Shifting the narrative: building public support for social care reform

In this election year, there is much speculation about which issues will feature in the campaigns. The NHS is a given. Social care, having become a political hot potato in previous election battles, may not be so prominent. But, while political parties may choose to steer clear of meaningful debate before the election, it’s clear that whoever takes the reins of power next will need to grapple with this increasingly urgent issue.

Despite multiple attempts, England remains one of the few developed countries in the world that has not made substantial efforts to reform the way people with needs arising from age, long-term illness or disability are supported. We lag at least two decades behind many other countries such as Germany, Denmark, Japan and South Korea, which foresaw the future pressures and addressed them by putting in the building blocks of a functioning system.

Meanwhile, people and unpaid carers are increasingly struggling to access the support they need to live a full life, waits for care assessments are long and the workforce is under immense pressure. It’s becoming increasingly difficult to see how this inaction can continue.

So what can be done differently this time to make sure meaningful reform actually happens?

Starting in the right place

In our work at the Nuffield Trust, we have studied the care systems of several other countries and we are often asked how they managed to reform their systems when things seem to be so intractable here. I think the answer lies in the starting point for public debate and then in the framing of the narrative around what social care is and why it matters.

Looking back at debate around social care at previous election times in the UK, the focus has very much been on costs and who pays. It is undeniable that these are crucial issues but, as the starting point for building support for change, they are problematic. While the likely sums needed to transform social care pale into insignificance against current spending on the NHS, any reform is going to need a new sustainable source of funding. But raising new money requires public support and the public need to be persuaded of the case for change. 

Focusing on cost and individual expenditure as a starting point immediately narrows the debate and fails to paint a persuasive picture of a system worthy of investment. Concern over having to sell property to pay for care, for instance, is unlikely to feel relevant to a younger person struggling to get on the property ladder, or to a family struggling with the day-to-day cost of living, nor to a disabled working-age adult keen to work but lacking the support to do so.

Raising awareness

Low levels of public understanding of what social care is, how the system works and what people may be entitled when they come to need care are a fundamental obstacle to building support. Many people don’t have a good understanding of what social care is unless they have direct experience of it. Just under half the population believe social care to be free at the point of use as part of the NHS. So, when politicians announce new taxes to fund a reformed care system, often the assumption is that we are to be charged for something that is currently ‘free’. 

In the heat of past political campaigns, revenue-raising proposals have been attacked for political gain, exploiting the public's lack of understanding. Raising public understanding needs to be the first step if there’s any chance of having a fruitful national debate.

Positive framing

When we’ve looked at social care reforms in other countries, they have been successful in building public support for taxes and levies by creating a positive story, framing social care as something worthy of investment and an essential part of national infrastructure. Japan, in particular, successfully shifted debate from a negative story of costs and burdens to a positive place where a new system would not only provide high-quality support to people with care needs, but also support wider society and the economy by freeing up unpaid carers and creating employment through a thriving provider sector. Germany, too, created a narrative about solidarity and mutual support. France has recently established social care as the fifth pillar of the welfare state, bestowing on it a status and value equivalent to health and pensions, and firmly planting it as a vital component of public infrastructure.

Our society accepts that health care and education are public goods that benefit all. Even the debate around childcare, which has many parallels with social care, has shifted in recent years to a place where pledges by politicians to invest, expand and make more generous the public offer are on the whole seen as a vote winner. That more positive narrative is where social care needs to get to.

Looking forward

To get from where we are now to a place where public and political debate is fruitful, we need to start with a clear vision of what can be achieved and to build public support around a positive narrative of investment and strength. 

In recent years, we have seen great progress in this direction with high-profile figures and influential organisations doing just this. Last year’s Archbishop’s Commission sought to construct a new narrative around social care grounded in mutuality and interdependence. Similarly, the House of Lords Social Care Committee published a report entitled A gloriously ordinary life, which highlighted that social care is about enabling people to live fruitful, active and valuable lives. 

Instead of reducing social care to a ‘life and limb’ service for older ‘vulnerable’ people, there is an opportunity for politicians to frame it as the essential service that will support us all to live well whatever our circumstances; to take away the worry of who will support and care for us, our parents and relatives; and offer reassurance that compassionate, valued and well-trained staff will be there for us. 

Embedding this positive framing in the mainstream political debate will require bold political leadership as we edge towards an election and into the next parliament. Public finances are strained, so a reform agenda will need to be incremental and thoughtfully implemented, but the starting point needs to be the solid building blocks of a system we can all aspire to and want to invest in. Social care has been so badly let down by successive government of all hues. The next government cannot afford to follow suit.