The COVID-19 pandemic hit social care hard, exacerbating long standing problems in the care system, and intensifying pressure on the workforce. We commissioned research from Dr Simon Williams at Swansea University to examine public attitudes to and experiences of social care two years on from the start of the pandemic. This two part series explores some of his findings, including:
- a significant proportion (4-in-10) of people who felt that they or someone in their household/close family needed social care during the past two years did not receive or make use of it;
- social care work was widely felt to be under-valued and unattractive as a career option (both to individuals personally and to others). There was great public support for further improving the pay, working conditions, career and professional development opportunities of social care workers; and
- there was substantial public support for social care reform, for making social care reform a priority for government, and for reducing (and removing if possible) the costs to individuals of paying for care.
The need for more consistency, personalisation, integration, recognition and investment in social care were themes that emerged in the focus groups.
This article looks at public perceptions, the consistency and quality of social care services, and access to services.
The full Swansea University research report is available here.
Public perceptions of social care
A common theme in focus groups was that social care was seen as a “secondary”, “fallback” or “Cinderella” service to the NHS, and social care workers were seen as “second-class citizens” compared to NHS workers.
Some participants argued that, unlike healthcare, which is perceived to be relevant to people of all ages, social care is primarily associated with “the elderly”, meaning that many people don’t see it as a priority, until they, or someone in their family, need it:
“It [social care] most definitely does need to have more recognition. If you ask people ‘do you want more buses, or do you want better social care?’ [they will say] ‘well I’m not really at that stage at the moment, so I'll have more buses. … But if you ask do you want a GP practice in the area or do you want X, people will always choose a GP surgery … but they are intertwined. [Social care] It’s a second thought. … you only need it when you need it. It shouldn’t be health or social care - it should be health and social care.” (Alys, Female, 30s)
Consistency and quality of care
Satisfaction with social care was variable, with approximately one-third of those surveyed either very or quite dissatisfied with the social care services received (and a little over half either very or quite satisfied).
Participants in the focus groups felt that care was not consistent enough in quality, and there was a lack of “continuity” of care (e.g. a lack of communication or coordination between different care staff or care providers).
“When my wife got to the point where she needed care at home, I was dealing with social services, but I didn't actually know where to start. it's not easy to navigate your way through, and you find yourself talking to different people at different times, but about the same thing. (Wynford, Male, 70s)
“What I found really sad was that my mom had dementia and there was no continuity … three times in a day she had the visit and you could have three different people, and that’s someone with memory issues. It was difficult to get a pattern. […] you're afraid to complain in case you lose the service.” (Eira, Female, 60s)
Access to care services
Dr Williams raises concerns that a significant proportion of the population (4-in-10) who needed social care did not access it. The main reasons people gave for this were:
- the pandemic (e.g. “it was due to Covid they stopped coming to see me”; “I was afraid of catching Covid, I’m high risk”);
- a lack of availability or staff shortages (e.g. “no carers available to look after my mother”, “was referred but LA [Local Authority] said too busy to do assessment”);
- being deemed ineligible or otherwise not being offered care (e.g. “I was not offered the help I needed”);
- not wanting to ask for help (e.g. “Pride, not wanting to be a burden”; “I haven’t felt like bothering Social Services as media says how overwhelmed they are”); and
- the application or access processes being too complex.
Many people also reported a negative association receiving care services or of going into a care home. The study concludes that efforts are needed to shape a more positive image of social care, and de-stigmatise the need for care, so that some people do not feel shame about needing it.
According to Dr Williams, the Welsh Government and stakeholders need to take action to:
- increase the provision of care for those who need it;
- encourage and enable those who feel they need social care to apply (and work to de-stigmatise social care);
- simplify the application and administrative process and providing more support for applying to/accessing social care;
- work to reduce the time delay between application and receipt of social care services; and
- consider broadening the eligibility criteria to access services.
The social services legislation which governs the assessment process and eligibility criteria for care services is currently undergoing an independent evaluation, with the final report due this autumn. One of the crucial questions will be whether the eligibility ‘bar’ for access to services has been set at an appropriate level, to ensure that everyone in need of care and support is able to access it.
Dr Williams’ research suggests the criteria may be too restrictive, with some people being denied access to the services they need.
Dr Williams also notes that another challenge facing social care services, like healthcare services, is a potential backlog in those needing care, who were either unable to access services due to restrictions or staff shortages, or did not want to apply because they were concerned about infection risk or did not want to “bother” services.
The next article in this series will look at views on the social care workforce and how to address staff shortages, as well as social care reform.
Article by Amy Clifton, Senedd Research, Welsh Parliament