The Dilnot Report

Citation

(2011), "The Dilnot Report", Quality in Ageing and Older Adults, Vol. 12 No. 4. https://doi.org/10.1108/qaoa.2011.55912daa.002

The Dilnot Report

Article Type: News From: Quality in Ageing and Older Adults, Volume 12, Issue 4

The “big event” in the UK this summer was the release on 4 July of Andrew Dilnot’s Report of the Commission on Funding of Care and Support: Fairer Care Funding. The main recommendation involves capping the lifetime contribution to adult social care costs that any individual needs to make at between £25,000 and £50,000. Views on this report are varied but few are wholly favourable.

If the recommendations are implemented, the catastrophic cost of residential care could be limited, but many people will still have to sell their homes to pay for it and it does not solve the present crisis in the social care system. Residential care for five years (not uncommon for dementia sufferers) could easily cost individuals around £85,000 by the time the £35,000 cap is reached and for a full five years accommodation costs. So still many people will have to meet this cost from the proceeds of selling their home – their only asset. More seriously only those with substantial or higher care needs will have their care costs capped and met so those older people with low or moderate care and support needs will have to continue relying on family and friends, pay for it themselves or do with out.

Philip Spiers, of FirstStop (part of the Elderly Accommodation Counsel), says: “Although the recommendations are all welcomed particularly the capping of care costs, national assessment criteria, portability of care packages and, robust advice and information, questions arise as whether it goes far enough […] It does not address the […] underfunded dysfunctional social care system. Instead, it just looks at asset protection and consistency around assessing care and charging for it. This was a real opportunity to redesign social care to provide an integrated health and social care system fit for purpose for older people today […] A brave Government would look at how each generation can collectively contribute towards their own care costs even if it means a tax on the assets of the older population and compulsory insurance for the younger.”

A new charity, United for All Ages, points out that the Dilnot Commission has raised fundamental questions about how to create a fairer and simpler care system for this and future generations of older people. But they see the commission’s proposals as regressive, the winners would be richer families whose inheritance will be relatively protected while most families will face a more confusing and potentially costly care system. Instead of reforming the current inadequate system for funding care they argue that the proposals would lead to a more complex, fragmented and confusing care system. Some of the key questions surrounding the proposals include:

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  Everyone (except those below the proposed assets threshold) would be required to find the same amount of money regardless of their wealth. This could be seen as a care “poll tax” for the so-called squeezed middle.

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  Not many people have up to £50 k liquid assets and therefore would be required to find it by selling their home and/or using their estate for a deferred payment or by taking out an insurance policy which again would cost the same regardless of income or wealth.

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  Encouraging people to take out insurance creates a whole new industry, increases the transaction costs (as in the USA) and creates more complexity and fragmentation (it also paves the way for increased use of insurance to pay for health); there is no evidence from anywhere in the world that a voluntary insurance scheme funding care actually works.

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  It is not clear what “care” costs would be included in the cap. Would it include the preventative help and support that enable an older person to stay independent (e.g. help with cleaning, shopping, etc.) or would it just be high-level personal care? Will families have to make top-up payments to get the care they want, where they want it?

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  The cap on “hotel” costs (e.g. accommodation, food, etc.) of residential care mean someone in a care home for five or ten years with dementia, for example, would face a large bill of much more than £50 k, i.e. they could still lose their home. This would come to be seen as a big con.

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  the proposals also depend on the government committing to substantial extra spending on care – which is much needed but media reports suggest this may not be forthcoming. Older people and their families need change now, not in five or more years’ time.

Once again the criticism is that the Dilnot proposals perpetuate two separate systems of health and social care.

Stephen Burke, director of United for All Ages, said: “The care system is facing meltdown with older and disabled people increasingly unable to get the care they need and families facing crisis as they are expected to pick up the pieces. The postcode lottery in care is widely seen as unfair and getting worse. We cannot put off radical change any longer”:

[…] the idea of a care duty on estates above a certain value is still the best and fairest way forward. This could be “our legacy to the future” – a care system funded better now and sustainable for future generations, delivering real intergenerational fairness.

The Report of the Commission on Funding Care and Support can be downloaded at: www.wp.dh.gov.uk/carecommission/files/2011/07/Fairer-Care-Funding-Report.pdf

The Joseph Rowntree Report “Funding care: how can each generation pay its fair share” can be downloaded at: www.jrf.org.uk/publications/funding-care-fair-share

FirstStop is a registered charity bringing together under one telephone number and one web site the expertise of some of the most trusted and respected advice organisations in the UK with a particular focus on the needs of older people and their affairs. Funded by Department of Communities and Local Government (www.firststopcareadvice.org.uk/downloads/resources/3072.pdf).

The United for All Ages submission to the Dilnot commission in January 2011 can be obtained from: www.unitedforallages.com and by calling Stephen Burke on 01692 650816/07714 334510 or e-mail: stephen.burke@unitedforallages.com