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Health Foundation sets out five priorities for fixing social care

Without reform, government is 'choosing to prolong one of the biggest public policy and political failures of our generation'

Louise Prime

Friday, 06 September 2019

The Health Foundation is demanding that the government sets five priorities to fix adult social care in England, which it said this morning has needed to be done for decades. It warned that ultimately, government priorities and values – for example, about the balance of responsibility between individuals and the state – will drive decisions, but it insisted they should also be underpinned by evidence and analysis. And it argued that if the government chooses not to reform, it “will be choosing to prolong one of the biggest public policy and political failures of our generation”.

The charity pointed out that increasing numbers of people are unable to access social care, and care providers are at risk of collapse; but despite this, successive governments have continued “to duck reform” causing continued, unnecessary suffering for people and their families. It said that publicly funded social care – the help, care and support that adults of all ages might need because of disability, illness, or other life circumstances – is only available to those with the highest needs and lowest means. Furthermore, funding cuts mean that the number of older people receiving publicly funded care fell by 400,000 between 2009/10 and 2015/16, and many more go without the care they need. It added that about one in 10 people aged 65 face future lifetime care costs of over £100,000.


The Health Foundation has published its five priorities for government*, based on its assessment of the evidence and analysis of the costs of reform. These are:

  1. stabilising and sustaining the current system
  2. improving access to care
  3. providing social protection against care costs
  4. seeing the capped cost model as a flexible approach to reform
  5. exploring a range of options for raising revenue.

It said the government’s immediate priority should be “to stabilise and improve the current system, including by boosting staff pay and improving access to publicly funded care”. It has estimated that stabilising the current system by addressing demand pressures and increasing staff pay in line with the NHS would cost £1.0bn in 2020/21, £2.1bn in 2021/22 rising to £4.4bn in 2023/24, compared with the current baseline budget. Restoring access to 2010/11 levels of service would require around £8.1bn extra investment by 2023/24 on top of this (£12.5bn in total).

But it called for more fundamental reform to make the funding system fairer and provide government protection against social care costs. It said policymakers have choices on how to do this, based on their values, priorities, and public spending plans. The report’s authors argued: “A Dilnot-style capped cost model – which focuses extra state funding on those with the greatest lifetime care needs and protects them from bearing costs above a certain limit – could be used flexibly by any government, and already lies on the statute book.”

The Health Foundation outlined costs of implementing different models for reform, noting that “any credible reform option requires government investment”. These varied from a Scottish-style model, whose implementation costs it said could add around £4.4bn to spending in 2019/20, rising to £5bn by 2023/24; to a Dilnot-style model that, depending on where the cap was set, could range from about £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 – where the state covers all costs of a person's eligible needs).

The charity argued that although reform is often thought to be unaffordable, the government can – if it so chooses – “afford to provide more generous care, support and security for vulnerable people in society”. And it warned: “If it doesn’t, it will be choosing to prolong one of the biggest public policy and political failures of our generation.”

It went on: “Policy ideas are quickly politicised – labelled a ‘death tax’ or ‘dementia tax’. And the right ‘fix’ depends on your interpretation of the system’s problems…

“Ultimately, social care reform is political: decisions will be driven by government priorities and values – for example, about the balance of responsibility between individuals and the state. But they should also be underpinned by evidence and analysis.”


*Alderwick H, Tallack C, Watt T. What should be done to fix the crisis in social care? Five priorities for government. The Health Foundation, published online 30 August 2019.

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