/ Health

Andrew Dilnot tells us why social care reform is crucial

Money jar and hands

The Dilnot Commission has proposed radical reform of the present system for funding long-term care. We’re joined by Andrew Dilnot who explains why the government must act on the Commission’s recommendations.

People of all ages are living longer. That is something we should be celebrating. However, as people’s care and support needs grow, they face fear and uncertainty about the financial consequences.

Over the last year, we have been talking to people about their experiences and collecting evidence about the current state of the social care funding system. The resounding message back was that the system is broken. It’s confusing, unfair and unsustainable and needs to be fixed.

Care funding as it is now

Care is the one area of our lives where we cannot protect ourselves against the risk of high costs. While a quarter of 65-year-olds can expect not to need care, one in ten will have very high care needs costing in excess of £100,000.

At present, the state only covers the cost for those who have used up all but £23,250 of their assets, which can include their house. And private insurers won’t cover people because of uncertainty over the final bill.

We need a new system in which people aren’t fearful and are able to plan and prepare for meeting the cost of care.

Our plans for reform

We think people should be expected to contribute towards their care as happens now, but that their contribution should be capped to a maximum of £35,000 over their lifetime. The state would then step in and pay for care. Those with little money would continue to get state support, but the threshold below which people are entitled to that support should be increased from £23,250 to £100,000.

Under the current system, at the extreme, people face losing over 90% of their assets. If these recommendations were implemented, no-one going into residential care would have to lose more than 30%.

Under our proposals more working age adults would not have to pay any charges and younger people would not be subject to a means test. We recommend a shift to a new national eligibility threshold, to tackle the extremes of the ‘postcode lottery’, and better assessment processes for both those needing care and their carers.

We want to see significant improvement in the provision of information and advice, and more joined up working across the whole care and support system – health, housing, benefits and adult social care.

Change is crucial

This is a set of proposals that will concentrate help on those with the greatest needs, give peace of mind to all and create a new partnership between public and private sector.

Individuals with care needs, carers (both paid and unpaid), the financial services sector and the public and voluntary sectors, will all have a part to play. Together we can help people achieve the outcomes they want, offering choice and delivering services shaped around individuals and their families.

Last year, the government established this Commission to recommend what that new system should be. It is now up to the government to take forward those reforms.

What do you think of the Dilnot Commission’s proposals of reform for the social care funding system? And how do you think the funding of long-term care should change?

Mark says:
7 July 2011

The failure of both policy makers and politicians on the issue of social care, esp for dementia sufferers, is shameful so well done to Mr Dilnot for his excellent report. The lack of information and advice to consumers is huge. I know; my mother in law is working her way through the social care maze right now with my help. Already in 6 months virtually all my father in law’s lifetime savings are gone and we, as a family, are faced with a shortfall of around £700 per week (that’s £36,400 per year). It’s impossible to make ‘good’ decisions in a crisis and without the whole picture.
For example, the information and advice from the local authority and care agencies like Age UK and Alzheimers Society might well tell you ‘the value of your home is not included’ but in effect it is: how are we to meet that kind of shortfall without selling my mother in law’s home, borrowing money or using up my mother in law’s savings too?
In our case, the local authority might contribute as little as £100 per week due to my father in law’s pension income, yet good dementia nursing care is cheap at less than £800 per week.
As it happens, I don’t think the state should pay all the bills for social care, esp if you have assets inc housing equity. The problem is, as Mr Dilnot concludes, the potential scale of the sums demanded, all the more galling when dementia is really a health condition that should be considered on a par with having had a stroke, heart attack, cancer, etc. What are savings for if not for a rainy day. The problem is that dealing with social care costs isn’t just a rainy day; it’s a force 5 hurricane.

David says:
8 July 2011

Like Mark’s mother-in-law (his comment of 7 July 2011), I am about to enter the maze. My wife has Alzheimer’s and she is expected to enter residential care in 6 to 9 months time. Within six months, her savings will have all but disappeared, and the family will be faced with a shortfall of £700 a week, exactly as Mark’s mother-in-law. If as I expect we cannot do so, our home will have to be sold, and I shall move into rented accommodation. But then half the proceeds will be credited to my wife, and the council will make no contribution for a further two or three years. Catch 22?

Agreed that people should have to pay towards long-term healthcare, and not just rely on the state, or on rinky-dink “products” from the insurance industry, as the Tories seem to want (remember personal pensions?). But I worry whether £35,000 is anything like enough, given the dementia epidemic which my own family’s getting involved with. Labour suggested £20,000 just a year or so ago, and were rubbished by the Tories about having a “death tax”. Now the current figure being floated is £35,000. Is this just an expectation-setting exercise with a final figure at £80,000 or so, or are there detailed calculations in the Dilnot report (haven’t seen it)? Of course, people have paid National Insurance for a long time, expecting it would cover the NHS, state pension etc, but the government keep treating this as tax revenue and spending it on weapons etc. A smaller state in the sense of smaller global ambitions rather than smaller scope of state activity, would maybe be able to look after its own citizens in old age better. How do other European countries do it, does Dilnot contain comparisons with Germany, France, Scandinavian countries?