Tuesday, 12 February 2013

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

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 The King's Fund

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