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Ending the cycle of broken promises to reform social care funding in England must be a priority for the next government, a Health Foundation report says. 

Currently, one in seven people aged 65 and over face care costs over £100,000. Government only covers the costs of care for people with the highest needs and lowest means. Everyone else must pay for care themselves, get help from friends or family, or go without.  

The report sets out cost estimates for three options (see Notes to Editors) to protect people against the costs of care. It estimates:   

  • Providing basic protection for all against some care costs, with a Scottish-style model of ‘free personal care’ in England, could cost an extra £6bn in 2026/27, rising to around £7bn by 2035/36 
  • Protecting people with the greatest lifetime care needs against catastrophic costs, by introducing a Dilnot-style ‘cap’ set at £86,000, could cost an extra £0.5bn in 2026/27, rising to around £3.5bn by 2035/36 
  • Introducing an NHS-style model of universal and comprehensive care could cost an extra £17bn by 2035/36. 

The next government will face tough spending decisions. But a better, fairer and more generous social care system is affordable. By 2035/36, the cost of the current government’s version of the Dilnot model is equivalent to around 0.2% of GDP or an estimated £4.25 per household per week. 

Successive governments have ditched or delayed plans to reform funding for social care, leaving people suffering unnecessarily. Tony Blair promised reform in 1997. A decade ago, the coalition government legislated for a Dilnot-style cap on care costs but its introduction was later delayed. In 2021, Boris Johnson announced that the cap would finally be implemented. But, in a case of history repeating itself, the government has since delayed the cap until 2025 – after the next election. Ultimately, progress will not happen without political will and leadership. 

The analysis primarily focuses on funding reform. But a wider package of investment and reform in social care is also desperately needed, the Health Foundation says. Alongside funding reform, a credible plan for social care must include policies and funding to improve people’s access to good care, boost pay and conditions for staff, and better support unpaid carers. 

Charles Tallack, Director of Data Analytics at the Health Foundation, said: 

‘Despite the pressing need for change, successive governments have failed to reform the funding of social care, leaving a catalogue of broken promises, delays and abandoned manifesto commitments whilst people continue to suffer under a care cost lottery. There are a number of options for reform but legislation already on the Statute Book to introduce a cap on the lifetime costs of care and give more people state support means that a solution is within reach. There can be no excuse for inaction and prolonging one of the biggest public policy failures of our generation.’ 


Notes to Editors: 

At present, social care is funded by government for people assessed as having significant care needs and limited financial means (assets below £14,250). People with assets of more than £23,250 pay for all their social care – and there is no limit to what they might pay.  We model three funding reform options: 

  • Free personal care: Some basic social care services are funded by government for everyone who needs it. A wider range of care services are means tested – and individuals may have to pay themselves. 
  • A ‘cap’ on care costs: Social care is funded by government for people assessed as having significant care needs and limited financial means, but a cap limits the amount someone can pay over their lifetime to £86,000. 
  • A universal social care system: Social care services are free at the point of use for everyone who needs them, similar to the NHS. 


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