Ben Page, Chief Executive, and Anna Quigley, Director of Health Research, Ipsos MORI

Confusion and blind hope – the public and social care

Fewer and fewer people are eligible for public funding for their social care needs. Even among those that receive local authority financial support, our research shows that unmet need is a massive issue. And it’s only going to get worse.

The public aren’t ready for what might happen to them as they get older.

Fewer than three in ten are preparing financially for the social care services they might need in the future. There’s confusion and uncertainty about whose responsibility it is to pay for social care, with an assumption that one is already paying through their tax and national insurance. Half think that social care services are free at the point of need. And as doesn’t need repeating here, demand will continue to rise for some time. Demography is destiny.

So, there’s a great deal for us to be worried about. The good news is that there’s widespread agreement about an urgent need for action. There’s political consensus that something must be done, but the question is what?

There’s much discussion about the differences between NHS funding via central taxation and social care’s mixture of state and personal funding. But when thinking about achieving consensus on social care, a better comparison is pensions reform. The work of Adair Turner’s Pensions Commission during the early 2000s advocated a significant change in UK policy. Facing similar problems to those impacting on social care, the Commission recommended a gradual move towards a higher pension at a later age and the establishment of a new national pensions saving scheme. It obtained widespread cross-party agreement to changes that, just a few years previously, were inconceivable.

There are undoubtedly a number of lessons to be learned from the way in which the Commission went about its work that could be valuable for the current social care problem.  However, there is one important difference between the two areas: everybody wants a pension, but many of us would rather not think about needing social care. And going back to the NHS comparison, we see the same issue: everybody uses the NHS, but people don’t expect to need social care. Ultimately, it’s linked to getting old and dying – and people just don’t want to think about that. They don’t even understand it (63% think that the NHS provides social care services for older people).

Our recent qualitative research to support the Health Foundation and the King’s Fund’s work on social care funding showed that once people were made aware of how it currently works, they agreed it wasn’t good enough or sustainable. It is clear people want change – once they understand the current situation.

But what do they think of the various options? They struggle to get to grips with the cap and floor option. While they see capped costs as an improvement over the current situation, the stumbling block is that it still relies on using housing assets, which are along with the NHS, among the few things that are sacred in Britain.  Many think it difficult to manage given housing prices vary so much around the country. Free personal care is of course generally liked, but the public worry about how much it would cost in extra taxes.

The public instinctively like a joint NHS and social care budget; they recognise the potential efficiencies and coordination it could bring (if not the massive unmet demand it might reveal). But they also worry about conflicting priorities, thinking that social care will always lose out.

The public are realistic about what’s achievable, and do want to see a basic level of care provided for everyone by the government, despite the recognition that it will cost.  Underpinning all this is “fairness”; the public want to protect housing assets and be fair to older people who have paid taxes and NI their whole lives. In our view, it would be fair to extend NI contributions to working older people past 65, although overall the young are supportive of measures to help older people:  pensioners are a key group that the young see as a priority in society along with disabled people, and far ahead of the working age poor in their priorities.[1]

So what about higher taxes? Over the last few years, we’ve seen an increasing acceptance of the need for higher taxes for both the NHS and social care (e.g. 71% say they would support an increase in income tax in order to increase the amount of funding available for adult social care).^[7] In fact, a dedicated social care tax is often raised spontaneously in our qualitative research. Hypothecated taxes are easy for people to understand: they like the fact that the government would “have” to spend the money on social care – showing their distrust of ministers (just one in five trust them to tell the truth). While the Treasury has often argued hypothecation is inflexible and dishonest, it has real popularity. Theresa May has announced more money for the NHS funded by taxation and borrowing – we await the details, but can’t help feeling that Britain will “muddle through” rather than fix its social care crisis.