{"id":103,"date":"2026-09-14T11:15:51","date_gmt":"2026-09-14T11:15:51","guid":{"rendered":"https:\/\/reframingcare.stir.ac.uk\/?p=103"},"modified":"2026-09-14T11:16:08","modified_gmt":"2026-09-14T11:16:08","slug":"we-need-to-talk-about-how-we-talk-about-social-care","status":"publish","type":"post","link":"https:\/\/reframingcare.stir.ac.uk\/?p=103","title":{"rendered":"We need to talk about how we talk about social care"},"content":{"rendered":"\n

The Health Foundation\u2019s new report We need to talk: Public attitudes to social care and the NHS<\/em> gives us a lot to think about. As someone who has spent much of my career thinking about the relationship between the public and public services, the paper left me with at least as many questions as answers.<\/p>\n\n\n\n

The first is an old bugbear of mine: can you really be satisfied with a public service you don\u2019t use?<\/strong><\/p>\n\n\n\n

I have raised versions of this question repeatedly throughout my career and have never received an entirely satisfactory response (pun intended).<\/p>\n\n\n\n

The Health Foundation finds that only 14% of people agree that social care services in their local area are good, while 28% disagree and 34% neither agree nor disagree. Large parts of the population have little or no direct experience on which to base an assessment. A neutral answer might tell us something about the service. It might equally tell us that people simply don’t know. For those who don’t use social care (directly or indirectly through a family member or close friend), this is a measure of perceptions rather than satisfaction.<\/p>\n\n\n\n

But the picture changes when we look at people closer to the service – who are reporting on satisfaction. Among people who have used social care themselves, or whose friends or family have, 35% disagree that their local services are good. There is also a potential issue with unmet need as 33% of people aged 55 to 74 years 39% those with a health problem or disability disagree that services in their local area are good. So we cannot explain away poor perceptions of social care simply as an issue of public understanding. There is a genuine user satisfaction issue here alongside the general public perceptions concern.<\/p>\n\n\n\n

But what exactly are people evaluating?<\/strong><\/p>\n\n\n\n

Which brings me to my second question. The report contains some striking findings about how poorly understood social care remains. In England, 39% of people incorrectly believe social care is generally free at the point of need and 34% think the NHS provides most social care for older people. Only 49% correctly say that it does not.<\/p>\n\n\n\n

This offers the context for another finding in the report. When people across the UK are asked which areas should be priorities for future government spending, 60% select the NHS compared with 22% selecting social care for older people. The report understandably concludes that social care remains a relatively high spending priority, although it has now fallen behind defence.<\/p>\n\n\n\n

But how should we interpret that gap when a substantial proportion of people do not clearly understand where the NHS ends and social care begins? If I believe that the NHS already provides most social care for older people, what exactly am I choosing when a poll asks me to choose between spending on the NHS and spending on social care?<\/p>\n\n\n\n

We cannot answer that from these figures. A further complication is that some of the data reported here relate specifically to England while the spending-priority findings cover the UK, and we don’t have the cross-tabulation that would tell us how knowledge of the system affects people’s answers.<\/p>\n\n\n\n

Which, inevitably, leads the researcher in me to ask for more research.<\/p>\n\n\n\n

1. Is there a difference across the four nations of the UK?<\/strong> The systems, access rules and political debates differ considerably across the UK. In Scotland, for example, free personal and nursing care changes at least part of the story people about paying for care. We should not assume that public understanding, or misunderstanding, is identical across the UK. The benefit of the Ipsos Knowledge Panel is that it gives you enough data to do this analysis properly (which is why I selected it for the Life in the UK Index that I started at Carnegie UK). It would be nice to see more of this analysis coming forward.<\/p>\n\n\n\n

2. What happens to political prioritisation when we look only at people who understand that social care is not part of the NHS?<\/strong> Does social care become a higher spending priority? Does the gap between health and social care narrow? And do attitudes towards reform or funding change?<\/p>\n\n\n\n

The policy community uses this kind of public attitudes research to make judgements about what people care about and, in turn, what politicians are likely to prioritise. So if people don’t necessarily know what we mean by social care, we need to be a bit careful about what we conclude from their answers.<\/p>\n\n\n\n

But this is also where the strategic communications part of my brain kicks in. I don’t think the answer is simply to explain social care better. Of course, it would be helpful if more people understood that social care isn’t part of the NHS, isn’t free at the point of use for everyone and isn’t just about care homes (nor is it just about older people, though the Health Foundation are at pains to point out that they use that wording for trend data rather than trying to obscure the needs of working age people). But I am not convinced that what we need is a better-informed public who can accurately describe how the current social care system works. To be fair, I have found plenty of people working in and around social care struggle with parts of that.<\/p>\n\n\n\n

What matters more is whether people understand what social care is for, why it matters to all of us and what a better system could make possible<\/strong>.<\/p>\n\n\n\n

That is the challenge we have been grappling with through our work on changing perceptions of adult social care in Scotland. We know that when social care does appear in public debate it is very often through crisis: people stuck in hospitals, care homes closing, workforce shortages, families struggling to get support. All of those things are real and need to be talked about. But collectively they don’t give people much of a sense of what social care actually does when it works well, or why it should matter to them.<\/p>\n\n\n\n

We have six months left of this phase of our Public Perceptions of Adult Social Care project and plenty still to do. We are now working to engage MSPs as we move into the new parliamentary session, while continuing to run workshops and support the social care leaders we have been working alongside for more than a year to put the framing into practice.<\/p>\n\n\n\n

You can read more about our work and access our resources at www.reframingcare.stir.ac.uk<\/a>. If you would like to talk to us about running a workshop, using the framing in your own communications or getting involved in the next six months of the project, please get in touch at jennifer.wallace@stir.ac.uk<\/a>.<\/p>\n\n\n\n

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<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

The Health Foundation\u2019s new report We need to talk: Public attitudes to social care and the NHS gives us a lot to think about. As someone who has spent much of my career thinking about the relationship between the public and public services, the paper left me with at least as many questions as answers.<\/p>\n

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