Blog 9th March 2021
In this blog I consider the crisis in adult social care in England, the Dilnot report and the failure of Rishi Sunak’s recent budget to address the funding of social care. I agree with Andrew Dilnot that the government should address this question urgently.
For many years it has been generally accepted that there is a crisis in adult social care in England. Over ten years ago, in July 2010, the coalition government commissioned the economist, Sir Andrew Dilnot, to investigate the funding of adult care and support services in England and to make recommendations. The Dilnot commission reported in July 2011 with its report and recommendations meeting with almost universal approval in the sector. However, since then the government has left the report ‘on the shelf’. Last week, Rishi Sunak, the Chancellor of the Exchequer, presented yet another budget that failed to address the crisis in social care.
The Kings Court Care Home in Barnard Castle, Durham.
Sir Andrew Dilnot is not impressed and urged the government to act by the autumn of 2021 at the latest, telling the ‘Guardian’ that:
“By the autumn, we very much hope that we’ll be past the worst of Covid, that the economy will be picking up again and the public finances should be improving… We’ll have in our minds the ways in which collective action has really helped us in the previous two years, and the ways in which we’ve let ourselves down by not having acted collectively, effectively enough… If we don’t make decisions (about funding social care) this year, it’s very hard to see how they can be implemented before the next election. I really do think this autumn is the time and we just need to ask ourselves, how high up our list of national priorities is this?”
So, what were the recommendations of the Dilnot commission?
- A Fixed Cap - There should be a cap on the amount that anyone would pay for their care in their lifetime, fixed at some figure between £25,000 and £50,000, preferably £35,000 (two thirds of people have care needs of less than £35,000). Once a person had spent up to the cap, the state would accept responsibility and they would not have to spend any more on care. However, individuals could choose to pay more (a top-up) if they wished. Local authorities would calculate how soon an individual would reach the cap, by assessing their needs, and pricing the care needed to meet those needs against standard pricing for that care in that area. Therefore, if an individual with greater means chose more expensive care, they would not reach the cap figure sooner. This is the reports ‘big idea’. It is intended that, by creating certainty over the financial risk, it would be possible for the financial services industry to create products to cover the £35,000, such as annuities that would increase should a care need arise, or an extension to life cover or critical illness cover.
- Increased asset limit - Currently people in residential care pay for the entire cost of their care until their assets (including any property) are reduced to £23,250. They then contribute £1 per week for every £250 of assets over £14,250 (known as the taper). Once their assets fall below £14,250, the state pays the entire cost. The report recommends that the £23,250 limit is increased to £100,000, and for the taper to apply to those assets between £14,250 and £100,000. This should reduce the need for people to sell their house to fund their residential care, something that research shows the public views as particularly unfair.
- Free state support - Individuals who, by the age of eighteen, already have a need for care should receive state support, irrespective of means. The report suggests that this immediate entitlement to state funded care should apply to everyone under the age of forty, because it is unreasonable to expect them to start saving for their future care before then. There would then be tiered caps dependent on age, being £10,000 for those in their forties, £20,000 for those in their fifties and £30,000 for those aged between sixty and 65.
- Aligned systems - The commission concluded that the current benefit system needs to be aligned better with the system for funding social care. Attendance Allowance needs to be clarified.
- Contribution to living costs - In addition to paying for social care (up to the cap), individuals in residential care should pay a nationally fixed sum towards their living costs. The report suggested between £7,000 and £10,000. Everyone would be expected to pay this. The expectation would be that most individuals would be able to pay through their pension income. Where individuals receive benefits, those would also go towards these living expenses.
- A national standard for eligibility - There should be a standard national basis of eligibility, rather than the current system that varies between local authorities. Throughout England, people would have the same assessment process, and there would be the same severity threshold for an assessed need to be eligible for state support. Assessments would also be portable, and until a receiving authority re-assessed a new arrival, it would continue to meet the assessed eligible needs. The assessments would be more transparent, allowing individuals to self-assess.
- Raising awareness - There should be an awareness campaign to make people much better informed, and less anxious about the future. The research supporting the report showed that ignorance and anxiety were significant obstacles preventing people from planning financially for old age.
- Local authority responsibility – The commission recommended a new strategy for providing information, assistance, and advice to service users and carers. While the commission recommended that local authorities work together with the third sector on this, as well as with other interested bodies like the Financial Services Authority, they want the buck to stop with the local authority. It supported the recommendation made by the Law Commission in their review of adult social care law that a new statutory duty be placed on local authorities to provide this information, assistance, and advice.
The Civic Centre in Newcastle on Tyne. At one time I was the Social Services Accountant at Newcastle on Tyne City Council.
- Legal duty for local authorities - In support of another recommendation made by the Law Commission, the report argued for a new legal duty for local authorities to undertake a carer assessment, and then to meet assessed eligible needs, either through support provided to the carer, or to the service user direct. This carer assessment should be simultaneous with, but separate from, the assessment of the service-user. It should also be portable, as service user assessments are recommended to be.
- Greater integration - The report urged greater integration between health, social care, benefits, and housing, with a particular focus on health and social care. It saw 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 supported the idea of palliative end-of-life care being free, and for NHS Continuing Healthcare patients contributing to their living expenses.
There was some scepticism about where the extra funding needed would come from. The Dilnot Commission thought that in the context of the total spend on adult services, the extra funding required was modest - 0.14% of Gross Domestic Product, increasing to an extra 0.22% by 2026. It suggested that government could raise revenue by taxation (either general or targeted) or by spending cuts but did not express a preference.
I think the government has failed to address the funding of social care for far too long. Hopefully, they will start to address it this year. If not, the consequences will be serious.
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