The sociocultural framing of public attitudes to sharing the costs of social care for older people in England

Authored by Josie Dixon, Josephine Exley, Gerald Wistow, Raphael Wittenberg, Martin Knapp and Nicholas Mays

Traditionally, research has found that people would prefer social care for older people to be funded by taxes or national insurance, like the NHS. However, more recent surveys appear to show increased support for shared funding. Shared funding is where services are paid for using a combination of Government funding and people contributing some of their own money ("out-of-pocket" payments).

We conducted 12 focus groups across England and used a framing approach to explore people’s reasons for supporting shared funding. The findings have been published in Health and Social Care in the Community. 

We found that support for shared funding was dominated by concerns about scarcity and affordability. Out-of-pocket payments were seen as necessary to support a fragile social care system. Sharing costs was also thought to be the fairest approach where neither individuals nor Government can afford to pay for care alone – described using phrases such as "splitting the difference", "fair on both sides" and "a mutual thing".

Given this scarcity, there was a limited vision for what social care could achieve, with a focus on funds being used to meet what were perceived as medically-related needs. This, however, was accompanied by associated anxieties about care quality, cliff-edge costs - whereby people have to find significant sums of money to pay for care very suddenly - and abandonment.

The private market for social care was viewed as potentially a way for individuals to obtain better care for themselves, but there were doubts about the availability of good quality care and concerns about what would happen to an individual when their money ran out. There was also a strong view that good, basic care should not be dependent on people’s ability to pay.

Despite concerns about scarcity and, often reluctant, acceptance that it may not be possible for social care to be funded by national tax or insurance contributions alone, there was also strong support for government making a much larger contribution than currently.

The full report can be accessed here >>>