The Dilnot Dilemma: is funding really the biggest issue?

We have reached a critical point in the journey towards a reformed care system in Britain. For many years social care was neglected, with the job of reforming the sector deemed by many to be too difficult.

The result, according to many health commentators, is a system which has been left to disintegrate, denying those who need the most help from accessing it.

The Care and Support Bill is an historic piece of legislation with the potential to transform the social care system in Britain for generations to come. The Bill goes a long way towards simplifying the legal framework and funding of social care, with specific measures including the introduction of a £72,000 cap on the cost of social care for individuals and an improvement in carers’ rights. This Government is, therefore, to be commended for acknowledging that the current care and support system is no longer fit for purpose and for introducing wide-reaching reform.

The Care Bill offers an ambitious and positive vision for the future of social care. There is an argument to say, however, that the Government is struggling to overhaul the care system completely. Since coming to power in 2010, £710 million in real terms has been slashed from social care spending at a time when the over 85s, the nation’s fastest growing demographic and the group most likely to need care and support, is on the increase. The sad reality is that while budgets fall and demand rises, it will be increasingly challenging for the Government to deliver their vision for care.

Ahead of the Autumn Statement at the start of the month, the charity Age UK released its ‘Five challenges to the Government on care’. In it, they outline the key factors which they believe will be pivotal in determining whether the current social care reforms succeed or fail.

These include calls for a new national eligibility threshold to be set at ‘moderate’; for changes to be communicated to older people and their families so they understand what is on offer; for the rates of care which go towards the cap to be fair and reflect the true cost of providing decent quality care; for there to be a straightforward and fair way to complain; and for there to be enough investment into the social care system so that it is fully funded, and able to deliver care and support to older people who need it.

The charity has been campaigning for the Care Bill to be strengthened in several areas, but the issue which is consistently emphasised is the lack of adequate funding. The report, co-authored by Age UK’s Charity Director General, Caroline Abrahams, is a stark reminder of the risk that the Care Bill could promise much and deliver little.

It concludes: “Above all, [...] it looks like the social care ‘coat’ being designed for 2016 is being cut according to the insufficient ‘cloth’ that the Treasury is making available, so that a great opportunity to transform social care could go to waste.

“With our hospitals full to bursting and winter still to come [...] there will never be a better time for the Government to commit to looking at the true costs of running a social care system fit for a civilised society, and of acting to close the all too obvious financial gap.”

Imperative though it is to have a frank discussion about how care is going to be paid for, there is a potentially larger issue to consider. As a society we have yet to fully address the questions of what the social care system should include; what the system should provide; and who ought to bear the costs of this provision.

Perceptions of the social care system as a whole remain vastly different to the reality, with many believing that because they have ‘paid in’ to the system their whole lives, that it should be there to support them in later life. However, unlike the NHS, which is free at the point of use for everyone, social care is, as Peter Beresford, Professor of Social Policy notes, “still rooted in the poor law principles of needs and means testing.”

Under the proposed Care Bill, changes to the system will remain focussed on the process of means testing, with the national eligibility criteria likely to be set at the ‘substantial’ level and so-called ‘hotel’ costs not included in the overall cap.

This is the system being ‘cut to fit the cloth’; yet as a society we have had no say over whether more ‘cloth’ needs to be made. In wrestling with the question of how to pay for care, the Government is arguably edging perilously close to employing a ‘sticking plaster’ method, leading some to fear that they will merely patch up the holes rather than provide the overhaul Dilnot originally outlined.