and social care pressures. Enhancing visibility and accessibility of Meals on Wheels services, via resources like the Meals on Wheels UK map, could enable more effective care coordination. We advocate for integration of social care and health data systems to enable seamless referrals to Meals on Wheels services through the Meals on Wheels UK resource, improving early intervention and long-term outcomes for patients and the public.
3. What is the cost of inaction to individuals and how might people’s lives change with action on adult social care reform?
3.1. Inaction leaves vulnerable individuals at risk of malnutrition, loneliness, and deteriorating health, which can escalate into hospital admissions or permanent residential or nursing care. Reforms prioritising social care services, such as Meals on Wheels, would allow individuals to remain in their homes and communities for longer, improving their quality of life while reducing reliance on costly care options (11, 12).
3.2. For example, the average cost to the recipient of a two-course meal (as offered by local authority Meals on Wheels services in England) in 2023 was £38.99 per week, while the same cost across the whole of the UK was £33.74 (5). In contrast, residential and nursing home care can cost around £800 and £1,078 per week, respectively (13). Despite the lack of robust cost-benefit analyses of Meals on Wheels services, these figures suggest the potential of Meals on Wheels to bring significant savings, at least for recipients of care who are self-funders. We call for the national Government to develop funding mechanisms to support local authorities to re-introduce, expand and protect Meals on Wheels services. This would allow all eligible adults to benefit from an affordable, preventative service that supports their independence, reduces malnutrition and social isolation, and alleviates pressures on the NHS and social care systems by delaying the need for more costly care options.
4. Where in the system is the cost of inaction on adult social care reform being borne the most?
4.1. The cost is disproportionately borne by the NHS, which absorbs the financial burden of avoidable hospital admissions and extended stays, and by individuals, who face deteriorating health and reduced independence.
4.2. Social care services, such as Meals on Wheels, provide early support that reduces the likelihood of hospital admissions and delays in care. Coordinated approaches between health and social care, offered by many Meals on Wheels services, can identify at-risk individuals sooner and ensure timely interventions (14). We call for the government to incorporate the Meals on Wheels UK website (https://mealsonwheelsuk.org/) into existing government directories as a central resource for finding meal services, to enable health and care practitioners to signpost adults with care and support needs to Meals on Wheels.
5. What contribution does adult social care make to the economy and HM Treasury, and how might this change with action on reform?
5.1. Adult social care is integral to preventing the escalation of care needs, facilitating timely hospital discharges, and decreasing hospital readmissions (2, 12), yet its contribution is often overlooked. By supporting individuals to live independently, adult social care reduces reliance on acute health services and costly residential care, which could contribute to significant economic savings. Services like Meals on Wheels can also enhance workforce productivity by providing respite for unpaid carers (3, 14).
6. To what extent are the costs of inaction on adult social care reform considered by the Government when evaluating policies?
6.1. There is limited evidence that the costs of inaction on preventative services like Meals on Wheels are systematically considered in policy evaluations. Incorporating these costs into assessments, such as through economic modelling, could highlight the value of investing in social care reform.
I would be delighted to provide further insights and discuss my findings in person, if invited to give oral evidence to the Committee.
CITED REFERENCES
1. Care Quality Commission: Beyond barriers: How older people move between health and social care in England. Available at: https://www.cqc.org.uk/sites/default/files/20180702_beyond_barriers.pdf. 2018.
2. Sahyoun NR, Vaudin A: Home-Delivered Meals and Nutrition Status Among Older Adults. Nutr Clin Pract. 2014, 29:459-465.
3. Papadaki A, Wakeham M, Ali B, et al.: “The Service, I Could Not Do without It…”: A Qualitative Study Exploring the Significance of Meals on Wheels among Service Users and People Who Refer Them to the Service. Health & Social Care in the Community. 2023, 2023:6054895.
4. Thomas KS, Mor V: Providing more home-delivered meals is one way to keep older adults with low care needs out of nursing homes. Health Aff (Millwood). 2013, 32:1796-1802.
5. National Association of Care Catering: Meals on Wheels Report 2023. Available at: https://bit.ly/MOWReport23. 2023.
6. Ismail S, Thorlby R, Holder H: Reductions in adult social services for older people in England. Available at: https://www.nuffieldtrust.org.uk/files/2018-10/qualitywatch-social-care-older-people.pdf. 2014.
7. Wright L, Vance L, Sudduth C, Epps JB: The Impact of a Home-Delivered Meal Program on Nutritional Risk, Dietary Intake, Food Security, Loneliness, and Social Well-Being. J Nutr Gerontol Geriatr. 2015, 34:218-227.
8. Department of Health and Social Care: Care and Statutory Support Guidance. Available at: https://www.gov.uk/government/publications/care-act-statutory-guidance/care-and-support-statutory-guidance. 2024.
9. Papadaki A, Wakeham M, Ali B, et al.: Accessing Meals on Wheels: A qualitative study exploring the experiences of service users and people who refer them to the service. Health Expectations. 2024, 27:e13943.
10. UK Government: Care Act 2014. Available at: https://www.legislation.gov.uk/ukpga/2014/23/pdfs/ukpga_20140023_en.pdf. 2014.
11. Campbell AD, Godfryd A, Buys DR, Locher JL: Does Participation in Home-Delivered Meals Programs Improve Outcomes for Older Adults? Results of a Systematic Review. J Nutr Gerontol Geriatr. 2015, 34:124-167.
12. Thomas KS, Mor V: The relationship between older Americans Act Title III state expenditures and prevalence of low-care nursing home residents. Health Serv Res. 2013, 48:1215-1226.
13. Age UK: How much does care cost? Available at: https://www.ageuk.org.uk/information-advice/care/paying-for-care/how-much-does-care-cost/. 2024.
14. Papadaki A, Ali B, Cameron A, et al.: 'It's not just about the dinner; it's about everything else that we do': A qualitative study exploring how Meals on Wheels meet the needs of self-isolating adults during COVID-19. Health Soc Care Community. 2022, 30:e2012-e2021.
December 2024