Waiting for the Dilnot Commission: four challenges for change

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With the report of Andrew Dilnot's independent Commission on Funding of Care and Support just days away, hopes are high that it will provide solutions to an issue that has stubbornly resisted previous efforts at reform going way back to the 1999 Royal Commission established by Tony Blair's government.

If this journey were a Beatles song, it would be 'The Long and Winding Road'. Some parts of the journey are best forgotten – the 'death tax' poster and the disingenuous distraction of the Personal Care at Home Bill spring to mind. But if the road is straightening out, it's likely that there are some steep hills to ascend before the destination is reached.

We hope that Dilnot's proposals will chime with our analysis in the original Wanless report and our major review of social care funding last year. The idea that the costs of an ageing population are best met through a partnership between the individual and the state, and through a mixture of funding mechanisms, has ceased to be radical idea and for most has become conventional wisdom. The postcode lottery and lack of portability of care from one part of the country to another are important concerns that the Commission has been trying to address, together with the need for a clearer, more comprehensible, system with better information and advice.

So what are the big questions we should be asking about the Commission's recommendations when they are published on 4 July?

The first question is how much genuinely additional resource – public or private – would be brought into the system if the proposals were enacted. There is a single unpalatable truth that ageing societies throughout the world must devote a bigger share of national wealth to meet the costs of people living longer, irrespective of the funding systems they use. Even if nothing is done, the Office for Budget Responsibility estimates that the percentage of GDP spent on long-term care will rise from 1.2 per cent to 1.9 per cent over the next 20 years – and it would still be a confusing and crummy system that leaves hundreds of thousands of people without the care they need. Bringing extra money into the system will be the biggest and toughest test, swimming against a choppy Treasury tide of fiscal caution.

The second question is whether the proposals will command enough cross-party consensus to avoid the political acrimony and point-scoring that bedevilled previous efforts. Reform demands that politicians sing from the same hymn sheet in communicating tough messages to a largely indifferent or unaware public whose priorities are much more immediate than the distant risks of ageing. There are many unifying points of agreement between the parties, with both the Prime Minister and Leader of Opposition making the right noises about consensus. But recent press coverage suggests differences within the coalition.  A swift and supportive response from the two parties that form the coalition government would be an essential first step in planning an all-party road map for reform.

Third, will the proposals provide a clearer and more transparent offer about what people can expect from a new system? Upfront honesty about how the costs of care would be shared will enable people to plan ahead and consider how they can use their own resources to suit their own preferences. If the proposals include, as expected,  a cap on how much people are expected to contribute to the costs of their own care, this will remove a huge area of worry for the 1 in 10 people with care needs who will face costs of £150,000 or more. It will also reduce the pressure on those who find they are no longer entitled to 'free' continuing health care. An upfront offer will then create new choices, for example, a stable policy environment that stimulates insurers to offer affordable policies to protect people's assets. This would represent a huge improvement over current means-tested arrangements, which offer no choice to individuals.

The final question is how the proposals will meet the many aspirations for a decently funded system fit for the 21st century. This has been an issue since the birth of the NHS in 1948, and more than 60 years of social change has taken its toll. Rebuilding a decent system of care and support will take years, and it will be impossible to satisfy all demands for change.

Dilnot's recommendations are the starting point and offer the best – and possibly the only – prospect for real change for the foreseeable future. His report will be testimony to the coalition government's pledge to establish an independent commission that would produce clear recommendations within a year. Now it must see the job through.


Des Cohen

Comment date
01 July 2011
I find that these cvomments start at the wrong point in the discussion. Where they need to start is with an an analysis of current provision and the deficiences that are only too evident. To then discuss more effective structures for delivering a truly national system of care of quality for everyone as opposed to the present profit based system which has nothing to recommend it and is obvioiusly failing to deliver quality care. To then address how best to fund a newly structured national system of care that eliminates the present profit-based suppliers in ways that are fair, and ensure that those who are in greatest need receive fiscal support from the Government. There must be systems in other countries that meet these criteria and from whom we can learn.

frank kenward

Comment date
29 November 2012

You are right however, as daft as it seems even though the deficits are glaringly obvious, they have no idea where to start.


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