Ethical issues in self-funded social care: co-producing knowledge with older people

Project lead: Dr. Denise Tanner

The number of older people funding their care has increased within the context of transformations in statutory social care, the impact of austerity and cuts to social care funding. There is little research on self-funded care, despite its significance to policy and practice. Older people’s perspectives are marginalised in policy and practice, which are dominated by managerial concerns of resource allocation and service provision, and in research, where their voices are largely absent.

This study takes an innovative approach to researching self-funding through ‘co-production’ with older people and knowledge exchange with key stakeholders. It is a collaboration between academics, social care commissioners, providers, practitioners and older people in three research sites. It will illuminate ethical dimensions of self-funded care by bringing older people’s lived experiences to the fore and contextualise these by seeking the views of care services’ commissioners and providers and family/friends who support older self-funders. The key goals are to:                            

  • Understand older people’s experiences of self-funding.
  • Develop theoretical understanding of the ethical issues involved in self-funded care.
  • Engage with older people, practitioners, health and care services’ commissioners and providers to transform understanding of self-funded care and produce accessible outputs to impact policy and practice. 

The Care we want

The Care We Want is an audio drama created in 2019 by Nick Le Mesurier and Dr. Denise Tanner from the School of Social Policy at the University of Birmingham, based on findings from the research project. All parts read by Co-researchers and staff involved in the research project. It evokes some of the experiences of older people who fund their own care and those who serve them, and the dilemmas older people face when contracting with care agencies. It has been widely shared with private care agencies, local authorities and the University as a training aid. The voices are those of some of the older people who have taken part as co-researchers in the study in Solihull. The research is a joint project undertaken by the University of Brighton, University of Lincoln and University of Birmingham. Technical support has been given by CoSS e-learning team.

Download a transcript of the audio file (PDF)

Research objectives

The overarching aim of this study is to generate ‘co-produced knowledge’ of self-funding through accessing lived experiences of older people to transform policy and practice. In recent years the organisation and delivery of social care has been restructured on market-based principles and underpinned by a narrative of consumer choice and individual responsibility.  Ethical issues surrounding risks and responsibilities in relation to self-funded care are not sufficiently understood.  Our three inter-linked areas of interest in this project are: 

  • the need to understand older people’s experiences of self-funding;
  • the development of theoretical understanding of the ethical issues involved in self-funded care; 
  • the ways in which knowledge which is ‘co-produced’ with older people and through knowledge exchange processes with service commissioners and providers can transform understanding of self-funded care and impact policy and practice.

Our core research questions are:

  1. How are relationships of care negotiated and managed by:
    1. older people who are self-funding, 
    2. those who may be acting on their behalf (i.e. family, friends or neighbours), 
    3. front-line care staff and provider organisations?  
  2. What risks does self-funded care generate for different stakeholders (older people, carers, service commissioners and providers) and how are these managed? 
  3. What insights can the ethics of care contribute both to understanding care relationships in a self-funding context, and to informing commissioning and service provision?

We also will explore:

  1. What local information is available about older self-funders and how this is used to inform service commissioning
  2. How older people’s assessments of their care needs impact on identifying, purchasing and managing care services. 

Outputs and impact

The project commenced in April 2017 and will finish in July 2020. Most outputs will be produced later in the project but existing outputs include:

Journal publication based on pilot work

Tanner, D., Ward, L. and Ray, M. (2017) ‘Paying our own way’: Application of the capability approach to explore older people’s experiences of self-funding social care. Critical Social Policy, 38(2): 262-282. https://doi.org/10.1177/0261018317724344

Conference papers

Ward, L., Ray, M., Tanner, D., Jehu, L. Locke, P. and Markham, C. (2017) ‘Ethical issues in self-funded social care: co-producing knowledge with older people’, Institute for Research into Super diversity Conference on Global Perspectives on Research Co-production with Communities:  Ontologies, Epistemologies and Methodologies, University of Birmingham, 14 September 2017.

Ward, L., Ray, M., Tanner, D., Jehu, L. Locke, P. and Markham, C. (2018)Co-research and care ethics: working with older co-researchers to explore older people’s experiences of self-funding social care" and

Ward, L., Ray, M., Tanner, D., Jehu, L. Locke, P. and Markham, C. (2018)The Averil Osborn Symposium: Participatory approaches in ageing research: A dialogue between older people and researchers , in the conference

The above are both forthcoming papers to be presented at British Society of Gerontology Annual Conference, 5 July, 2018. 

Research team

  • Dr. Lizzie Ward,  Senior Research Fellow, University of Brighton (PI)
  • Professor Mo Ray, Professor of Health and Social Care Integration, University of Lincoln
  • Dr. Denise Tanner, Senior Lecturer in Social Work, University of Birmingham
  • Dr. Llinos Jehu, Research Fellow, University of Birmingham
  • Dr. Philippa Locke, Research Fellow, University of Brighton
  • Dr. Claire Markham, Research Fellow, University of Lincoln.

The team also includes a local partner community organisation and a team of co-researchers in each site. 

Partner organisations and sponsors

The project is funded by Wellcome Trust.

Further details

Website (in development): http://www.olderpeopleselffundingcare.com/

Twitter: https://twitter.com/SelfFundingOP

Find out more about some of our other social care research projects.