Approach
The social care review team examined social and health care policy, services and spending as well as demographic, social and technical trends in order to estimate the potential demands on social care now and in the future. The analysis was used to develop a model for estimating the level and type of services that are likely to be needed over the next 20 years, and to determine how much these could cost.
To construct the model, the review team developed a new measure, the gain for one year of life of having Activities of Daily Living needs (such as being able to wash, dress and go to the toilet) improved from being entirely unmet to fully met (ADLAY).
The review assumed that services should be provided up to the point where they cost no more than £20,000 for each ADLAY gained. The ADLAY is similar to the Quality-Adjusted Life Year (QALY) used by the National Institute for Health and Clinical Excellence, which, at the time of the review, was using a similar figure for the cost-effectiveness of health care interventions.
The review then modelled three scenarios. Scenario 1, the baseline case, assumed that patterns of social care services and outcomes will be broadly the same in the future as they are now – so increases in spending will be driven solely by changes in the number of people with care needs.
Scenario 2 was more ambitious; it assumed changes to the social care system so that it could deliver, for all those in need, the highest possible care and safety outcomes that could be justified given their cost. Scenario 3 was more ambitious again; it built on scenario 2 by assuming that the social care system would also deliver better outcomes in terms of social inclusion and a broader sense of well-being.
The review then assessed a number of possible ways of funding care on the basis of factors such as fairness, economic efficiency, user choice and sustainability/acceptability. Finally, it used its modeling again to look at how the top three funding systems to emerge from the initial assessment might affect overall demand, total costs and the split between private and public contributions.
It concluded that moving to a partnership model of funding would be the best option, and compared its model with the existing model of means-testing.
