Michelle Mitchell, Chief Executive, MS Society

This article forms part of the LGA think piece series 'Towards a sustainable adult social care and support system'.

The case for building public consensus for social care reform

I have always believed that when a cause is worthwhile, you will be able to find a way to build consensus across party lines, across sectors and in the public’s mind. But social care is one of the few policy areas in which coming to agreement and driving forward change has been particularly difficult and slow. 

The imperative for change has never been clearer. In spite of charities’, think tanks’ and local government’s best efforts and continued calls over the last two decades for a sustainable funding solution to meet growing demand for social care, governments have not reformed the way the system is funded. As a result, more and more people aren’t able to access the crucial care they need, while it is reported that increasing numbers of homecare providers and care homes are on the verge of collapse.[1]

The effects of this broken system are clear. The Care and Support Alliance’s (CSA) recent research found that over half of disabled people, older people and their carers aren’t getting the care they need and can’t do the things that are important to them.[2] We hear countless stories like Edith’s, who at the age of 30, faced the possibility of having to go into a care home, because the support she needed to remain independent, work and live a fulfilled life with MS was no longer available. This simply can’t go on. Caring for disabled people and older people in our society could hardly be a more emotive issue, but despite this and much robust evidence about the increasing difficulties faced, we have continued to ‘go on’.

We’ve seen many consultations and reviews come and go over the past decades. The announcement that the Green Paper has been delayed until the autumn raises fears that once again the issue is seen by government as ‘too difficult’ and too expensive to solve. The NHS long-term funding settlement has also rightly raised the question, ‘what about social care?’ We all know that if we do not put social care on a sustainable footing, the NHS will struggle to achieve its ambitions, even with increased funding. This and the delay in the Green Paper’s publication have put greater onus on the Government to deliver a long term solution for social care. What can be done differently to ensure that this Green Paper delivers the change people so desperately need?

I am convinced that achieving public consensus, as well as political consensus, is crucial to achieving the change we need to see.

Public polling consistently demonstrates that the British public are proud of the NHS and want to see funding for it increase, even if that means paying more tax. We are starting to see similar consensus on the need for more funding for social care, but a major barrier we still face in successfully driving through reform in practice is that many simply don’t understand how it works. This makes the ability of experts, patient groups and others to win the argument much more difficult.

What advice would I have for the Government in the face of this challenge?

Well, there is reason to be positive that building that public consensus is possible. In a recent Ipsos MORI poll, the public named community and social care services in their top three spending priorities for any new NHS funding, with over 4 in 10 prioritising it, above even surgery and primary care.[3]

Firstly, if the Government is to persuade the public of the need for change, the Green Paper must be serious about public engagement. Our recent focus groups found that once people living with MS were informed about how the current system works and understood the solutions on the table, they were able to make realistic and difficult decisions about how the system should be funded. The trick is not to patronise the public, but engage them early and explain the issues honestly.

Secondly, I’d urge the Government to be bold in its vision for the future of our care system. Again, our focus groups and those of other CSA members have found that difficult funding decisions are only acceptable to the public if this results in improved care. The public is unlikely to stomach any proposals that ask them to pay more to support the same inadequate system. So the Government must do more than just maintain the status quo, and must deliver improvements that people need to see. Over a third of respondents from the CSA’s research said that an improved care system must include better quality of care, while 4 in 10 want the system to provide more support that prevents more responsibility from being placed on unpaid carers.

Finally, part of being bold means taking a whole system view. The Health Secretary has said that the reason for the Green Paper’s delay is to allow long-term plans for social care to be aligned with those for the NHS. But taking a whole system view does not just mean looking at plans for health and care together, vitally important though that is. It means not leaving anyone out of those plans. Too often social care is thought of as something only older people need, but over half of those who receive it are of working age and those numbers are increasing. Many more working age and older adults rely on millions of unpaid carers who also are not getting enough support. Any funding solution that does not work for everyone who needs care and provides unpaid care is not going to be sustainable or acceptable. If the Government are to win the support of the 5.7 million working-age disabled people in this country, they would be wise to take note.

I believe the social care crisis is solvable. The Green Paper must be the start of reform that sees us secure a social care system that enables people to access high quality, affordable care, when they need it regardless of their age. To make this a reality, we must learn from past mistakes, engage the public in a meaningful way and most importantly, not be afraid to be bold.

Michelle Mitchell, Chief Executive, MS Society

[1] ADASS, ADASS Budget Survey 2018,

[2] Care and Support Alliance, “Big Social Care Survey”, 2018

[3] NHS at 70, Public attitudes to the health and care system, Ipsos MORI and NHS Providers, 2018