Perhaps the most striking promise made by Boris Johnson when he first became Prime Minister two years ago was that, ‘we will fix the crisis in social care once and for all with a clear plan we have prepared’. In particular, he stated that ‘My job is to protect you or your parents or grandparents from the fear of having to sell your home to pay for the costs of care.’ Meanwhile, since then, the high level of mortality in care homes in the initial months of the COVID-19 pandemic has for many dramatically underlined the need for reform of both the funding and the provision of social care. This week the UK government is finally expected to announce its plans for the future funding of social care in England.
But how do the public think that social care should be funded? This is one of the issues that was covered by two surveys we have conducted via NatCen’s mixed mode random probability panel since the onset of the pandemic. The first of these was conducted in July of last year, shortly after the first wave of the pandemic (and on which we previously reported here). The second was conducted in June of this year, just as lockdown restrictions were gradually being removed following a programme of a mass vaccination. In both cases the question asked was as follows:
Who do you think should pay for social care for people who cannot look after themselves because of illness, disability or old age?
The individual should pay what they can and the government* should pay the rest
The individual should pay what they can up to a capped amount and the government* should pay the rest
*The funding of social care is a devolved matter and thus in Wales the answer referred to ‘the Welsh government’ and in Scotland to ‘the Scottish government’.
This question was also asked on the 2012 and 2018 British Social Attitudes surveys, and so we can also see to what extent attitudes have changed in recent years – not least, perhaps, because of the experience of the pandemic.
Table 1 shows the distribution of responses across Britain as a whole on the four occasions on which it has been asked. Note that the second option in the table approximates to the current system in England, whereby individuals have to pay for social care until they have less than £23,250 in assets, while the third refers to the proposal made by Sir Andrew Dilnot in a report commissioned by the government a decade ago that there should be a cap on the total amount that any one individual has to pay for social care during their lifetime and that individuals should no longer have to pay at all once their assets fall below £100K. It is thought that the UK government is now minded to move towards a similar system, albeit perhaps with a substantially higher cap than the £35K that Sir Andrew proposed.
Table 1 Attitudes towards Funding of Social Care 2012-21
Source: 2012 & 2018: British Social Attitudes: 2020 & 2021: NatCen Panel
Two key findings emerge from the table. The first is that the current position is relatively unpopular. Only around a quarter say that the individual should pay what they can and only then should the government pay the rest. As a result, given that hardly anyone thinks that individuals should be solely responsible for paying for the costs of care, it appears that a majority of the public believe that the government should play a more significant role in the funding of social care than it does in England at present. Second, however, this does not mean that people necessarily believe that the government should pick up all of the bill – as happens in Scotland and (almost entirely) does so in respect of the NHS. Indeed, support for this option has fallen from nearly a half in 2012 to little more than a third now. Despite the well-publicised problems of the social care sector during the pandemic, a wholly government funded service is now marginally a less popular option than the idea of a lifetime cap.
It seems then that the government may be moving in the direction of a system for funding social care that could prove relatively popular with the public as a whole. However, it is a system that would be more expensive than the current regime in England – and thus may be thought to cut across a traditional Conservative preference for smaller government and lower taxes. Is there then a risk that any proposal for extra funding to support a lifetime cap would prove less popular with the government’s own supporters?
Table 2 suggests that this does not appear to be a risk. Those who voted Conservative at the last general election are only marginally more supportive of the current system than are those who voted Labour. But whereas the most popular option among Labour supporters (backed by 43%) is for the government to pay the whole bill, Conservative voters are most likely to back the lifetime cap. This perhaps is not surprising. For while Conservative voters are less keen on higher taxation, as the Prime Minister recognised two years ago they are also more likely to be concerned about the prospect of having to sell their own home to pay for care. Most likely the proposal for a lifetime cap appeals because it would appear to offer a way of resolving that particular tension.
Table 2 Attitudes towards Funding of Social Care by 2019 Vote and Age, June 2021
Source: NatCen Panel, June 2021
Where there is rather greater disagreement is between younger and older people. As Table 2 shows, just over a third of those aged 18-34 support the principle behind the current system in England, compared with just under a quarter of those aged 65 and over – for whom paying for social care is more likely to be a pressing issue. However, this does not mean that older people are looking to the government to fund the full cost of social care. Rather as many as a half back having a lifetime cap, twice as many as say that the government should pay for everything. So, the direction in which the government is thought to be headed appears to be particular popular among that section of the population most likely in the short-term, at least, to be affected by its proposals.
Still, even if there is widespread support for increased government funding for social care, this does not necessarily mean that there is agreement about how the necessary funding should be obtained. The suggestion that it might be funded through national insurance is giving rise to particular controversy (and is opposed by Labour) because, inter alia, that tax is not paid by people above retirement age even if they are still in employment. In short, those most likely to benefit from any change in the short run at least would be the one group that would not have to pay.
Although not covered in our recent surveys, this rather complex issue was addressed on the 2017 British Social Attitudes survey, which asked:
People are living longer and the costs of social care are going up. How do you think the extra costs of social care should be paid for in the future?
By the individual and their family, from their savings
By the individual, by paying into an insurance scheme
By local authorities, through increasing council taxes
By national government, through increasing national taxes
By national government, through increased national insurance contributions
In 2017, at least, there was little in the way of consensus as to where the extra funds for social care should be found. As Table 3 shows, while a quarter or so did back an increase in national insurance, a similar proportion backed an increase in other ‘national taxes’, while much the same proportion too favoured an individual insurance scheme (an option that Dilnot argues might become more attractive if there were a lifetime cap). That said, this still means that around three in five backed an increase in one or other form of taxation. Meanwhile the only difference between Conservative and Labour supporters was that funding via individual insurance was rather more popular among Conservatives, while for Labour voters, national taxes other than national insurance was the single most popular option.
Table 3 Attitudes towards Sources of Funding for Social Care by 2017 Vote and Age, 2017
Source: British Social Attitudes 2017: Unweighted N=3004
As we might anticipate, there were some differences between younger and older voters here too. But the disagreement between them was not so much about the merits of funding an increase via national insurance rather than other taxes, as about whether it should be funded via taxes or by individuals themselves. Even so, even among those aged 18-34, just over half (54%) backed one of the taxation options, while among those aged 65 and over, nearly two-thirds (64%) did so.
The principle of moving towards increased government funding for a system that introduces a lifetime cap would appear to have the potential to be relatively popular, including not least among those who voted for Boris Johnson in 2019. Somewhat thornier, perhaps, is the question of what taxes should be increased to provide the necessary funds, but even here it is not clear that funding the increase on national insurance is one on which Conservative and Labour voters are as opposed as the two parliamentary parties now threaten to be.
Funding for the two COVID-19 surveys reported here was generously provided by UKRI/ESRC as part of its COVID-19 programme. Responsibility for the views expressed here lie solely with the author.