Dilnot Commission… half-term report

To coincide with half-term week the Dilnot Commission on the funding of long term care has set out its own mid-way prognosis. This shift in gear from quiet contemplation to ‘thinking aloud’ is not before time, given the few short months between now and early July when it will report.

I was reassured that most of Age UK’s top concerns for the future of care have been taken squarely on board by the commission. Above all, Andrew Dilnot and his fellow commissioners have fully recognised that extra public spending is non-negotiable and that today’s safety-net system must be sustained and improved before anything else.

The commission is also placing great store on giving people the opportunity to protect themselves against the costs of care. They have firmly concluded that today’s means-tested system must be laid to one side; but they are equally certain that offering free care from tax funding is a political and financial non-starter. That leaves a very wide range of options involving individuals with middle and high means sharing the costs of care with the state (so-called ‘partnership’).  

On top of that the commissioners are hopeful that viable financial products can be promoted that will enable those who wish to protect themselves from the remaining costs of care. The task for the commission is to determine the optimal form of co-payment system to foster this additional voluntary risk-pooling – and which is also fair between income groups, achieves good value for the public purse and incentivises early use of services when people may want to put off getting help.

From the mood music, my guess is that beyond the means-tested safety net the commission is playing with some combination of a modest state contribution for all care users and a capped liability scheme for those facing truly catastrophic costs.

The commissioners are clearly willing to embrace some of the thorniest issues littering the field, for example the relationship between today’s social care system and free services classified as NHS continuing care. It is also becoming clear that they believe the system will need to include clear national entitlements, which implies swimming against the tide of localism.

However, on the critical question of money, the commission is so far keeping its counsel. How much public spending is needed, and where should it come from? In Age UK’s view the share of GDP spent on older people’s care may need to double over 15 years, if we are to really achieve a system that offers quality care for the poorest as well as a contribution for everyone else.

To address this challenge, we want the commission to seek out revenue raising options which are equitable and affordable, across both age groups and the distribution of wealth.

If the commission can’t identify this extra revenue, our fear is that it will come under increasing pressure to recommend the transfer of spending from disability benefits to the funding of care. And at that point the wheels would come off the process of consensus building.

The welfare reform proposals just introduced to Parliament prove, once again, that undermining the disability benefit system is politically toxic. Stripping benefits from one group of disabled people, only to give care to another, would just ‘rob Peter to pay Paul’. If a reform package entailed reducing the incomes of frail and disabled older people, it would fast unravel in the light of political and public scrutiny.

Andrew Dilnot, Chair of the Commission on the Funding of Care and Support, will be speaking at Age UK’s Agenda for Later Life conference on 8 March. You can still book your place online.

4 responses to “Dilnot Commission… half-term report

  1. I agree with you that some of the early indications from the Dilnot Commission would suggest that they intend to fully embrace some of the age old problems in the funding of long term care. Certainly it will be very welcome if there is a resolution of the tension between the partly-funded social care system and the free services currently classified as NHS Continuing Care, this has been a longstanding grey area which has been interpreted in a multitude of ways by different PCT’s. It will also be good to see an unequivacle statement on free and means-tested entitlements set on a national basis so that elderly people and their relatives can have a common understanding of what they can expect from both Social Services and the NHS in terms of quality and funding support .

    It’s clear that there is going to be far greater sharing of costs but the split between the State and the individual will heavily depend on just how much extra public funding is forthcoming. As the demographic pressures increase in the years ahead I would be surprised if the State is able to fund much more than the critical/substantial means-tested cases that are currently funded. I also agree with the suggestion that today’s system must be improved before anything else otherwise it’s difficult to imagine why elderly people would wish to pay more for the current standards of care.

    As always the devil will be in the detail but the fundamental question of where the additional funds are to come from has yet to be faced by both Andrew Dilnot’s team and then later the politicians. I believe this can only be achieved by a radical restructuring of the provision of long term care away from the NHS and towards a higher quality of social care provision, both in the community and the residential care sector.

    I have expanded on this much more in my blog at http://www.grumblesmiles.com.

    John Graham OBE

  2. Here in Kent the County Council has already stated that they intend to de-commission all council run homes for the elderly so that care will be devolved to private concerns who will ‘deliver cheaper and better care’. Given the well-documented worries over the reduction in funding for the body which regulates homes and some of the cases of neglect, how are we to believe that cheaper yet better care will ever be the case?

  3. I admiire the eloquent contributions above, this might be less so.
    I have read the brief article on the Dilnot commission in the news papers today and, as with many other government initiatives there seems to be the usual amount of non joined-up thinking.
    There is a theme that people should contibute and also that the burden should be ‘shared’ between the individual and the government.
    There is a suggestion that houses should be rented to pay for care. Not much sharing here; renting equals income; income equals tax paid to the govrnment. Not only do they not pay anything for care, they get income when you try to help yourself!
    Incidentally as a rough rule of thumb, one month’s house rental equates to one week’s care home charge.
    Sell and invest – what in? This gives less income than rental, but at least you can spend your capiital untill it’s all gone.?
    Nowhere is it acknowledged that care home fees have a care element and a residential element. How about giving tax relief on the care element? Help those who help themselves.
    Also, why is vascular demetia not counted as a disease?
    etc etc etc
    I could go on, but I know a brick wall when I see one, and I care for my head.
    How much ‘real world’ evidence did they take?

  4. I am a carer, caring for my elderly mother for the last six years living in in a shared property. At cost of twenty thousand a year if she had been in a home I have already saved the government a lot of money, far more than the maximum they suggest should be paid, At this late stage if I can no longer care because it becomes too difficult what happens to my home? Surely it should revert to me and not to the government to pay for her care? If i had not been caring for her over the last six years, her half share of our home would have been used up in nursing home fees already…At seventy, I do not feel I should have to move home to release her capital for the government to use when I have already saved government £120.000 by caring for her day and night for the last six years, and part time for five years before that.. There should be some consideration for carers who do take responsibility for their loved ones. I worked hard for 40 years and earned my own pension, so i didn’t even qualify for carers allowance. It seems the feckless get everything and those who make every effort to support themselves and others in life are penalised, and get no recognition for their contribution..Please sign my e petition here….
    http://epetitions.direct.gov.uk/petitions/627.

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