The Commission on Funding of Care and Support has presented its findings to the government in its report, Fairer Care Funding. Economist Andrew Dilnot was asked by the coalition last year to look into how the system of funding social care in England could be changed amid concerns it was getting harder for people to get access to state support.
What does it propose, what does it mean?
The key proposal: a social insurance model with an excess
The centrepiece of the reform package is a proposal to share the costs of care in later life between individuals and the state, with individuals paying for their own care until they reach a “cap”, after which the state pays for their care. This is a “limited liability” model of social insurance, whereby those of us who can afford it and who have lived long enough to accumulate wealth, are expected to pay the “excess”. On this basis, none of us will be expected to lose all our savings and assets in order to cover the “catastrophic” costs of sustained high-level care and support (often in residential care).
The key recommendations are:
- An individual's lifetime contributions towards their care costs are currently potentially unlimited. Dilnot proposes capping these somewhere between £25k and £50k (Dilnot suggests £35k), after which the individual is eligible for full state support.
- This is the report’s "key proposal". By creating certainty over the financial risk, it should be possible for the financial services industry to create products to cover this £35,000, such as annuities which would increase should a care need arise, or an extension to life cover or critical illness cover.
- The means-tested threshold, above which people are liable for their full care costs, should be increased from £23,250 to £100,000. This should reduce the need for people to sell their home in order to fund their residential care, something which research showed the public views as particularly iniquitous.
- National eligibility criteria and portable assessments should be introduced to ensure greater consistency.
- All those who enter adulthood with a care and support need should be eligible for free state support immediately rather than being subjected to a means test.
- People should contribute a standard amount to cover their general living costs, like food and accommodation, in residential care.
- Universal disability benefits should continue, but Attendance Allowance should be rebranded so people understand its purpose.
- An awareness campaign should be launched to help people understand the system and engage with it.
- Carers should be supported by improved assessments which aim to ensure that the impact on the carer is manageable and sustainable. This recommendation would form part of a new legal duty on local authorities.
- The deferred payment offer should be extended so it is available to everyone, wherever they live.
- The report urges greater integration between health, social care, benefits and housing, with a particular focus on health and social care. It sees pooled budgets, and fully integrated care trusts, as ways to surmount the problems caused by the different funding streams for health and social care. It also supports the idea of palliative end-of-life care being free and for NHS Continuing Healthcare patients making a contribution to their “living expenses”.
The future of social care funding in the UK is clearly contentious, having profound fiscal and wider policy implications. It is estimated that the Dilnot recommendations would cost the taxpayer around £2 billion a year initially, with this figure to increase as the population ages.
The Coalition Government’s White Paper is expected to be published by December 2011 but the extent to which the Government plans to follow Dilnot’s recommendations remains to be seen. However, one thing is certain for all involved in adult social care (whether as service user, carer, care provider, care commissioner or inspectorate) we are all set to see significant change.