In this guest column: PLMR’s Nathan Hollow, Trustee of The Care Workers’ Charity, discusses the experience of voting on Baroness Louise Casey’s Big Conversation on Care – you can find the original at Care Home Professional here.

Never let it be said I don’t know how to spend a summer break. Free from the shackles of childcare and banned by Thames Water from tending to my garden, I’ve spent the last few weekends sweltering in the sun and voting on more than 1,000 proposals in Baroness Louise Casey’s Big Conversation on Care. At the time of writing, that’s about a third of submissions.

And as a (late) 30 something, the activity left me sweating in more ways than one.

An inspired concept

First, credit where it’s due: the format of the Big Conversation is an inspired choice. With one simple question, and no need to explain the pitfalls of the existing system to participants, the exercise simply asks that you submit a sentence-length idea and vote agree/disagree on everyone else’s suggestions.

It’s quick, accessible, requires no prior knowledge, and generates what every politician really wants – reams of opinion data. The resulting hundreds of thousands of data points will no doubt be ploughed through by AI-powered civil servants, leaving Casey, Cooper, and Burnham with a broad overview of the values, feelings, and fears sitting behind the public’s attitudes to social care reform.

We all want free stuff…

Thankfully, results to date are more reassuring than we cynics in the sector might have thought. Overwhelmingly, people want care workers to be better paid, trained and valued. They want a system that is easier to navigate, is joined up with the NHS and focuses on prevention. They want more support at home, more help for unpaid carers, and a system that scales with and meets our needs. All of these proposals achieved 80% or above support; music to the ears of all National Care System (NCS) advocates.

The most popular funding ideas followed a similar theme: pooled risk, costs spread over a lifetime, and general taxation being favoured over private insurance models. In short, the NHS principle; Burnham must surely be punching the air with delight.

Decades of public polling data, and one Olympic opening ceremony, all show that Brits love the NHS. Nothing unites the nation more. Now we can add to that an NCS offered on the same terms. Free at the point of need social care is in; forced house sales, unlimited liability and private insurance is out.

But who picks up the £17bn price tag? It was at this point that I found myself turning a little rouge. Was the latest heatwave or the rising anger at the intergenerational unfairness of it all?

…and someone else to pay for it

See, if you spend even five minutes voting on the proposals, which helpfully include the submitters age, you’ll notice there’s one thing missing: young people.

In fact, from the more than 1,000 statements I looked at, the average age of the submitter was 60. Just 4% came from people under 30, rising to 15% for under 45 years old.

An example

Now, there’s no way to tell the age of people voting. Perhaps it is just older folk who opted to submit an idea, while Gen Z focused on the brightly-coloured voting buttons. But the submissions paint a clear picture of who the most engaged respondents believe should pay.

Suggestions that people should contribute throughout their working lives appeared repeatedly and garnered consistently high support (c. 90%). National Insurance was a particular favourite. However, when a proposal explicitly asked those coming towards, or in, retirement to chip in – perhaps by adding National Insurance to pension income, introducing a new ‘retiree tax’, or taking it from housing wealth – support nosedived to sub-20%.

Taking average age and popular opinions together, the pattern was clear: collective responsibility, as long as it’s not older people responsible.

Adding additional general taxation to cover the nation’s social care costs may be necessary, but for my generation, the first in history to be poorer than the one before us, how sustainable is such a system?

How fair is it when those needing care today don’t want or need to contribute – and what are the future prospects for a generation likely to have to remain in work into our 70s? For the NCS to succeed, it will need to take everyone in society on the journey – not just those currently perusing the brochures of their nearest luxury care home.

The NEET paradox (that’s Not Everyone is Elderly, Though)

Selfish tax concerns aside, the age problem goes much deeper than a simple ‘who pays’ conversation. It’s the much worse, ‘whose voice is heard’ problem.

Working-age adults with learning disabilities, acquired brain injuries, lifelong physical disabilities, or autistic people were barely featured in the proposals I looked at – just 33 focused on younger adults using care services. Dementia and older people, meanwhile, were expressly mentioned significantly more.

And of these 33 proposals, bluntly, some of the views expressed belong in the comment section of certain newspapers, not a national conversation on people’s care needs. A particular lowlight was, “We should review who is assessed as disabled as the numbers seem high, particularly among young people.” 67% agreement. Sigh.

Thankfully, there were some proposals that sought to better the lives of young adults using care services, with strong support for more independent living options (89% support) and an end of repeated assessments for those with lifelong conditions (80% support). Overall, proposals for working-age adults were substantially more likely to focus on how people can exercise autonomy, participate in society and live fulfilling lives.

But here’s where we return to the ‘NEET’ problem again. Even this small discussion about younger adults is just that – about them, not led by them. Only six of the proposals were submitted by someone under 45.

Wider communications promoting the conversation further risks reinforcing this generational divide; even the imagery I’ve seen focuses on older people. While other ads may exist, they’ve not come across the social feed of this 30-something.

I’m not convinced these ads would stop the average younger person from scrolling through Instagram. I don’t know how the organisers, Make, are assessed, but history suggests these Government contracts will be targeting engagement only – not who engages. It was the same problem with the prior care recruitment campaign: any click will do.

This is a real danger for the Casey Commission. A national conversation can be open to everyone while still being shaped overwhelmingly by just a few voices, especially if younger people don’t see themselves or their interests featured in the discussion or imagery.

Don’t mention the ‘P’ word

If you’ve spent any time on the site, I’m sure you will have noticed that quite a few of the popular proposals focus on the p-word: profit. When the business model of care provider organisations is raised, there is overwhelming hostility towards those organisations making a profit.

Billionaires? Banned (87% support). Private equity? Banned (83%). Offshore ownership? Banned (84%). In general, any proposal that focused on preventing or limiting profit-making faired extremely well, averaging 85% support. Despite the majority of the sector being operated on these terms, and investors of all sizes being the primary driving force for building care infrastructure over the last thirty years, there’s little thanks from the public.

Instead, there’s strong support for boosting the role of the non-profit sector, with 85%+ support for proposals focused on either making all care non-profit or increasing the number of directly-Council run services. There’s also strong (88%) support for making the whole NCS government-run, matching the NHS model.

What the future holds

The public wants a more professional, preventative, and easier to navigate care system. They want it to be free at the point of use, or at the very least to include protection from catastrophic costs. But, at least from the voices involved so far, they also want someone else to pay for it. That’s certainly a policy headache for the politicians and a financial one for the Treasury.

Clearly, the lack of engagement with younger people so far – both those using care services, and in the wider population – is a problem that needs urgent attention. The topic, and how long we’ve waited to get a shot a meaningful change, makes it vitally important we don’t end up with another demographic schism that undermines the success and longevity of any reform that follows.

For providers, certainly those with institutional ownership, their worst fears may be coming true. There’s a deeply ingrained reputational problem here, with the public’s language focused on ‘profiteering’ and ‘asset stripping’, rather than ‘investment’ or ‘access to capital’.

I’ve always been bullish on the likelihood that care is nationalised wholesale; it’s simply too expensive for the Government to do. But, with next to no public support for current operating models, the fear now must surely be that profit caps become topic de jour. Our trade bodies and sector leaders have some big and urgent work to do to convince a sceptical public that the status quo has been a success for the nation, not just for the shareholders.