The BBC’s Care Calculator website reveals that many people are over-optimistic when it comes to care costs and who pays for it. Experts Martin Knapp, Jose-Luis Fernandez and Teresa Poole take a closer look at the findings
As the government prepares to publish a green paper on the adult social care system next month, a study has shown that people’s expectations of the level of free care provided under the current system are often over-optimistic.
The statements of public attitudes captured by the BBC Care Calculator website also demonstrated a willingness to pay higher taxes to fund improvements in social care services, and support among most respondents for universal levels of publicly funded support that do not depend on an individual’s assets.
Our analysis examined the responses of 9,588 people who during early 2008 used at least one of the interactive tools provided by the BBC Care Calculator (see box below).
Almost four-fifths of respondents to the survey were under 65, 31% said they had a disability, and 11% received social care support at the time of the survey. Only respondents in England were included in the analysis.
The government’s public consultation document last year, The Case for Change – Why England Needs a New Care and Support System, argued for reform of the adult social care and support system, citing a £6bn public funding gap in 20 years’ time and criticisms that the system penalises those who save for old age. The green paper is expected to outline alternative funding models and to call for a public debate on the options for meeting social care needs in the future.
Levels of support
More than half (55%) of those who used the interactive care calculator said that the level of support in England depicted in the examples was worse than they had expected. For 40% of respondents it sounded “about right”, while nearly 6% said it was better than expected.
In particular, older people and those living with others found the levels of support worse than they expected. These results confirmed that people’s expectations of the level of support are often wrong. As a result, individuals are often ill-prepared for the private costs of needing care.
The questionnaire explored in more detail people’s views of the long-term care funding system and how it might be reformed. There was clear dissatisfaction with the level of publicly funded support offered to disabled and elderly people. Of the 2,467 users in England who completed the questionnaire component, almost nine out of 10 rated support levels as “inadequate to meet individuals’ needs”. Younger people in particular took this view.
But when asked in broad terms how care should be funded, there was no consensus about whether this should only be the responsibility of the state. More than half backed a system where the care provided by local councils was funded exclusively from general taxation.
But 40% said local councils should provide a basic support package and that, if more support were needed, individuals who could afford to should “top up” by privately buying more support. Individuals with lower incomes or savings, disabled people, social care users and younger people were significantly more likely to call for a system funded exclusively from general taxation, but this was less popular with owner-occupiers.
A key parameter for any reform of the funding system will be the extent to which means-testing plays a role in deciding an individual’s eligibility for publicly-subsidised care and support. Two-thirds (65%) of respondents said everyone should receive the same amount of free social care regardless of the level of assets they owned. But nearly one-third (29%) disagreed, saying that people with more assets should receive less state support. Owner-occupiers and people with savings above the means-test threshold (£21,500 in 2007-8) were significantly less likely to agree that savings should be taken into account, but this was also true for old people and people with disabilities.
Ways of funding
The questionnaire investigated people’s views of four different ways to fund improvements in social care, all of which are likely to feature in the public debate after the green paper.
● A large majority (82%) of respondents said they would be willing to pay higher taxes, but 11% said they would not be (the rest were unsure). People with savings above £21,500 were less in favour of a rise in income tax, whereas recipients of care were more likely to agree with the measure.
● The green paper consultation document points out that in 2004 people aged over 60 owned about £932bn in equity in their homes. Older people can utilise some of their property wealth through “equity release” schemes, making funds available for care. Asked if the state should subsidise these types of financial products, for example by offering tax breaks, 42% agreed, 30% did not, and 28% were unsure.
● Some countries, including Germany and Japan, have responded to the need for social care funding reform by introducing state-organised social insurance schemes. Respondents were asked if everyone in full-time employment should be made to take out insurance to cover their future care costs and similar numbers were in favour (37%) and against (36%). More than a quarter of respondents were unsure, suggesting perhaps that they were unfamiliar with this type of funding model. This option attracted groups of people who would appear to have different reasons for benefiting from an insurance model: older people, people with disabilities, people living alone, and people with higher savings.
● The Wanless social care review proposed a partnership funding scheme whereby everyone in need of care would be entitled to an agreed level of free care and the incentive for further private expenditure on care (up to a maximum level) would be by the state making a matched contribution. (People on low incomes would be eligible for benefits to fund their contributions.) Three-quarters (73%) of respondents supported this approach, with older people, disabled people, and those with higher incomes or wealth significantly more in favour. Just over 11% were against this model, and 16% were unsure.
Building a consensus
The results confirm how challenging it will be for the government to secure a consensus across society about the way forward. People’s views do not always appear consistent, a fact that might reflect a lack of understanding of the different types of funding models.
Although the focus of the questionnaire was on social care funding options, it also explored views on how informal care should be encouraged. Out of the options available, nearly 45% of respondents opted for improved financial support for carers including grants and benefits; with a lower level of support for improved day care (12%), improved respite care (12%), and improved rights to flexible working (10%). Interestingly, almost one in five respondents (19%) did not favour any measures “because [informal care] discourages government support” for care.
The effects of the recession
In Autumn 2007, when the green paper was announced, there was a degree of optimism in the social care world that the reform process would lead to a higher priority for adult care services and an improved funding package. A year and a half later and the outlook appears very different.
Public finances are in their worst state for a generation, following the financial crisis and the government’s bail out of the banking system, and the economic outlook remains very uncertain. The process of reducing government debt to more manageable levels will mean a squeeze on public services that is likely to continue for several years. This will put even greater pressure on the already stretched local authority adult social care budgets.
It is in this context that the green paper reform proposals will appear, probably next month. By the time any funding reforms are actually being implemented, the cuts in public spending growth will have taken hold so the likelihood of the reforms creating a more generous system looks very remote.
What is the care calculator?
The BBC Care Calculator was created for the BBC by the Personal Social Services Research Unit (PSSRU) at the London School of Economics. The Care Calculator included three elements:
● An interactive web tool, which sketched a broad picture of the levels of social care support received by different types of people in need in England. Individuals using the care calculator were asked to rate whether the level of public support described were better or worse than they expected.
● A “care map”, which provided links to local council social services departments and organisations offering expert advice in the different local areas in England.
● A questionnaire, which collected views on how adult social care should be funded in future and ways to encourage informal care.
Martin Knapp is director and Jose-Luis Fernandez deputy director at the Personal Social Services Research Unit at the London School of Economics. Teresa Poole is an independent consultant.
Published in the 21 May 2009 issue of Community Care under the heading ‘Care Costs the Public View’