In Focus: Protecting the nation  

Social care: learning from the past and looking to the future

  • Communicate historic developments around social care provision
  • Explain the current political situation around social care
  • Identify ways social care funding could be tackled in the near future
CPD
Approx.30min
Social care: learning from the past and looking to the future
(Matthew Lloyd/Bloomberg)

The planned introduction next year of a lifetime cap of £86,000 on personal care costs has been cancelled. To be fair, only the bravest of punters would have bet on it going ahead.

That is a shame, because changes to the creaking social care system are long overdue.

Leading charity Age UK called the sector “under-funded, under-staffed and under-valued”. 

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Wealth can be a big insulator against social problems, of course.

But almost everyone would benefit from a better system both financially and in terms of peace of mind, particularly with conditions of ageing such as dementia becoming more common, and eligibility rates for NHS continuing healthcare funding falling.

The current means-test threshold – the point at which people are expected to pay all their own care costs – has been frozen at £23,250 since 2010, creating more self-funders each year. 

Industry figures suggest those in residential homes pay £60,000 a year on average and more in wealthier areas or better homes.

These are huge sums to find, swallowing up capital on top of pension incomes.

There is also a sense of injustice from the fact that self-payers may also be paying up to 40 per cent more than council-funded fellow residents in the same home receiving the same care.

The current rules make it hard to plan for the possibility of needing to pay for social care, encouraging people to cross their fingers and hope it will not happen to them.

Without the means to pay, people often reluctantly fall back on selling their homes or relying on working-age family members to fill the gaps, leaving both themselves, their loved-ones and the country poorer.

Governments that trumpet reform without ever seeing it through are heaping further confusion onto existing uncertainty.

The situation today is no better – some would say much worse – than in 2019, when Boris Johnson pledged from the steps of 10 Downing Street to “fix the crisis in social care once and for all”.

The cap has gone but with a new party in power and reports suggesting new Prime Minister Kier Starmer is planning a royal commission to look at social care, can we finally look forward to a brighter future? 

Learning from the past

One of the lessons of the past is that inquiries and commissions do not guarantee action.

After all, it has been more than a decade since Andrew Dilnot’s commission on the funding of care and support came up with the idea of a cap on care costs and revised means-test limits. 

As far back as 1999, the Sutherland commission on long-term care highlighted many problems that mostly still need to be tackled today:

  • An inadequate and unsustainable funding model.
  • Fragmented care services, lacking coordination between health and social care services.
  • Poor quality of care, including inadequate staffing and training.
  • Unfair charging systems and a reliance on "intrusive" means-testing.
  • Lack of public awareness and understanding, leading to misconceptions and inadequate planning. 
  • Neglect of informal caregivers, such as family, who were often overlooked and unsupported.

The commission argued for free personal care for those aged 65 funded by general taxation, a suggestion not taken up in England or Wales, although it was implemented in Scotland in 2002.

The problems mostly come back to the central issue of lack of funding.