Daniel Cameron is Research Director at Ipsos MORI. He led research to support the Health Foundation and The King’s Fund’s work on social care funding, which aimed to deepen our understanding of public attitudes towards several potential funding options for social care. We asked him to tell us about the work and its findings.
How did you approach the research into public attitudes towards social care funding?
We ran in-depth workshops in London, King’s Lynn and Leeds, spending two days with around 40 people in each place. We asked people what they know about how social care works now, and discussed the priorities and principles that they think should underpin funding in future. Then we explained five different options for reforming social care funding, outlined in a new report from the Health Foundation and The King’s Fund, and asked people’s views on which option or combination of options they preferred.
What did you find out about people’s understanding of how social care is funded?
People generally know very little. Many assume they’re already paying for social care they might need in future through their tax and national insurance. As one person said in a workshop: ‘I thought I had a contract with the government that if I paid in all my life, I would be able to get out at the end.’
Once we’d explained the current situation, people were very concerned that the support they thought they were entitled to wasn’t actually there.
Even people already engaged in some way with social care said they struggled to understand how services are delivered and how decisions are made. That’s probably not surprising given there isn’t a single overall service equivalent to the NHS with responsibility for social care. People aren’t clear about the role of local authorities, and didn’t really know how to access care, so tended to think they would approach their GP if they needed support.
‘The current system of social care is a minefield.’ (Workshop participant)
One thing we spent some time unpicking was how lots of people had struggled to get support in place for themselves or a relative, but generally hadn’t thought more broadly about that experience and what it means for how our society prioritises and funds social care. Maybe that’s because people are often focused on sorting out a crisis and can’t take a step back. There’s also the issue that social care is linked to getting old and dying – and people don’t want to think about that.
How did people respond to the different potential funding models that you put forward?
The first option we looked at was continuing with the current way social care is funded. Once people had that more detailed understanding of how things work now, there was a consensus that it wasn’t good enough or sustainable. It was clear people wanted change.
People struggled to get to grips with the cap and floor option, even though we had some leading social care experts explaining it in the workshops. This option would put a cap how much each individual would have to pay for social care and a floor which would stop their assets being run down beyond a certain level. In general they saw it as an improvement on the current situation, but there were still big concerns around people’s housing assets being used and that this would be hard to manage fairly with house prices and asset values varying across the country.
Free personal care, similar to the approach already in place in Scotland, was simple for people to understand and people generally liked it. But they were a bit worried about how it would be implemented and how much it would cost.
A dedicated social care tax was something that came up even before we introduced the idea, and people were broadly supportive. Hypothecated taxes are often easy for people to understand, and people like the fact that the government would have to spend the money on social care.
The final option we looked at was a joint NHS and social care budget. Instinctively people liked this in terms of the efficiencies and cooperation it would bring. But there was quite a strong concern about the conflicting priorities across the two services and the fact that social care might lose out. As one workshop participant said: ‘If it comes down to saving a sick child or an elderly person who might not last another couple of years, where will the money go?’
People liked the money being joined up in principle but wanted a guarantee that social care would be protected.
Which funding option were participants most supportive of?
People weren’t expecting a gold-plated service but would like to see a basic level of care provided for everyone by the government, even though they realise that would be expensive. Most people supported a social care tax, and tended to favour a high level of government responsibility for paying for care costs, with some debate about how much wealthy people should contribute, and what it really means to be wealthy (for example people may own a house, but have very little income spare to pay for care).
Workshop participants share their views:
‘All care should be a basic standard. If you’ve worked hard all your life, you should be entitled to a nice, clean bed, and someone looking after you.’
‘If you asked people whether they would pay two extra pence on income tax rather than take away assets later on they would choose the former.’
There was a big emphasis on fairness in all the discussions. People recognise the need to protect housing assets and be fair to older people who have paid taxes and National Insurance their whole lives. They understood that this might be placing a burden on younger generations, but this was generally accepted as unavoidable – even though this is one of the biggest challenges often discussed in policy circles.
It will be interesting to see whether the debate over intergenerational fairness changes over the next decade, becoming more of an issue as the younger generations realise what it means for them.
How could a deeper understanding of public perceptions about social care help the government to introduce changes in ways so they are well-received?
One of the biggest challenges is that people don’t understand how social care is funded now and how alternative options might be an improvement. It makes communicating changes very hard. Any discussion of an option where housing assets are used will cause real concern and anger, even though housing assets have been considered as part of people’s ability to contribute to funding their own social care for decades.
So building the public’s understanding is important, but there’s no magic bullet for discussing the changes without having to go through the pain of the public’s reaction. I’m sure that’s part of the reason this hasn’t been tackled so far. But knowing there’s an appetite out there for a tax to pay for social care really helps. This shows that when people know more about how it’s currently funded, they think this is an area that should be prioritised in future.