This working paper from the Health Foundation and The King's Fund considers five approaches to funding social care for older people in England. The chosen models reflect the solutions most commonly raised in the debate around social care funding, and are not a comprehensive list of possible models.

The objective of this paper is not to put forward a single recommendation, but to set out the implications of each of the models.

The five models

  • Improving the current system.
  • The Conservative Party’s proposals at the time of the 2017 general election (a revised means test and a cap on care costs).
  • A single budget for health and social care.
  • Free personal care.
  • A hypothecated tax for social care.

Key conclusions

  • There is scope for making small improvements within the current system, and this approach would recognise the great difficulty successive governments have faced in achieving major reform. However, it would not address many of the fundamental problems with the current system, including the downward trend in the numbers receiving publicly funded care. Nor would it protect people against ‘catastrophic’ care costs.
  • The Conservative Party’s proposals would have, for some, resulted in a more generous system than the one currently in place. However, there are real concerns around implementing and operating such a complex system. There is also a question as to whether this would be the best use of additional funding for social care.
  • While a joint health and social care budget might support progress towards more integrated care, it will not in itself address the differences in eligibility between the two systems, or generate additional revenue for health or care.
  • Free personal care would mean increasing the government’s ‘offer’ on social care. However, given this would require an increase in public spending, there is a question as to whether this would be the best use of additional funding for social care.
  • A hypothecated tax may help gain public support for raising additional funding for social care. However, this would represent a significant shift from the existing system, and could exacerbate the lack of alignment between the health and social care.