30 August 2019
The need to fix the crisis in social care has been well articulated for decades. Yet politicians continue to duck reform, and people continue to suffer unnecessarily.
The immediate priority for government should be to stabilise the current system and increase the number of people receiving publicly funded care. This will require additional government investment.
But more fundamental reform is needed to make the system fairer and provide people with protection against social care costs. Policymakers have choices on how to do this – and a Dilnot-style capped cost model could be used flexibly by government, depending on political values and priorities. Increases in taxation are likely to be needed to fund the costs of reform.
Other policy changes, like the closer integration of NHS and social care services, are an important part of making the health and care system work better for patients, but they are no replacement for the changes needed in the way social care funding and entitlements work.
Worries about increased government spending to pay for reform have been a barrier to change in the past – and things are likely to be no different this time around. Reform certainly requires investment: the cost of implementing a Scottish-style model, for example, could add around £4.4bn to spending in 2019/20, rising to £5bn by 2023/24. The cost of a Dilnot-style model depends on where you set the cap – ranging from around £1.7bn in 2019/20 rising to £2.1bn by 2023/24 under the least generous scenario (a £78,000 cap), to £6.8bn in 2019/20 rising to £7.8bn in 2023/24 under the most generous (a £0 cap). These are not small sums.
In the context of England's wealth and broader public spending, however, social care reform is not so unaffordable. Public spending on services in England was £525bn in 2017/18 (in today's prices). Of that, we spent around £18bn on adult social care. Across the whole UK, we spent £22.7bn on social care – 1.1% of GDP. This compared to wider health spending in 2017/18 of £153bn, equivalent to 7.1% of GDP – and projected to grow to 7.9% in 2023/24.
Simply meeting the government's basic promises – first the prime minister's pledge to provide security for people in their old age, and second the government's 2018 commitment that social care will not impose additional pressure on the NHS – requires investment and reform. The bare minimum for even the most unambitious government, therefore, would be to keep existing services running (£4.4bn by 2023/24) and implement some kind of credible reform to the funding system to provide security for people against care costs – for example, a Dilnot-style model with a £46,000 cap. This would add another £3.1bn investment by 2023/24 (so £7.5bn overall). But – as we've outlined – government must also act to improve access to publicly funded care.
In the end, the appropriate level of spending on adult social care comes down to political choices – for example, about the right amount and balance of spending between public services, and how to raise the revenue to pay for them. If it chooses to, the government can afford to provide fairer and more generous care and support for vulnerable people in society. If it doesn't, the government will be choosing to prolong one of the biggest public policy failures of our generation.
About the authors
- Hugh Alderwick (@HughAlderwick) is Assistant Director of Strategy and Policy at the Health Foundation
- Charles Tallack (@CharlesTTHF) is Assistant Director for the Health and Social Care Sustainability Research Centre
- Toby Watt (@TLSWatt) is a Senior Economist at the Health Foundation.
- All figures listed in this article are in real terms at 2019/20 prices.
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