Do we know what we want? Understanding public perceptions of social care funding

Dan Wellings is a Senior Fellow at The King’s Fund, with a specific interest in patient and staff experience and public perceptions of the NHS and social care. Prior to joining The King’s Fund, Dan was Head of Insight and Feedback at NHS England and before that a Research Director at Ipsos MORI.

As policymakers embark on a review of social care funding options, we spoke to Dan about the challenges they will face in understanding public perceptions of social care funding.

Why is it currently so important to understand what the public think about social care funding?

There is widespread agreement amongst those working in this area that there is a significant issue in social care, both in terms of the way it’s funded and the funding gap. Various governments have tried to address this over the last 20 years. But to introduce solutions to address these issues you’ve got to take the public with you. In order to take people with you, you first have to understand where they are.

One of the biggest issues in social care policymaking is that policy makers often assume the public are further advanced in this debate than they are. Public understanding of social care is limited and there is a lack of clarity around the current offer particularly around how it is funded. This is unsurprising given its complexity. In order to propose solutions on how you pay for social care, there first has to be widespread public recognition that there’s a problem – and that isn’t the case.

The reason why that’s a problem was highlighted at the recent election. The Conservative manifesto proposed a funding solution with a £100,000 floor (ie individuals facing social care costs would be able to protect the last £100,000 of their wealth). Perhaps the most controversial element, and the one that created anxiety amongst many people, was the idea that they might have to sell their houses to pay for their care. No doubt those who wrote the manifesto thought that they would be providing a solution to an issue that many people thought needed fixing. Given the lack of understanding of social care it was unsurprising that it only served to create a new problem rather than being seen as a fix to an existing one. The subsequent clarification that there would be a cap (ie that there would be an upper limit on what a person might have to spend on their own social care) was probably too little and too late for many. The case for change had not been made. If you want to provide a solution, you’ve got to spend time explaining to people why you’re doing it.

Why is it difficult to get to the bottom of public attitudes on social care and social care funding?

The key challenge is the lack of understanding of social care funding and even what social care actually is.

One of the biggest misunderstandings about social care is that many people assume a lot of the services are provided by the NHS. People grow up with the NHS but for the most part they only encounter social care when they are older or have an older relative and it can be a confusing system. For example, in the context of dementia care – when is it continuing health care provided by the NHS? When is it social care? People tend to assume that public services are far more joined up than they actually are. It’s often only when they start to need care and support that they realise that social care isn’t NHS care.

Many people assume it will be free and don’t tend to plan for social care costs. Sometimes even people working in the health and social care system don’t understand where NHS care finishes and social care begins.

The Health Foundation and The King’s Fund are planning some joint work in this area, including deliberative events with the public. How will that contribute to the debate?

While central funding solutions will be developed, they will go nowhere if there isn’t work with the public on really understanding what we need to do to make the case for change.

The solutions have to fit with what the public views as fair, and fairness means different things to different people. We need to ask what people think is fair and make sure that we are working with what’s important to them. We also have to propose solutions that people can understand.

We know that different age groups will have different perspectives, and other factors such as gender and social class also have an impact. From what we know at the moment, there appear to be some lifecycle variables which are important – there is definitely an age effect. As you start needing social care or as your parents start needing social care, your awareness and understanding will go up. For example, people who are aged 55-74, perhaps unsurprisingly, are more likely to have given some thought to preparing financially for social care than younger age groups, but it’s still only about 44% of people in that age group.

The work with the Health Foundation will help us to understand what the issues are, and that puts us in a better position to try and solve them. It comes back to the point earlier which is, too often in policymaking, we don’t start with our baseline – where do people stand on this issue now?