Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Nina Hemmings: What the British public think about social care

  • Comment

Last June, the public social care system quietly turned 70.

But in its birthday year, how did the public rate local authority-provided adult social care? If the results of the most recent British Social Attitudes survey (BSA), carried out by the National Centre for Social Research, are anything to go by, there’s a lot of room for improvement.

For instance, when respondents were asked how satisfied they were with social care provided by authorities for those unable to look after themselves because of illness, disability or old age, only a quarter (26%) say they are very or quite satisfied, as shown in Figure 1.

Not only is it a very poor rating in itself, levels of satisfaction fell in 2014-15 and have remained consistent since then. It also compare badly to public views about healthcare: 53% of people said they were satisfied with the NHS overall and 70% for outpatient services, for instance.

Source: The King’s Fund and Nuffield Trust analysis of NatCen Social Research’s BSA survey data

It’s worth noting that the BSA data covers Britain and, as social care is devolved, different arrangements exist in England, Scotland and Wales. But what might broadly lie behind this low satisfaction with social care? A closer look at the data suggests age and experience, knowledge and the media, and fundamental problems in funding, access and quality are all factors.

On age, we know that people aged 65 and older rate NHS services more highly than those younger than them. The same seems true for social care, with 30% of 65- to 74-year-olds and 38% of people aged 75 and older stating they are satisfied, as shown in Figure 2.

Source: The King’s Fund and Nuffield Trust analysis of NatCen Social Research’s BSA survey data

It is noticeable that people in their mid-fifties to early sixties report relatively high levels of dissatisfaction. This echoes polling by professional services firm Deloitte from last year which showed that this group, who are more likely to have older parents, prioritise social care for older people as an area that should be protected from future government spending cuts.

It’s also likely that people in this age group are the ones most acutely experiencing the “pressures of arranging care, often at moments of crisis, and relief when care was put in place”, as research by the Health Foundation and the King’s Fund put it.

Another possible contributor to the low satisfaction rating for social care is a lack of knowledge and experience of social care – what it is, who is responsible for funding and delivering it, and how to access it.

While considerable effort goes into devising and testing satisfaction in social care, responses to questions about it attract a relatively high proportion of “don’t knows” – 9% compared to less than 1% when asked about satisfaction with GPs, and 3% when asked about satisfaction with outpatient services.

The same questions also attract a high proportion of ‘neither satisfied nor dissatisfied’ responses, 31%, compared to 13% for GPs and 15% for outpatients. This data, shown in Figure 3, hint at a possible problem for those surveyed in forming an opinion about social care.

Source: The King’s Fund and Nuffield Trust analysis of NatCen Social Research’s BSA survey data

On the other hand, the media attention that social care receives at sporadic times suggests the public are not always indifferent or unengaged.

This seems to be reflected in the BSA data. As Figure 1 shows, there was an increase in dissatisfaction in 2017, perhaps reflecting heightened public concern at a time when the Conservative social care reform proposals were aired, pejoratively characterised by some as a ‘dementia tax’.

Notwithstanding the above, there is another, more straightforward, explanation for the low satisfaction ratings for social care: many people are genuinely dissatisfied. The exact reasons for low satisfaction may not be pinpointed precisely in the BSA survey data, but ample evidence points to problems of access and quality in social care services.

Local authorities in England have witnessed a 49% real reduction in government funding between 2010-11 and 2017-18. While they have sought to protect their adult social care budgets, support is increasingly reserved for those with the severest needs, meaning fewer and fewer people are receiving publicly funded social care.

Between 2009-10 and 2013-14, the total number of adults receiving long-term, publicly-funded social care fell by 27% as eligibility criteria steadily tightened. National eligibility criteria was introduced in 2015 but between 2015-16 and 2017-18, the total number of people receiving long-term care in England fell by 1.7% to 857,770 people.

Over half of older people with care needs have unmet needs, and complaints to the Social Care Ombudsman have risen by 169% since 2010-11 – with the most common complaints about councils relating to assessments and charging.

It is perhaps unsurprising that the public are dissatisfied with a public service that is unfair, unclear and unfit to meet the rising needs across the population. That dissatisfaction remains high suggests there is much to be gained from moving forward with the long-promised reform of social care services. The overreliance on informal carers and self-funders to prop up the system is unsustainable.

The promised green paper offers a chance to move policy onwards. Crucially, the government must address the funding crisis facing the sector, and this will be complex as public awareness is low and different groups have different perceptions.

But there is growing evidence of public consensus to pay more for a system that works better. One recent survey found that 82% of the British public support a 3.9% increase in social care spending, and a paper found a significant consensus across the UK that everyone should pay into a collective, public fund for social care.

After nine years of austerity, there is therefore a clear opportunity in the 2019 spending review and green paper for the government to take steps towards a sustainable future for social care.

Nina Hemmings, research in health policy, Nuffield Trust

  • Comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions.

Links may be included in your comments but HTML is not permitted.