Adult social care: why it has even lower public satisfaction than the NHS

The public has grasped what people who use social care already knew: it doesn’t provide all the support they need. Simon Bottery of the King’s Fund and Laura Schlepper from the Nuffield Trust explore the data from the British Social Attitudes survey.

Blog post

Published: 14/04/2022

In March, a witness told the House of Lords Adult Social Care Committee that he avoided contacting his local authority because he feared it would be used as an excuse to reduce the amount of social care support he receives. Andy McCabe, who has spinal muscular atrophy, said: “When I contact social care because I need a review, advice or support, I always have a worry, a concern and fear that my budget will be cut. Just by contacting them, and them getting more involved in my life, suddenly things might start getting pulled away.”

This is a depressing picture of adult social care, shared – said Andy – by many other people drawing on services. And now there is evidence that the wider public also harbours deep misgivings about social care. The 2021 British Social Attitudes survey, carried out by NatCen Social Research, and published by The King’s Fund and Nuffield Trust, found that in 2021 just 15% of the public said they were satisfied with social care and 50% said they were dissatisfied. This is the highest dissatisfaction rate of any of the health and care services asked about – general practice, A&E, inpatient, outpatient and dentistry, as well as social care.

The joint top reason for dissatisfaction, held by 59% of those dissatisfied and echoing Andy’s concerns, is the worry that people don’t get all the social care they need. However, this was by no means the only reason. Equal top was workforce: 59% said they were dissatisfied because the pay, working conditions and training for social care staff are bad, while 44% said it was because social care is not affordable to those who need it, and 43% were dissatisfied with the support available to unpaid family carers. Other dissatisfactions were with the lack of integration between health and care (32%), understanding how to get social care (21%), and lack of dignity and respect shown by social care staff (14%).

Some groups of people were more dissatisfied than others: 61% of older people (aged over 65) were dissatisfied, compared with 46% of younger people, and 58% of Labour supporters, compared with 43% of Conservative supporters. 

The question about social care changed slightly in 2021, to capture perceptions of all social care services rather than only those services provided by local authorities. That means we can’t compare levels of satisfaction to previous years. However, the 2021 survey does allow us to consider not just the views of the wider public but also people, like Andy, who had direct experience of adult social care. The BSA survey found 14% of people had had contact with social care services in the previous 12 months (the 2021 BSA survey was conducted between 16 September and 31 October 2021), either for themselves or someone else.

For social care (and other health and care services), this contact appears to crystallise opinion: more (66%) said they are dissatisfied with social care (compared to 49% who had not had contact) and more (18%) said they are satisfied (compared to 15% who had not had contact). The level of dissatisfaction among those who had had contact with social care services was again the highest of all the services measured. It is notable that this level of dissatisfaction is far higher than typical levels of dissatisfaction recorded in an annual survey by local authorities of people using social care services (though there was no such survey in 2020/21 because of Covid-19, so we lack a direct comparison).

The level of concern raised by the public and service users is grounded in reality: the number of people able to access long-term care has been falling since 2015/16, workforce pay has failed to keep pace with other industries so vacancies are at record highs, and one in seven people are now estimated to face lifetime care costs of more than £100,000. The sector has deep problems and people appear to realise it. And, of course, the BSA survey followed more than a year of media coverage during the Covid-19 pandemic when there were thousands of deaths in care homes, and social care and its workforce were seen to be under immense strain.

It might be expected that this level of dissatisfaction would give a strong impetus for major changes to adult social care. And certainly the government has promised significant reforms, with plans to make the means test more generous, introduce a cap on lifetime care costs and end the unfair situation in which people who fund their own care pay much more than those who are funded by the state. There are also pledges of more money for workforce wellbeing, investment in innovation and technology, and support for social care-related housing.

However, the changes have been controversial, in part because they are funded by a 1.25 percentage point increase in national insurance and partly because the cap, in particular, has proved to be much less generous than was expected. All this may explain why the public appear to be thoroughly unconvinced that the reform will tackle the main problems: a separate Ipsos MORI poll for the Health Foundation found that only 7% of people in England think the government has the right policies for social care.

Social care, then, continues to be beset with problems and with little confidence that solutions are to hand. The House of Lords Adult Social Care Committee should brace itself for continued dissatisfaction from the witnesses to its enquiry.