A new royal commission on social care must tackle the fundamental problem: the means test

Even if the government’s rumoured royal commission on adult social care goes ahead, it would not be the first attempt to crack the issue of social care through royal warrant.

In December 1997, the Blair government appointed Stewart Sutherland to lead a royal commission, but it was an unhappy experience, wracked by internal dissent and broken relationships. Its main recommendation has never been implemented in England.

The key challenge for any new commission will be to do better. The first essential will be to ensure it has terms of reference that cover the most fundamental issue in social care and the one that broke the Sutherland Commission: the means test. Without this, a royal commission will not be worth the purple ink in which it is (metaphorically) written.

The mean test separates social care from a free-at-point-of-need NHS. People with assets (such as a house) often get no state-funded social care support; they have to rely on family and friends, go without care or pay for it themselves. Some of those who pay for themselves will rack up huge care bills and often have to sell their homes to pay for them. It causes intense bitterness among those who fall foul of it.

The Sutherland Commission fell apart trying to tackle the means test. Most of the Commission members wanted fundamental reform so that everyone would be entitled to free personal care – help with washing, dressing etc (people would still have to pay for their housing and living costs, though, even if they were in a care home).

This argument – care for more people or better care for the same number of people – is one that still divides opinion in adult social care.

However, two members said that this was unaffordable and one of them, David (subsequently Lord) Lipsey organised an effective guerilla campaign against the main report’s proposals. Lipsey argued – and continues to argue – that England can’t afford free personal care for everyone. He did want to see more public money go into social care, but he wanted it focused on those who had least assets. That meant retaining the means test and providing more and better support for those who already qualify.

This argument – care for more people or better care for the same number of people – is one that still divides opinion in adult social care. The 2011 Dilnot Commission (which was not a royal commission) didn’t go nearly as far as Sutherland’s but even its argument for a relatively small relaxation of the means test ran into controversy. For some, any money spent on giving social care support to people with even moderate wealth is money wasted.

How do we resolve this? Not by returning to the idea of free personal care as envisaged by the Sutherland Commission. It may conceivably have been affordable back in the boom years when it was first proposed but it’s hard to see how it would be nowadays, when the local authorities that commission social care are declaring bankruptcy, and the current system urgently needs funding simply to keep afloat.

The status quo on social care is not acceptable and a royal commission that neglects reform of the means test will have failed.

Yet nor can it be right that we continue to shut people out of state-funded support simply because they have relatively modest savings and assets. If Bevan had applied that logic in 1948, we would not have an NHS and the middle classes would now have to pay for their own cancer care. The status quo on social care is not acceptable and a royal commission that neglects reform of the means test will have failed.

The commission will need to explore the middle ground, re-examining the proposals of the Dilnot Commission but also considering the social care model in much of Europe where there is no initial means test – everyone gets some state-funded support, but people are required to pay towards it (often substantially) according to their wealth. More radical still would be to look at Scotland, which adopted a slimmed-down version of the original Sutherland Commission recommendations. The new commission’s task will be that much harder because it will need to find a solution that works for working-age adults as well as older people, on whom Sutherland focused.

Any new system will inevitably require more money, but the new commission should not shy away from initiating the public debate on funding that will be needed if we are genuinely to tackle this great stumbling block of social care reform: the means test.