Social care reform: avoiding the obvious [1]

The first in a series of ‘posts’ considering the options for the reform of social care funding.  The English Government has announced that it will publish a Green Paper on care and support for older people[1] by the summer of 2018;[2] these posts will consider the pros and cons of the various options that may be considered.

The background

This first post sets the scene by providing a brief overview of the three most recent heavyweight reports on how social care funding should be reformed: reports of inquiries chaired by Sir Stewart Sutherland (1999),[3] Derek Wanless (2006)[4] and Andrew Dilnot (2011):[5] a historian/ philosopher, a banker, and an economist/ statistician respectively.

The Sutherland Commission’s remit did not extend to considering the ‘adequacy of current levels of funding’ (page xii) and the Dilnot Commission’s remit was that its approach had to be ‘consistent with the Government’s deficit reduction plan’ (page 13).  The Wanless Review however (the only report not commissioned by a Government)[6] was allowed more leeway: its terms enabled it to consider how ‘social care might be funded, bearing in mind the King’s Fund’s commitment to social justice’.

All three reports contain extensive background papers and together they provide as comprehensive an assessment as one could possibly need to make an informed decision on the likely implications of the various reform options.  Although the three reports proposed three different ways of reforming social care funding, they all (essentially) agreed on the nature and the extent of the challenge England faces.  They all agreed that the current means tested system is not fit for purpose and that an overall increase in funding for social care was required.

The succeeding posts in this series, will flesh out and critically analyse the detail of the proposals made by the three reviews, but their headline recommendations were:

  • The Sutherland Commission: ‘personal care’ should be free (at the point of need) on a similar basis to the way that health care is provided (ie funded out of general taxation). Individuals would however have to pay for their non-personal care costs (shopping, cleaning, laundry etc) as well as their housing costs.[7]
  • The Wanless Review: a ‘partnership model’ should be developed[8] whereby the state provided – free of charge – a minimum guaranteed amount of care (possibly 66 per cent of what the report identified as its ‘benchmark’ standard[9]). Individuals would then have to make contributions (matched pound for pound by the state) until the benchmark standard of care was reached. Those on low incomes would be supported by the state making additional means tested contributions.[10]
  • The Dilnot Report: favoured a ‘cap on costs’: when an individual’s lifetime contribution towards their personal care amounted to £35,000, their subsequent social care needs would be funded free of charge by the state.

 

Implementation.

The Sutherland proposals were not accepted in England or in Wales. They were however adopted in Scotland (for people aged 65 and over) and this was implemented via the Community Care and Health (Scotland) Act 2002.[11] The system has now operated for 15 years without the Scottish Parliament increasing taxation to pay for it.  Although the feasibility of extending the right to people under 65 is being investigated,[12] the overall scheme is not without its challenges.[13]

The Wanless Review has proved to be influential in adding depth to the evidence base and analysis, but has not resulted in legislation.

The Welsh Government decided not to adopt the Dilnot proposals[14] but they were incorporated into the English Care Act 2014 sections 15 and 16.  The Act provides for a cap on costs set at a significantly higher figure than recommended by Dilnot[15] and initially this was scheduled to come into force in 2017.  The date was then put back to 2020 and it appears that it will not now come into force.  It is however unclear whether the current Government has abandoned the idea of a cap.[16]

The next post in this series will consider the merits of a ‘cap on costs’ as a component of any social care funding reform and in particular the administrative impact that such a scheme would have on local authorities.

.

[1] The emphasis on older people will be considered in a future ‘post’.  However it should be noted that only about 42% of public funding for adult social care is spent on ‘older people’ and that the list of the ‘independent experts invited by government to provide advice and support engagement in advance of the green paper’ did not include any disabled people – see Peter Beresford Why is the government waging a war against disabled people? Guardian 23 November 2017.
[2] Department of Health Government to set out proposals to reform care and support 16 November 2017.
[3] Royal Commission on Long Term Care With Respect to Old Age (1999) Cm 4192-I The Stationery Ofdice (Chaired by Professor Sir Stewart Sutherland).
[4] D Wanless Securing Good Care for Older People (King’s Fund 2006).
[5] Commission on Funding of Care and Support Fairer Care Funding (2011).
[6] The Sutherland Report resulted from a Royal Commission announced in December 1997 following a Labour Party Manifesto commitment to do this; the Wanless review was commissioned by the King’s Fund in 2006; and the Dilnot Commission was established in 2010 as a result of the May 2010 Coalition Agreement ‘Programme for Government’..
[7] Which would include a standard housing related payment if in a care home – Royal Commission on Long Term Care With Respect to Old Age (1999) Cm 4192-I The Stationery Office p.68.
[8] Although the Wanless Review considered the ‘free at the point of need’ proposal had considerable merits.
[9] A standard slightly more generous than generally provided under the 2006 means tested system – D Wanless Securing Good Care for Older People (King’s Fund 2006) p198.
[10] D Wanless Securing Good Care for Older People Summary (King’s Fund 2006) p.xxx.
[11] The detail being in the Community Care (Personal Care and Nursing Care) (Scotland) Regulations 2002.
[12] Scottish Government Feasibility Study into Extending Free Personal Care to Under 65s (September 2017).
[13] In 2016 it was estimated that for social services in Scotland to be sustainable it would require increased spending of between £510 and £667 million in the next four years by 2020 (an 16–21 per cent increase) Accounts Commission Social work in Scotland (Audit Scotland 2016) p.5.
[14] Welsh Government Written Statement – Further Update on Reform of the Arrangements for Paying for Social Care and Support 11 November 2015.
[15] Dilnot indicated that the cap need not be set at £35,000 but that anything above £50,000 ‘could mean that the overall reforms would fail to satisfy our criteria of fairness and sustainability’ – Commission on Funding of Care and Support Fairer Care Funding (2011) p.33. The English Government proposed a cap of £72,000.
[16] See T Jarrett Social care: Government reviews and policy proposals for paying for care since 1997 (England) Briefing Paper Number 8000, House of Commons Library 23 October 2017 p.20.

.