Wanless Social Care Review

Securing Good Care for Older People, found one million people aged 65 and over were already using publicly funded social care services in England and that councils were spending around £8 billion a year on means-tested services for them.

It noted that further billions more were being paid out in benefits to older people with disabilities, and that older people themselves were spending around £3.5 billion on home and residential care.

Yet the year-long review concluded that the social care system was 'falling short' of the government’s aspirations for it: to give people choice over the services they received, to promote their independence, and to prevent them needing hospital or residential care.

It also found there was 'widespread dissatisfaction' with the means-tested funding system and the 'unfairness' of the way in which funding rules were applied, which had led to a 'postcode lottery' across England.

Against this backdrop, the review looked ahead to the next 20 years, when the proportion of older people in the population is set to increase dramatically. 

The report concluded that because people are living longer but not living longer in good health, the number of people needing help with one or more of the activities of daily living – such as washing or going to the toilet – is likely to double by 2025.

To judge the impact of providing care for them, the review developed a new measure, the ADLAY, to try and quantify the gain for a year for an individual of having their need for help with the activities of daily living improved from being entirely unmet to fully met.

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 review then modelled three scenarios. Scenario 1 assumed that patterns of social care services and outcomes will be broadly the same in the future as they are now.

Scenario 2 was more ambitious and assumed that changes could be made to the social care system to 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. 

To deliver scenario 3 in 2002, the review calculated that total social care spending in England would have had to have risen from £10.1 billion (1.1 per cent of GDP) to £13 billion (1.4 per cent of GDP).

To deliver scenario 1 in 2022, it calculated that total spending would have to rise to £24 billion (1.5 per cent of GDP), simply because of the ageing population. To deliver scenario 3, it calculated that total spending would have to rise to £31.3 billion (2 per cent of GDP).

Finally, the review considered how these increases might be funded. It looked at a number of options, from the unpopular means-tested model, to a 'partnership' model in which taxpayers and older people shared the cost of care, to a 'free' model similar to that introduced in Scotland.

After examining the fairness, efficiency and sustainability of the different options, and the amount of choice and dignity they would offer those needing care, Securing Good Care for Older People concluded that a 'partnership' model would be the best approach.

The government would fund a minimum level of care, but people would be free to top this up to achieve better outcomes.

The review argued that this would shift attention from people’s means to their needs, ensure their basic needs were met and produce better value for money, while still giving people an incentive to save for their old age – although it would also be more expensive than the present system.

The review calculated that to deliver scenario 2 under a partnership system at the time that its final report was published, total social care spending would have needed to rise by £4.2 billion; although this would have been offset by a £2.5 billion saving on means-testing.

The government’s response to Securing Good Care for Older People was to set up its own review of social care funding, which it asked Sir Derek to join. To keep up the momentum for change, The King’s Fund joined Caring Choices, a coalition of 15 organisations from across the long-term care spectrum.