Care funding commission chair denies government pressure

 The chair of the commission on the funding of long-term care, Andrew Dilnot, tells Jeremy Dunning that the government has not pressurised him to deliver the most politically convenient outcome

Andrew Dilnot was a shrewd choice for the government to chair its Commission on the Funding of Care and Support.

Carefully non-partisan while director of public spending experts the Institute for Fiscal Studies from 1991-2002, he has spent the last eight years in academia, as principal of St Hugh’s College, Oxford.

The economist also brings expertise on the subject of the future funding of care, having served on a Joseph Rowntree Foundation (JRF) inquiry into long-term care funding, which reported in 1997.

Such a background informs his insistence that the commission, announced last month, will be fully independent and able to recommend measures that may be unpalatable to some in the coalition, including prime minister David Cameron himself.

Shortly after the commission was announced, Cameron said he remained opposed to any compulsory levy on estates to fund care – or “death tax”. The issue caused a pre-election row after the Tories accused Labour of planning to introduce a £20,000 levy on estates to fund care. Following Cameron’s pronouncement, care services minister Paul Burstow made clear any recommendation to implement such a levy would be rejected.

However, speaking exclusively to Community Care before the commission’s first meeting, Dilnot says he would not have taken the job if he had felt compelled to deliver a politically acceptable solution.

“It was made clear to me that we were an independent commission. That’s how I think of it. I wouldn’t have taken it on otherwise, so we don’t feel constrained,” he says, adding that he would be would be surprised and disappointed if the government rejected realistic recommendations.

Besides independence, Dilnot’s other assets include being an able communicator, specifically when it comes to grappling with numbers. He is a former presenter of BBC Radio 4’s series on numbers and statistics, More or Less.

He sees a vital role for the commission in spreading greater understanding among people about how the system works.

However, Dilnot recognises the difficulties of the issues facing the commission, which he sums up as people living longer, rising expectations of services, and greater independence for older people through technological progress.

Dilnot says: “All of those things mean we will continue to spend a large proportion on care and we’ve to decide how to split that up between the public and private sector.”

At the coalition’s behest, the commission will consider the respective benefits of a voluntary insurance scheme, as backed by the Tories, and the Lib Dem-favoured partnership model set out by Derek Wanless in his 2006 report for the King’s Fund. This will involve all users receiving state funding for personal care that they would then top up.

Another option likely to be considered is making personal care free at the point of need, funded by a combination of taxes and a compulsory national care insurance scheme. This was put forward by the 1997 JRF inquiry of which Dilnot was a member.

He says that, 13 years on, the model ought to be re-examined to assess whether it is viable in the light of the state of public finances, though he is careful not to sign up to any solution.

Dilnot adds that, until the commission holds its first meeting, he is unsure whether it will order new research or rely solely on existing work, including that carried out for the Labour government. However, it does want to hear from experts, he says.

Dilnot, and his fellow commissioners – former social services directors Jo Williams and Lord Norman Warner, the latter also a former Labour health minister – have little time to spare and a lot of material to wade through.

The commission must submit the criteria against which it will adjudicate on competing options to ministers by next month and will also feed into October’s comprehensive spending review.

It must report to ministers by the end of next July. “We are under considerable time pressures,” he says, “We’ve got to move with some speed.”

Many in the sector hope that this commission does not meet the same fate as the 1997-9 Royal Commission on Long Term Care, which had its central recommendation – free personal care – rejected by the Labour government.

The signals from the coalition suggest the commission’s work will be taken seriously though, as Burstow and Cameron have made clear, certain recommendations will be treated more warmly than others.

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This article is published in the 26 August 2010 edition of Community Care under the headline “All funding options remain on the table”