What does the British public think about social care?

As The King’s Fund and Nuffield Trust today publish analysis of the latest British Social Attitudes survey, Nina Hemmings takes a closer look at how satisfied people are with social care.

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Published: 07/03/2019

Last June, the public social care system quietly turned 70. 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 (BSA) survey carried out by the National Centre for Social Research are anything to go by, there’s a lot of room for improvement.

When asked ‘How satisfied or dissatisfied are you with social care provided by local authorities for people who cannot look after themselves because of illness, disability or old age?’, only a quarter (26%) of the British public say they are very or quite satisfied (see chart).

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

Satisfaction with local authority-provided social care and with the NHS overall (2005 to 2018) 07/03/2019

Chart

Note:  

The 2018 BSA survey questions reported here were jointly sponsored by the Nuffield Trust and The King’s Fund. On social care satisfaction, the questions asked were: ‘And how satisfied or dissatisfied are you with social care provided by local authorities for people who cannot look after themselves because of illness, disability or old age?’ [2012–2018], ‘At some point in their lives, people can need regular help looking after themselves because of illness, disability or old age… From your own experience, or from what you have heard, please say how satisfied or dissatisfied you are with the services provided to people who need this kind of regular help with looking after themselves, whose family cannot provide it?’ [2005, 2007]. Question not asked 2006 and 2008–2011. Overall satisfaction: ‘All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?

Source:  

The King's Fund and Nuffield Trust analysis of NatCen Social Research's BSA survey data. There has been no statistically significant change in satisfaction since 2015.

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

Age and experience

We know that people aged 65 and older rate NHS services more highly than those in the youngest age groups. 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 (see chart).

Satisfaction with local authority-provided social care by age group (2018) 07/03/2019

Chart

Source:  

The King's Fund and Nuffield Trust analysis of NatCen Social Research's BSA survey data

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But it is noticeable that people in their mid-fifties to early sixties report relatively high levels of dissatisfaction. This echoes polling by Deloitte (2018), which showed that this group (who are more likely to have older parents) in particular prioritise social care for older people as a public policy 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”. 

Lack of knowledge and the media

A possible contribution to the low satisfaction rating for social care is simply 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 the satisfaction question for social care, the fact that it attracts a relatively high proportion of ‘don’t knows’ (9% of those asked selected the ‘don’t know’ option – compared to less than 1% who did so when asked about satisfaction with GPs, and 3% when asked about satisfaction with outpatient services), and also a high proportion of ‘neither satisfied nor dissatisfied’ responses (31%, compared to 13% for GPs and 15% for outpatients) hints at a possible problem for those surveyed in forming an opinion about social care (see chart).

Percentage of respondents stating “neither satisfied nor dissatisfied” and “don’t know” (2018) 07/03/2019

Chart

Source:  

The King's Fund and Nuffield Trust analysis of NatCen Social Research's BSA survey data

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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 the first chart shows, there was an increase in dissatisfaction in 2017 – a reflection perhaps of heightened public concern at a time when the Conservative Party’s social care reform proposals were aired, and pejoratively characterised as a ‘dementia tax’ by some.

Access and quality

There is of course another, more straightforward, explanation for the low satisfaction ratings for social care, and that is that many people are genuinely dissatisfied with social care.

The exact reasons for low levels of satisfaction may not be pinpointed precisely in the BSA survey data, but ample evidence points to problems in access to and quality of social care services.

Local authorities in England have witnessed a 49% real reduction in government funding between 2010/11 and 2017/18. And 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 even still, 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.

Listen to the public: time to act

It is perhaps not surprising 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 over-reliance on informal carers and self-funders to prop up the system is not sustainable.

The promised green paper offers an opportunity 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 population groups have different perceptions. But there is now growing evidence of public consensus to pay more for a system that works better, with one recent survey finding that 82% of the British public support a 3.9% increase in social care spending, and another paper finding a high degree of consensus across the UK that everyone should pay in to 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 to secure a sustainable future for social care.

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