On Monday 4 July 2011, the Commission on Funding of Care and Support (the Dilnot Commission) delivered its recommendations on the future funding of care and support.
Read about the current situation on care funding, and what we would like to see from care reform.
What’s happening on care?
The Dilnot Commission was set up in July 2010 by David Cameron's coalition Government, tasked with making recommendations for changes to the funding of care and support in England. It published its recommendations on 4 July 2011. The independent Commission is chaired by the economist Andrew Dilnot.
Social care is the name given to the range of care and support services that help frail and disabled people remain independent, active and safe - for example, help with getting out of bed, bathing and preparing cooked meals.
Social care provided by councils is currently means-tested. That means that those who are above a particular threshold are charged in part or in full for their care.
Those who need residential care or long-term support can pay thousands of pounds for care over their lifetime, and some have to sell their home to pay for this.
The Dilnot Commission
There is no doubt that reform is needed quickly to support people using care services currently, as well as preparing better care for future users.
The key test of the Government’s response is whether it will commit to publish a White Paper by Easter, including details on how the new proposals will be funded.
The Dilnot Commission published its recommendations on 4 July 2011.
Overview of key proposals
Andrew Dilnot has suggested the following proposals
There will be a more generous means-testing threshold
This should be set at £100,000 for people in a care home, which is a large increase from the current threshold of £23,250. This means that more people will be eligible for state support towards the cost of care. Those who have assets between £14,250 and £100,000 will pay a contribution towards their care, but costs will be met in part by the state. The threshold for home care will be unchanged, and the value of a house will not be taken into account. People who have more than £100,000 will pay for their care in full up to a maximum limit, or until they reach the means test threshold.
There will be a cap on care costs
The Commission recommends this cap should be set at £35,000. Once someone has reached this limit in their personal contributions the state will pick up all ongoing care costs. People living in a care home will have their ongoing living costs capped at £7,000-£10,000 per year.
Disability benefits support independence
Dilnot has recommended that Attendance Allowance and Disability Living Allowance remain a feature of the support provided by Government. He said that they provide an important contribution to people’s disability costs, encourage early intervention and help people who rely on unpaid care to meet their needs. He has suggested changing the name of Attendance Allowance so that its purpose is clearer and there is better take up.
To reduce the postcode lottery for care services
Dilnot has proposed that there is a national threshold for care eligibility. This means that there will be one level of eligibility across all councils, which will remove the local variability that exists currently. Assessments will be portable which means someone moving house can be assured they will receive care in their new area.
Frequently asked questions
Q. How does the cap work? And why is it set at £35,000, it seems very high?
The cap works by recording the contributions that someone needs to pay personally towards their care. Contributions will be made by everyone who has more than £14,250 in assets, and will be paid in full by people who have more than £100,000. The cap will rely on a local council assessment of the individual. The council will decide how much care is needed by the person, and how much it would cost to provide. The meter then starts and someone’s contributions begin to build up to the £35,000 limit.
Once someone is deemed to have spent more than £35,000 the local council will pay for the remainder of the care costs. It will not be necessary to prove the money has been spent. Councils will assume people funding themselves will spend the same amount as someone supported by the local authority with the same needs.
£35,000 was chosen because it means that no-one has to spend more than 30% of their assets. It helps people avoid the catastrophic costs of care which can affect some under the current system.
Q. I need care at home. Is the value of my house taken into account under the new proposals?
No, the value of your house is only taken into account if you move into a residential care home. If you live in your own home and need care it is only your savings and income that is counted.
Q. So after I’ve spent £35,000, does this mean that care is completely free once I’ve moved into a care home?
No, it doesn’t, but it does mean that the cost of the care itself will be met by the state. You will continue to be liable for general living costs. The Commission has recommended that these should be capped at £7,000-£10,000 per year.
Q. I’ve heard that my Attendance Allowance might be lost to pay for the changes to social care. Is this right?
No, Andrew Dilnot has expressed his support for disability benefits, which include Attendance Allowance and Disability Living Allowance. He thinks that they have an important role to play so that people can afford low level services, meet the cost of disability and to meet costs if they have informal care provided by family and friends. Your Attendance Allowance will remain as it is for the time being, although Dilnot has recommended that it is rebranded to make its purpose clearer.
Q. My family currently help support me by providing a little bit of help. What will happen to carers under the new system?
Andrew Dilnot has recognised the vital work that carers do in supporting older people. He thinks that the new system will make things easier for carers because the person they support will be able to get better formal care. But importantly, he also thinks that carers should be eligible for services and assessments in their own right, so that they are able to access support for their own needs.
Q. I currently receive care, should I contact my local council to ask about the changes?
No, at this stage, the proposals will not change the way that care is provided. There needs to be a white paper, where the Government puts forward its plans for change, and then there will need to be legislation. It is likely to be around 2014-15 when these proposals might come into effect.
Q. I think that care should be free, paid for by the taxpayer, like the NHS is. Why wasn’t this recommended?
The Dilnot Commission were given a set of criteria that their proposals had to fit alongside. One of these was sustainability, and Dilnot argues that free personal care is not sustainable, both in terms of finance (as this would be the most expensive option) and politics (as a new Government could choose to overturn such a policy). Evidence from other countries where free personal care is available shows that the funding pressures become so great the care becomes restricted and availability declines. There is nothing gained from an expensive reform to social care which lasts only a few years.