The policy measures mentioned on the previous page would help maintain a system in which only people with the highest needs and lowest means receive publicly funded services. Many more people need care and support. Some pay for it themselves or get help from friends and family. But large numbers go without. Unmet need for social care is likely to be high.

Between 2009/10 and 2014/15, the number of older people receiving publicly funded care fell by around 400,000, with likely year-on-year reductions in subsequent years too. At the same time, the number of people needing social care has been increasing. More broadly, Age UK estimates that 1.4 million older people have difficulties with activities of daily living – like eating, washing, dressing, and going to the toilet – but do not get all the support they need. We know very little about levels of unmet need for social care among working age adults.

The government must act to improve access to care. One way to do this would be restoring levels of eligibility for publicly funded care to those that existed in 2010, before cuts to services. This could be done through changes to eligibility criteria – for example, by reducing the national minimum threshold and providing additional funding for local areas to meet it. We estimate that doing so would require an increase of £6.0bn to 2019/20 budgets growing to an extra £12.5bn by 2023/24. (This is £8.1bn on top of the £4.4bn required just to stabilise the system.) Both estimates include meeting demand pressures, and the projection to 2023/24 includes the cost of increasing staff pay in line with the NHS.

Improving access and stabilising the provider market need to go hand in hand. One reason for this is that self-funders typically pay more for their care than those receiving publicly funded services, cross-subsidising the lower fees paid by local authorities. This means that any major increase in the proportion of publicly funded clients, without increases in the fees paid for them, could result in loss of income for providers. This could further destabilise the market, increase costs for self-funders, or both.

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