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.