Paying for Care: Behavioural Insight Research

Understanding why people fall into adult social care debt, and how to help them pay

Adult social care debt is a growing challenge for local authorities across England. In East Sussex, the Council’s 2023 Adult Social Care strategy included commitments to improve financial communications and support people who get into care-related debt. With adult social care accounting for 95.5% of all long-term debt, ESCC commissioned SMG to understand why some people were not paying their assessed contributions and how best to support them to do so.

Starting with a desk review, we then used mixed methods to engage 134 people across surveys and interviews with stakeholders (ESCC staff, debt advisers and care providers) and care recipients and/or their financial representatives.

We applied exchange analysis and the COM-B framework to understand the full picture of why people were not paying, revealing a consistent finding: most people in debt cannot pay, rather than will not pay. Barriers including challenges within the system itself can create or compound debt even among people who are willing and motivated to pay.

The research produced a comprehensive set of findings and recommendations, including:

• A detailed COM-B diagnosis identifying the factors that currently reduce people’s capability, opportunity and motivation to pay, with practical recommendations for addressing each
• A communications review with specific guidance on redesigning letters, invoices and staff interactions to be clearer, more supportive and less likely to trigger avoidance
• A risk-based segmentation framework to help ESCC direct resources proportionately, with seven needs considerations shaping how support is tailored to individual circumstances
• Recommendations for both settling existing debt compassionately and preventing future debt through system reform.

The findings provide ESCC with a clear evidence base to shift from a debt recovery model to one centred on payment support, with a tailored approach likely to deliver better outcomes for both care recipients and the Council.