Reforming social care funding: a step in the right direction?

Today's announcement that the government will act on the recommendations of the Dilnot Commission is a significant milestone in the tortuous journey of social care reform. How we pay for long-term care is a policy conundrum that successive governments have wrestled with for at least 15 years, generating two independent commissions, three consultations, and several White Papers.

If it was difficult for the previous government to crack when the economic sun was shining, the risk that austerity would condemn it to remain in the political long grass was real. So progress of any kind should be warmly welcomed.

The proposals will help in three ways. First, they establish for the first time in the history of the welfare state that the government should place a limit on how much people have to pay for their social care. It extends to social care the protection from catastrophic bills that – thanks to the NHS – we have always enjoyed in relation to health care costs. This is an important development and its totemic policy significance should not be underestimated. Second, the combination of a cap of £75,000 on care costs (£61,000 in Dilnot's 2010 prices) and the lifting of the means test threshold to £123,000 will benefit many people with modest means who at the moment stand to lose nearly everything if they have as little as £23,250. The combined impact of the means test and the cap will benefit around 100,000 people. Despite briefings to the contrary from those who wanted to bury the report, Dilnot was never going to be a handout for the very rich (who can afford their own care anyway). A third benefit is that it brings social care out of the shadows and sets a clear framework of expectations about how care costs are shared between the individual and state, a partnership approach we have consistently advocated since the late Derek Wanless's seminal report Securing Good Care for Older People. Taking away the uncertainty about where responsibility for the unpredictable costs of care might fall makes it much easier for individuals to plan ahead in a way that is impossible in the fog of the current system. But there are dangers.

Trying to explain these changes to a public that is largely unaware that there is currently no limit to their potential financial liability for care costs will be a massive public relations challenge. To those unacquainted with the sheer awfulness of the existing means test, talk of £75,000 charges for care and £12,000 towards living costs every year will seem a monstrous new burden rather than a benefit. Nor will the cap cover costs higher than what councils would usually pay for care (and nor should they).

Then there is great nervousness in the care sector that the Dilnot reforms might be perceived as having 'solved' the problem of social care funding – which they have not. This is a staging post on the continuing journey of reform not the final destination. That it has taken at least 15 years to get this far tells us that there was never going to be a one big solution that would single-handedly transform social care funding. And the changes won’t be introduced until 2017, which means that seven years will have gone by since the coalition said it recognised the 'urgency' of sorting out social care. In the meantime, pressures are mounting, with cuts to local authority budgets, squeezed providers and fewer people using services. As more of us need care and support, we've barely begun to grapple with the implications of delivering better-quality care in an age of austerity when public finances and private pockets are strained. Implementing Dilnot is a momentous step forward, but there is still a mountain to climb.

Read our response to today's announcement on social care spending

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#40045 lynne livsey
Gerontologist/freelance researcher

Reading the DH policy statement that was published after todays announcement by Jeremy Hunt, it appears that the raised threshold of £123k only applies to residential care - is this right? Does this mean that the means test threshold for domiciliary care is unchanged?

#40046 Richard Humphries
Assistant Director, Policy
The King's Fund

Hi Lynne. My understanding is that the £123k threshold applies to residential care only; Councils do not take into account value of property when financially assessing for home care. I will check this out with DH. However the £75k cap on care costs does apply to home care as well as residential care.

#40047 Lynne Livsey
Gerontologist, freelance researcher

Thanks Richard - that's helpful!

#40056 Mike Lauerman

Richard you have extracted a sliver of hope from an increasingly dysfunctional set of policy drivers. A step along a tortuous slow lane on what should be a super higyway.

#40065 geoffrey

I am a 73 year old homeowner suffering from from rheumatoid arthritis, diabetes and a number of other medical conditions. The proposals may seem to be to my advantage, but I cannot support them.

It appears that money can be found to placate the comfortably well off like myself. Those people who say it is unfair that they having been careful with their money are supporting the "feckless." The feckless probably started work at 16 in a low paid job and have never earned much above the minimum wage all their lives. But if you have had a decent job with a pension and have managed to buy your own house you are very fortunate.

Like everyone else I would love to think that there w,as a possibility of preserving some of my capital for my children. BUT, if we we can find the billion pounds it is reported it will cost,The sort why cannot we find money to support elderly carers who are receiving little or no care? The sort of cases that concern me are those of carers supporting partners with severe dementia who receive little or no support and yet are expected to care. 24/7 with sufferers who need attention both day and night, who never receive respite care.

#40083 Lucianne Sawyer
social care consultant
Community Care Research & Consultancy

Your article is very helpful Richard, but I absolutely endorse Geoffrey's comments - particularly in relation to the burden carried by family carers. I was a carer myself for some years for both parents with dementia, one of them with Parkinson's disease as well - and had very little help. Since then, particularly as a researcher and then a domiciliary care provider, I have seen so many elderly carers struggling to keep going - and even when their needs were assessed, very often they could not afford the help which might have been available. I wonder how many will really be helped by this new measure.

#40084 Richard Humphries
Assistant Director, Policy
The King's Fund

Geoffrey & Lucianne thank you very much for your comments. We are absolutely clear about the scale of unmet need and will continue to argue the case for better overall funding. Important to emphasise that the recent measures are about how the costs are shared, not the overall funding required and where this comes from.

#40318 April Pickersgill

Hi Richard,

I wondered if you could be of any help...

I'm a journalism student at Nottingham Trent and I'm doing an assignment on elderly care, and how elderly have in the past had to sell their homes to pay for care.

If you could answer the following questions it would hugely benefit me in my studies. Many of them touch on what you have mentioned already, but a few more general answers would really help.

The questions I wanted to ask were:

Firstly, what are your views on social you feel paying for care is one of the biggest concerns for the elderly?

Have you heard of anyone selling their home to finance care?

Secondly, since you have heard of the Dilnot report, and the plans to cap the amount elderly pay on their care, do you feel this is a good enough change to make to help? Or is a £75,000 cap still not going to tackle the issue of elderly selling their homes?

What are your reasons for/against the plans?

Do you have any ideas on what could be done to solve any of these issues better?

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