Perhaps the political debate should focus less on social care as a costly problem and a political minefield, instead drawing on co-created and strength-based solutions.
In 2024 we look back on a decade since the Care Act 2014, as we look forward to the next election. The Care Act introduced a national eligibility framework for councils provided social care, and responsibility for prevention, support to carers and the promotion of wellbeing. The Care Act also included planned charging reform, which has not yet come into force, including a cap on lifetime care costs, introduction of a fair cost of care and adjustments to the thresholds for means tested care.
Social care provision and the Care Act are complex, and our polling shows a lack of knowledge about social care among the general population, divided opinions, and limited evidence of support for the changes associated with charging reform.
Perhaps this is one reason why charging reform was delayed from 2020 to 2023 and then to 2025. This may also be why political parties are saying very little about social care as we approach the election.
So, ten years on from the Care Act what is the public’s view on the quality and availability of social care? In our polling for the Health Foundation in 2023 only 12 per cent agreed that social care services in their area are good. It is notable that nearly a third said they neither agree nor disagree, suggesting a lack of awareness about the quality of social care among those who have not had personal experience of it.
At the same time a small minority (6 per cent) agree the government has the right policies for social care (which contrasts with 20 per cent agreeing in 2017), while 63 per cent disagree, perhaps also reflecting dissatisfaction with the government more generally. It’s therefore not surprising that only 5 per cent think the standard of social care will get better over the next 12 months and half (52 per cent) think it will get worse.
The sector has high levels of vacancies and turnover, and the public does have consistent views on the need for a larger and better paid social care workforce. Three quarters think there are too few care workers in Britain relative to the need for social care, and 63 per cent think care workers are paid too little.
However, it is unclear how people think workforce improvements should be paid for. One of the challenges in discussing social care with the general public, is limited awareness that most adults with care and support needs do not receive publicly funded care but instead self-fund their own care or are supported by unpaid carers. For example, over half don’t know whether or not social care services are generally free at the point of need (38 per cent think they are free and 17 per cent don’t know).
When it is explained that social care services are means tested (in contrast with the NHS), a third (34 per cent) think it is fair that social care is means tested (and therefore some people will need to pay for their own care), while half (51per cent) think it is unfair that care is means tested (and therefore not free to all at the point of need). Less than a third (30 per cent) are preparing financially for the social care services they might need when they are older.
Perhaps because of this lack of understanding about social care funding, and limited public recognition of the high costs self-funders may face, there is limited support for the changes associated with Care Act charging reform. When asked about priorities for social care the most common responses relate to how services could be improved. Less than a quarter mention providing state protection against high care costs (22 per cent) (a care cap) or making more people eligible for free care services (14 per cent) (increasing the means test threshold).
Despite this, there is an expectation that increased funding for social care should come from the government. When asked about which areas should be prioritised for public spending the top two areas are the NHS and health care (56 per cent) and social care for older people (25 per cent). However, polling for the BBC in 2022 showed nearly a quarter of the public (23 per cent) did not know how the government should fund increased spending on social care. Among those who expressed an opinion, views were divided (as they are for NHS spending) with similar proportions selecting an increase in income tax (17 per cent), an increase in national insurance (17 per cent), spending cuts to other services (15 per cent) or an increase in government borrowing (15 per cent). This makes it challenging for political parties to make manifesto pledges on social care which would garner widespread support.
There are no easy solutions for increased public funding for social care, given the fiscal situation and politicians’ focus on funding the NHS. Even the Association of Directors of Adult Social Services (ADASS) report, ‘Time to Act: road map for reforming care and support in England’ highlights short term changes requiring limited resource, recognising that further investment may be a longer-term aspiration.
Perhaps the political debate should focus less on social care as a costly problem and a political minefield, instead drawing on co-created and strength-based solutions.
The Care Act has outcomes at its heart - whether people are able to meet their own personal care needs, maintain relationships, engage with work, training or volunteering and make use of community services without an adverse impact on their wellbeing. Social care is about supporting people to live life to the full. Our research on unmet need showed that independence and social connection were highly valued by older people and the lack of these was of more concern to people than a lack of support with specific types of personal care.
We also found people with care needs living in precarious situations with unsustainable support arrangements. In planning a way forward for social care, the government could fund research with the general public, people with care and support needs and carers about the lives they would like to lead, what matters most to them and the support and resources they need to flourish throughout their lives. This would enable politicians and policy makers to develop a more positive narrative around care and support, so it does not get side-lined as too difficult.
Combined with engagement with the social care workforce, this could help generate innovative solutions which address needs more holistically, help engage people in planning ahead, and give unpaid carers and the care workforce the recognition and support they deserve.
References
3 in 4 Britons say there’s too few care workers in Britain relative to the need | Ipsos
Public perceptions of health and social care (May 2023) - The Health Foundation
The State of the State 2017-18: Austerity, government spending, soical care and data
