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Who should pay for social care services?

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Does it make sense to have separate funding systems for health and social care? And what should be the balance between the individual and the state in funding services?

These are some of the key issues currently being considered by the independent Barker Commission, set up by The King’s Fund to explore whether the post-war settlement, with separate systems for health and social care, remains fit for purpose.

In 1948, the health and social care systems in England were set up as two separately funded services. Sixty-five years on, people are living longer, with a mixture of needs – including multiple long-term conditions, dementia and frailty – that are becoming increasingly hard to compartmentalise.

So, what does the general public think?

Recent surveys suggest that the public’s understanding of the distinction between health and social care is generally poor – with people often assuming that social care will be free as part of the NHS. Ipsos MORI’s latest polling of Londoners shows that nearly three in five Londoners incorrectly believe that they won’t have to pay anything towards the costs of their old-age care. Most people are not financially prepared for their own future care needs and do not plan ahead.

To understand more about what the public think about who should pay for care, we have taken a look at previously unpublished results from the most recent British Social Attitudes (BSA) survey. The results (Figure 1) show that the public is divided: half of those surveyed feel that the state should fund social care; the other half think that individuals should contribute to their care costs. More than one in five support a threshold for means-tested support and more than one in four support a cap on the amount individuals would need to contribute (although the level of the cap is not specified).

Figure 1: Who do you think should pay for social care?

Pie chart showing that 48% of people think government should pay for social care

Breaking down the figures by age group shows that people aged 45 to 54 years old are the most in favour of state funding of social care (57 per cent compared with 50 per cent overall). The younger age groups (18 to 34) are more supportive of people paying only what they can afford towards their social care costs, and less supportive of a capped model (21 per cent compared to 27 per cent overall). People aged 55 to 64 years old are the most in favour of a capped model (36 per cent compared to 27 per cent overall), perhaps because they are already feeling the pressure of care bills for older family members.

Figure 2: Who should pay for social care by age group

Bar graph showing responses to who should pay for social care by age group

Data also shows that people’s opinion on the funding of social care is related to their household income (Figure 3): lower income groups (gross income of up to £2,200 per month) are more likely to think that social care should be state funded (57 per cent compared with 50 per cent overall); higher income groups (gross income of more than £2,200 per month) are more supportive of a shared responsibility between the government and individuals (60 per cent compared with 50 per cent overall). Higher income groups are more likely to support a capped model, perhaps seeing this as a way to protect their income and assets.

Figure 3: Who should pay for social care by pre-tax household income group

Bar graph showing response to who should pay for social care by pre-tax household income group

The BSA survey results show a clear split in public views – highlighting the need for a bigger debate about how the kind of health and care system we need in the future should be paid for. The issues are complex: difficult choices lie ahead about how much to spend on health and social care and how to fund this. The government, in the Care Bill going through parliament, is proposing to introduce a cap on the costs of care for the individual – set at £72,000 from 2016. This will protect people from some of the worst iniquities of the current system, but will not solve the social care funding challenge.