'You talking to me?’ The challenge of engaging with the public about adult social care

In the film Taxi Driver, Robert de Niro famously repeats the phrase ‘You talking to me?’ It’s a one-way conversation: in the scene, he is talking to a mirror.  

That feels a little like a metaphor for previous attempts to talk to the public about social care. Government and the wider social care sector have certainly tried to start a conversation but there has been little, if any, impact on awareness. Few people have been reached and many of those have not understood. Social care has in practice often been talking to itself.  

As a result, public awareness of social care remains low. Around a third of people think that social care is either provided by the NHS or is free at point of need. (It is neither: it is largely provided by private companies, commissioned by local authorities, and – unlike the NHS – it is means tested.) As a result of the misunderstanding, when people do come across the social care system they are often shocked at how little support they will receive, if any.  

Nor is it top of mind for people when they are asked about issues the government should prioritise. In October 2025, only 2 people out of 1,002 polled said social care was the biggest issue for government and only a further 28 thought it was one of top priorities. This is despite people being generally unhappy about the state of social care – they rate it worse than any other health and care services.  

So, the promised national conversation on social care by the Casey Commission is both welcome but will also be a significant challenge. A key part of that challenge in the past has been trying to explain our current, incredibly complicated, system to people.  Thresholds, floors, caps, tariffs – the terminology and the concepts are arcane and hard to grasp.  

When you succeed, the effect can sometimes be surprising. After one session at a large-scale event with the public, a man approached me at the coffee break to check he had understood the rules on care costs and housing assets. ‘Am I right in thinking that if I need to go into a care home, my house won’t have to be sold to pay the costs if there is someone living in it?’, he asked. When I confirmed that, broadly, that was right I expected him to be outraged and want to change the system. Instead he said: ‘Right, I’m going home to invite my girlfriend to move in with me immediately.’  

One approach that the Casey Commission might consider is not trying too hard to explain the current system. Yes, it’s important that people understand the basics of who provides and pays for it, but it is probably a fool’s errand trying to go into the details. She might in fact go even further and not worry too much about using the language of ‘social care’ but instead talk about something like ‘care for older and disabled people’. A key element of Baroness Casey’s speech to the Nuffield Health Summit was that people think about the circumstances they are in rather than worrying too much about labelling the services – whether health or social care – that they receive.  

Not getting too deeply into the technicalities and using language that people themselves use would help the Casey Commission to focus on things that matter the most: what do people want the system to do in the future and who should be responsible for making it happen? This is very much the ground that Baroness Casey said she wanted to cover in her speech. She bemoaned the fact that social care had not had a 'moment when the nation decided what it was for, what people should expect or who should pay, and how.’  

It’s also an area about which we know relatively little. As we say in our recent report, there is a gap in our knowledge of the sorts of care people most value, what sort of services they would themselves most consider using and, if more money is to be spent, what people would most want it spent on.  

That focus on the care we want, rather than the failure of what we have now, would make for a more positive and forward-looking conversation. It would allow for a serious discussion about a ‘social covenant’ between individuals, families and the state and about their relative responsibilities for providing and paying for care. This was one of the key recommendations of the 2023 Archbishop’s Commission on reimaging care and it is a critical one.  

That will not be an easy conversation, and it may be hard to find a consensus. People may not be where we would like them to be. But it would at least focus our minds on what we want in the future rather than what happened in 1948. And that would be a strong step towards building a better system.