Not my priority: how the public sees social care (and what can be done about it)
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Without adult social care support, a full life would be impossible for many people. It helps people carry out basic tasks such as washing, dressing and eating but also, for some people, allows them to go out in their communities, meet friends and families, or go to work. Yet, issues with access to support, quality, the workforce, local variation and market instability has led to wide acknowledgement that reform is essential.
So why has this reform not happened?
In this report we explore why public opinion and attitudes towards social care are a key barrier to change. Why is it that social care rarely figures as a key issue during elections, and why is it all too easy for politicians to duck reform and yet not be penalised at the ballot box? How can it be that satisfaction with social care is lower than any NHS service and yet there is little-to-no clamour for change from the electorate?
What does the public think about social care?
Many people do not understand the basics of social care, who provides it, how it is funded and what it does.
Social care is far down the list of policy priorities for the public, though it rises when people are prompted about it.
Public satisfaction with social care is very low and people are pessimistic about it getting better.
People want the state to cover most of the cost of social care but there is less agreement on the details.
What are the implications for reform?
Lack of understanding is hard to tackle because it is driven by several factors, including the broad nature of social care, its complicated funding system, the unclear boundary between the NHS and social care, the reality that few people draw on social care at any one time, and that social care is something that people just do not want to think about.
The outcomes, choice and control approach of the Care Act has passed people by. Expectations are around protecting ‘vulnerable’ people rather than improving freedom and choice.
Third parties – the media, families, friends – are a key driver behind public views on satisfaction with social care.
National political activity, rather than social care sector campaigning, drives public prioritisation of social care as an issue…
...but that is usually focused on the most difficult and contentious subject: how social care should be funded.
What should happen now?
Over decades now, there have been initiatives around starting national conversations or big public debates on social care, and yet the data presented in this report shows that none of these have had the intended impact.
To help break this cycle we suggest the following:
Explore what motivates the section of the public who regard it as a priority when prompted – what is different about them? What drives their views?
Work out how to reach people who influence attitudes to social care – those who have a stake in the system such as people who draw on services, their friends and families, and the workforce, as well as the media and politicians.
Consider how best to use the relationship between social care and the NHS, given the evidence that social care is prioritised more when it is seen as being instrumental in improving issues that the public do prioritise, most notably the NHS.
Accept that the public is in a different place from the social care sector and this should influence language and messaging.
Identify the social care ‘tangibles’ – for example, more staff and more people receiving publicly funded services - that resonate with the public and which matter most to them.
Because there is little to suggest that suggest that social care can be a vote winner, and a lot to suggest it can be a vote loser, seek to build political consensus.
Don’t start by talking about how social care is funded: it is the most contentious and confusing subject for the public and the most dangerous one for politicians.
Find the answers to questions that are unexplored, such as what sort of social care people most value, if more money were spent, what would people like it spent on?
Who do people trust the most on social care – government, councils, providers, charities, people who use services? Use all of this to present a more consistent and credible case for reform. Test the approach with the public and then track attitudes over time.
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