The costs of the prime minister’s planned new national care service should be shared between the state and the individual.
This according to the King’s Fund who have set out recommendations for social care sector reform following PM Andy Burnham’s bringing forward the reporting timetable for Baroness Casey’s review to 2027 and his setting out his vision for a new national care service.
The recommendations follow King’s Fund research revealing the proportion of people accessing long-term social care varies substantially even between similar local authorities, with some areas supporting up to twice as many people per 100,000 than their nearest ‘statistical neighbour’.
The think tank is calling for universal access to publicly funded care, but with co-payments from users, a cap on lifetime care costs, national, rather than local, funding for social care, as well as clear individual entitlements to social care support.
The King’s Fund maintained that together its social care reform proposals would cut unwarranted variation in access, ensure that everyone in need of social care would be entitled to at least some state-supported help, raise money more fairly for social care and give people greater freedom over how they received their support. It further maintained that it would also change the role of local authorities, who currently manage social care access, from ‘gatekeepers’ of public funds to organisations that help people find the care they need and join it up with health and other public services.
The public spending required for the new system – and the extent of co-payments expected of people receiving services – would be set every five years during projections of required long-term care expenditure.
Meeting long-term care needs
The report notes that while everyone should be entitled to some publicly-funded support to meet their long-term care needs, the cost of meeting the population’s need should be shared between the state and the individual, with the relative responsibilities of each clearly defined and understood.
Progressive contributions
It also calls for contributions to be progressive, with those who have more contributing the most, first from taxation on incomes and assets, or employment-based social insurance so that everyone pools the risk of care costs as a society; and second by making ‘co-payments’ for a time towards the cost of individual care.
As now, people would be expected to contribute towards the costs of that care, depending on their assets and income, but the contributions would be in the form of clear co-payments calculated as a percentage of their total care costs.
For home-based services, assets would include savings and for residential care the value of their home, if they have one. As now, people in residential care would be able to defer co-payments from their property until their death. People would also be expected to pay their own food and accommodation costs if in a residential care home or nursing home.
As now, access to advice and information would be free, as would short-term and crisis care (including reablement up to six weeks, equipment, assistive technology, occupational therapy, discharge support, safeguarding and protection).
Five-year cycle
But the level of people’s long-term care contributions would be determined by the government on a five yearly cycle, which would match the parliamentary cycle and give multi-year planning oversight, using an independently-produced projection of expected long-term care costs over that period.
The think tank recommends that the level of co-payments should be set at a level that balances the capacity of state financing over the five years with the ambition of not dissuading people from receiving long-term care support because of the level of contribution they must make towards its cost.
Equal access
Simon Bottery, co-author of the work and senior fellow for social care at The King’s Fund, said: “A national care service, which the Prime Minister has promised, must be genuinely national and ensure that all people, wherever they live, have the same access to social care support.
“Our new proposals for an ‘equal access’ national assessment would help prevent this issue of unwarranted variation and ensure that access to social care support is not decided by your postcode.
“But reform must go further than that and ensure that there is universal access to at least some publicly funded support, with a cap on the cost people are expected to pay to ensure that no one faces huge lifetime care bills. Currently, one in seven people aged 65 will spend at least £100,000 in lifetime care costs.
“We must also introduce fairer, national funding of social care, with greater choice and control for people and their families over how their care needs are met.
“The prime minister and Baroness Casey’s commitment to reform is clear but we are still awaiting the concrete policies that will turn this vision into a reality. To achieve that, their proposals will need to focus not just on who pays but on how the wider system operates on the ground.
“What The King’s Fund has set out today can begin to plug these gaps and help politicians and the public decide what type of social care system they want to see. There is still a long way to go to tackle the great unresolved policy problems of our generation, but we are at least on the road towards reform and we hope the work we have put forward will help build the fairer and more effective system that has been promised.”
