How to solve a problem like social care?
Increasing public interest in social care
Recent weeks have seen the future of social care rocket up the political and news agenda.
In the final days of the Conservative leadership election we saw significant pressure in the media, from the Daily Mail in particular, reporting on the number of people with dementia affected by the inequity of the current care system.
July 2019 also saw an important report from the Lords Economic Affairs Committee calling for the Government to back the idea of free personal care for all who need it. This means people receiving care in their own home, or living in a care home, would be able to get help with things like washing and dressing free of charge.
Encouragingly, in his first speech as Prime Minister, Boris Johnson included social care as one his top domestic policy priorities. He vowed to ‘fix’ the social care crisis and to ‘give every older person the dignity and security they deserve.’ In particular, the PM stated he wants to achieve this without people having to sell their homes to cover the cost of care.
Public support for action is growing
A petition signed by more than 150,000 members of public was presented to Number 10 calling for action on social care.
The petition is backed by the Health for Care Coalition, a group of 15 national organisations working across the health sector, and highlights the widespread support for the PM’s promise, calling for:
- Cross-party talks to help deliver a more sustainable social care system that has broad parliamentary support.
- Immediate funding increases in this Autumn’s spending review to shore up current services in the short term.
- Genuine long-term funding alongside key reforms to help deliver a solution for social care that lasts a generation and more.
We have supported the Coalition by sharing what people have been telling us about social care. We explain more about the evidence we shared.
The big question is how we should fund improvements in social care
The range of options for how we fund, charge for and protect people from the huge care costs the PM has referenced are broad. They include things like raising tax, pooling risk, and individuals taking out private insurance.
These have been well explored by policy makers, with the Nuffield Trust producing a useful summary explaining what they are and their relative merits.1
But to better understand what the public want from social care funding reforms, and how well any proposal might be received, we commissioned a poll of 2,000 adults.
We asked people which of the following they thought should be used to fund the extra investment needed in social care.
Tax vs insurance
It’s clear that there is significantly more support for raising general taxation to pay for social care. Indeed, research by others has consistently shown this to be the most popular option.2 What is perhaps more significant from our research is that this idea has a relatively even level of support across all age groups.
Compulsory insurance comes in second, with optional insurance trailing even further behind. Earlier indications suggested that Theresa May’s Government was attracted to the insurance model, but direction under Boris Johnson may well change.3
What we found was, unlike with general taxation, there is significant variation in how insurance models were perceived across age groups.
The popularity of compulsory insurance increases with age, the opposite is the case for optional insurance. This reinforces some of our earlier research, which found that over 55s are most likely to say that they would never save or plan for social care.4
It is likely that another factor that would impact the popularity of any insurance model would be whether the money you saved went into a shared pot or was saved into an individual care account for your needs only.
Can’t pay, won’t pay
We asked people if they would be ‘pleased’ or ‘displeased’ if they had to enter a compulsory social care insurance scheme.
With the exception of 18-24 year olds, more people appear to be displeased about the idea of entering into compulsory insurance.
To understand this more we asked people how likely they would be to voluntarily enter a social care saving or insurance scheme linked to their income.
Older age groups are less willing to save for social care they may need in later life. 18–34 year olds are the only group that is more likely than unlikely to think about saving.
The most common reason given for not wanting to join a voluntary scheme was that people felt they couldn’t afford to (40%). This was followed closely by those who said they wouldn’t pay in to the scheme simply because they felt they shouldn’t have to (31%).
Important elements missing from the debate
Much of the national debate is still focused on the issues affecting the 1.4 million older people in England unable to access the care and support they need. In particular, it has focused around those with dementia.
These groups are of course vital, and they represent the largest group affected. However, a significant amount of the money in social care is also spent on children and people of working age.
Whichever model is chosen by the Government, it is vital that is considers the views of these individuals and how it will work for them.
It is also not just about the money. Our research on social care has focused on the need for a properly resourced information and advice service to help people understand what support is out there and how best to access it.
What we can expect
With a flurry of announcements in relation to the PM’s domestic agenda in recent days, there is strong chance we will see something sooner rather than later regarding the Government’s plans for social care.
This will be welcome progress given the two-year delay to the social care green paper.
Whatever is put forward, we at Healthwatch will gather views from those receiving care and the wider public on the proposals, and feed this in to the debate.
[1] Oung C and Schlepper L (2019) “What principles should underpin the funding system for social care?” Nuffield Trust comment.
[1] Independent Age, (September 2018) Press Release, “Three-quarters of adults in England back free personal care for over-65s, says charity”
[1] The Telegraph (1st November 2018) “'Tax on age' to pay for social care being considered for the over-40s”
[1] Healthwatch England (2018).
Find out more
Find out more about what people told us about their views on the future of social care in our contribution to the Local Government Associations consultation on an alternative Social Care Green Paper.
