The British public are clear-eyed about the problems in social care

Social care - the care people receive when they cannot look after themselves due to illness, disability or age - is a political poisoned chalice. 

Unlike almost all health services, for most people social care isn’t free at the point of use and is only tax funded for those with very low means and high needs. A fragmented provider market, where private payers subsidise those who receive tax funded care is propped up by millions of unpaid carers. Low pay, years of stagnating wages, limited career opportunities, Brexit and the effects of the pandemic have made recruiting and retaining staff a particular problem, with 165,000 vacancies in social care in England last year. 

This paltry service means that hundreds of thousands of people and their families affected by illness, disability and old age are left struggling to get help with everyday tasks like washing, dressing and eating. Many have to quit jobs to care for loved ones. In what is often a shock to people encountering social care for the first time, it is not free as part of the NHS but instead can require large out-of-pocket payments, with no protection against catastrophic costs. 

Many people are unable to access the help they need altogether. Waiting times for an assessment are extremely long: in August 2022, an estimated 245,800 adults in England were waiting for an assessment of their needs, with 33% of people waiting over six months. Even when people do get state funded care, they are crammed into 15-minute visits with overworked and stretched social care staff often unable to provide the quality of care people need.  

Politicians of all colours recognise these problems. The trouble is, reforming social care does not offer the sugar rush of rapid pledges and immediate popularity, and requires political bravery to deliver long term improvements the public might recognise. Politicians have repeatedly failed to jump the first hurdle of accepting how bad the financial state of council funded care is, and how far the existing system is from a universal service like the NHS.  

Despite the former prime minister stating on the steps of 10 Downing Street that he would “fix social care once and for all”, a proposal to cap the lifetime costs of care, first floated over a decade ago and passed into law in 2014, has been postponed yet again. From the then health secretary Andy Burnham’s “death tax” to then prime minister’s Theresa May’s short-lived “dementia tax”, history is littered with failed attempts at reforming social care. 

The public have noticed the dire state of social care. In findings from NatCen’s British Social Attitudes survey, to be published next week by the Nuffield Trust and The King’s Fund, just 14% of people say they’re satisfied with the way social care services are running. A whopping 57% are dissatisfied. 

Nobody - the young, the elderly, men, women, Labour voters, Conservative voters - is more satisfied than dissatisfied. And people are clear-eyed about the problems in social care too. When asked to select reasons for their dissatisfaction, respondents rightly identify the scarce coverage of social care, the poor working conditions for staff, and inadequate support for unpaid carers. 

Perhaps most damning is respondents’ views when filtered for whether or not they have had contact with social care. People who have had contact themselves or via a friend or relative are a staggering 20 percentage points more dissatisfied than those who haven’t.  

So, what do these grim findings mean in the face of such political gridlock on social care? Experience from other countries suggests that to capture the public’s imagination and liberate politicians to act decisively on long-term care, a tipping point needs to be reached – a point of no return, where continued inaction is neither politically nor practically feasible. 

Many thought the tragedy of care home deaths during Covid-19 might be that tipping point, but inaction still rules. Might these findings – drawn from a gold-standard survey of public views and published 18 months out from a General Election – finally provide that tipping point?