How does the public think we should fund social care?

There is general agreement that the success story of our ageing population comes at a price. We face the prospect of devoting a larger proportion of our national wealth to paying for good health and social care that more of us will need.

But agreement about how this should be done has been elusive despite the best efforts of numerous independent reviews, commissions, White Papers and Green Papers over the past two decades. England remains one of the few advanced western countries that has not grasped the nettle of reform, and recently there have been calls for another independent commission with all-party support.

So it is timely to consider the latest evidence from the British Social Attitudes survey, conducted by NatCen Social Research, about what the general public thinks. In the 2015 survey, The King’s Fund sponsored a question about how social care, to meet needs arising from illness, disability or old age, should be paid for. More than 1,000 adults were interviewed between July and October last year and their responses were weighted to correct for non-response, and to match the British population in terms of age, sex and region.

Of those interviewed, almost half – 48 per cent – believe that the government should meet the costs of care through taxation (see figure). This chimes with the recommendations of most independent reviews which favoured public funding rather than private options (such as insurance or user charges). But there is equal support for individuals contributing from their own resources: 25 per cent thought that the individual should pay what they can with the government paying the rest. And another 22 per cent supported this – but with the proviso that no one should have to pay more than £72,000 in their lifetime (this being the amount that would have been ‘capped’ by the Care Act reforms that the government has postponed until 2020).

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Views do not vary significantly by age – no intergenerational split here – but unsurprisingly Labour supporters have a stronger preference for fully tax-funded social care (56 per cent) than Conservatives (31 per cent).

There are caveats. A single question cannot capture the range and permutation of potential funding options. For example, taxation could be general or specific, direct or indirect, taxation of income and/or property and wealth – each option eliciting different degrees of political and public attractiveness – or hostility. As well it could be argued that most people would choose better public services that are important to them as long as someone else pays for it. And while there is no country in the world that meets all the costs of care through the public purse, there is no country that allows all of the costs to fall on the shoulders of the individual and family either (though England is getting close). It is the mixture and balance of funding mechanisms and sources that is key.

The BSA findings reflect different views about the balance between state and individual contributions, with a fairly even split between those favouring taxation to meet the whole cost and those supporting an individual contribution if they can afford it. But it is important to note that respondents are drawn from the general public and may not necessarily have experienced how the care system currently works – namely that anyone with more than £23,250 in savings and assets (including the value of their house) is expected to pay for the full costs of their care (those with less than that get help only if they have very high needs). Currently 50 per cent of care home fees are met by individuals themselves, involving significant top-up payments from family members. Co-payment on this scale for NHS services would be greeted with public and political outrage. If respondents had been aware of just how much of the care cost burden falls on the individual, might support for wholly public-funded solutions have been higher still?

The consequences of last year’s Spending Review and local government financial settlement will see the share of GDP devoted to public spending on social care fall by the end of this parliament. By default this will shift more of the funding burden on to private individuals. The contrast, identified by the Barker Commission, with NHS funding and entitlements – free at the point of use, used by most of the population and funded largely through general taxation – is set to become starker still. It is unclear whether many people grasp these fundamental differences but public opinion is clearly at odds with the direction of government policy on how social care is funded. The need for a serious debate with the public about these differences and where the money to fund social care will come from has never been more urgent.

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Comments

#545829 Andrew Jardine
Head of Customer Experience
SALUS Global Knowledge Exchange

A very well articulated article Richard. In view of the upcoming (and now well known) challenges for the care sector; increases in case of dementia and with people just generally living longer I would fully agree the need for debate, leading to greater public awareness AND reform has become urgent.

#545830 Alex Coulter
Director
Arts & Health South West

Very interesting article. I think the point could also be made that not only will reduction of funding for social care by default push more of the burden onto individuals and their families, but more broadly push up the cost of the NHS with more people accessing emergency care.

#545835 BRIAN GUMBLEY
Director
MATM cic MH RECOVERY ORG

Richard your survey highlights UNsurprising options ----Our NHS is not only the pride of the world it is also the envy of lots of developed countries we pay a lot less into our NHS system per GDP than other good health care systems in the world -------------My opinion is that increasing the NI rates is the only fair way of funding health yes it is a tax but a fair one ,enabling all tax payers to pay a equal amount of tax according to income --making it so that tax avoiders or dodgers still pay into the system stopping the tax avoidence through DIRECT TAX - - all high earners should pay into public health costs-- why because most high earners or there families will require emergency treatment sometime in there lives some likely to be life saving treatment where ---at this point do we all want to go back to the days of bankrupting working people to have life saving treatment
IMPROVE COMMUNICATIONS and not only do we have better health but major cost savings within NHS
What people mean when they say lets pay something into the system privatelyor top ups -- usually means they want the choice of of what high incomes bring---- not fairness to all highlighting pure selfishness regarding equality in health---- most good a caring medical professionals would agree with this terminology

#545844 George Coxon
H&SC entrepreneur inc care home owner
Various

I'm 'the public' as we all are I know but will concede to a modicum of bias, even perhaps self interest merged with, I believe, a chunk of common interest too hopefully. So in offering thoughts it's important to acknowledge that if it was straightforward we'd have sorted it by now for sure.
As an ex senior NHS commissioner for many years with an even longer series of senior clinical roles too and now a care home owner and part of a provider led coalition of residential care providers I do have thoughts on some of the imperatives My key point contributions:
- fundamentally it's a real commitment to H&SC Integration
- blended funding with a realistic view on our demographic challenge for now and future generations
- establishing a principle that it's reasonable that wealth accumulated in ones lifetime should contribute to our changing needs in later life
- keeping people out of hospital and getting people out of hospital is a crucial focus Using more 'can do' thinking and 'risk sharing' tackling the blame culture as much as the conflicting organisational loyalty & protectionism
- remembering to engage and include dynamic progressive innovative independent social care providers in a respectful non patronising way

We surely want the same things? Safe quality happy later life lives. Including 24/7 care when the time is right. But we need to grasp the nettle, face the music & unite against the common enemy!!! It's not the needs of an ageing population living longer into old age with multiple comorbidities, it's not even the dominance of acute hospital care in a financially straining H&SC system. It's the perpetuation of territorialism and dysfunction between essential partners from 'the public' in all our guises to whole system of organisations and services.
I'm a pretty determined enthusiast with a credible but impatient voice gaining influence I'm told. So re who pays? I think we all do in more ways than just with money.

#545847 A lesser

I don't if you can help but I have an idea for Nhs the gov say charge 5 pnds
See a Doctor if they are unemployed =2 -50 if they can't afford they get it
Free to go . To visit Hospital. 25 pounds to stay 50 pounds no matter how
Long same rules apply as for Doctors. This would not. be popular but would
bring a lot of money to NHS and stop people who abusing NHS also in long
Gov will have to charge for the service and it will cost the public more
Because they will not be able support with out charge for lot longer may be
Wrong but don't think so we just wait and see

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