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Dilnot is not perfect but ministers should get on with implementing it


By Melanie Henwood, independent health and social care consultant

It was never likely that the government would accept outright the recommendations of the Dilnot report on funding care and support, but Andrew Lansley’s cautious response in the House of Commons on 4 July gives grounds for concern.  While welcoming the report, the health secretary stated that implementing the reforms would have “significant costs”, and that “in the current public spending environment, the government will have to consider the recommendations carefully against other funding priorities and calls on our constrained resources”.

It wasn’t exactly a ringing endorsement, and the apparent inability of care services minister Paul Burstow on Radio 4′s PM programme on the same day to give a commitment to reform before the next election (as he had previously done) was similarly reticent.  The proposed timetable for next steps has also been pushed back and proposals will not now be published until ‘next spring’.  Despite this, Lansley reiterated to the House that “it remains our intention to legislate (…) at the earliest opportunity.” In the interim there is to be ‘work with stakeholders’ beginning in the autumn. 

There will be much criticism about the lack of urgency and yet further consultation and debate. Perhaps the government is concerned that it must get any reforms in this area absolutely right, particularly in view of the recent disastrous experience with the Health and Social Care Bill and the mishandling of process resulting in review and back-pedalling. A repetition of that situation would not simply be inept but seriously damaging to reform. 

A less optimistic interpretation must be that already the government is preparing to water down its commitment to reform and is insufficiently convinced that the electorate will support such change. 

No one who reads the Dilnot report can imagine that the status quo is an option.  Doing nothing is not even good economic sense – the current broken system will continue to be costly and the gap between the funding going into support and what is needed will widen. It is impossible to introduce reform without cost, but the Dilnot analysis is economically grounded and actuarially sound.

It was clear 12 years ago that the prospect of introducing ‘free personal care’, then proposed by the Royal Commission on Long-term Care, was never going to get off the blocks – if it couldn’t gain a foothold in those halcyon days, it certainly would have no hope in these straightened times. However, there are still arguments about whether the risk of needing long-term care should be shared more broadly across the entire population, rather than falling solely on those people who need care and support (albeit that they would be protected from catastrophic costs under the Dilnot vision).

Ed Miliband has offered to put politics aside in order to work with the government to try and establish a way forward.  This is undoubtedly what is required if progress is to be made but the failed attempts to do something similar prior to the last election underline how difficult it is in practice to remove party politics from an issue that has historically been so divisive. There is no quick fix or magic bullet solution to these complex and emotionally loaded issues. If there were, then the question would have been resolved long ago instead of being the perpetual unfinished business it has become for successive administrations.

The Dilnot solution offers a practical and manageable model.  It is not a perfect solution – it leaves big questions of wider health and care integration largely untouched (but that was not within its brief). What it would do is provide a solution that recognises shared responsibility, protects people in greatest need and limits the liability of everyone to a maximum £35,000.  No one would need to view the future in fear and uncertainty or face the distress of losing everything they had worked for over the years.

Importantly, in resolving uncertainty the proposals would also see the emergence of new financial products and insurance which could further reduce individual liability and bring additional funding into the system. The Dilnot proposals are a compromise, but a realistic and compelling one. The challenge now is to government – and to parliament more widely – is to cease procrastinating, engage with this agenda and bring forward reform as a matter of urgency.

About Mithran Samuel

Mithran Samuel is adults' editor at Community Care.


One Response to Dilnot is not perfect but ministers should get on with implementing it

  1. country boy 12 April , 2013 at 1:03 am #

    Care, is obviously a complicated process. On this point I believe we would all agree. Having
    so many and different actions associated with it again, it will be impossible to please every one concerned in the process, including those expressing their respective wants or ‘needs’ as they see them. Coupled to this, there is what has been described as the ‘Big Picture’ – aptly
    named, nevertheless ill considered.

    Let us forget the ‘educated approach’ for a moment, and sit back and think a little common-sense.

    If there is a problem with your car, do you ‘phone the garage and say, “My car won’t start will you fix it?” Or would you prefer to
    establish what the problem is, and enquire re’ the cost of its repair?

    Care associated with Health & Social wellbeing is no different. Parts of the NHS work very well
    and there is no need to consider any change until
    the ineffective parts of the service have been

    At present, it is obvious changes are urgently needed which relate to basic care. Even though issues have been raised recently [and frequently
    over the not too distant past] nothing has been proposed/suggested to confront the problems.

    To improve things, £bn’s have been expressed for the need to put things right. Perhaps I miss the point. How can you put something right when you don’t know what the problem is, or its cause? To put a price on it under such circumstances is to [again] throw money at something which has little hope of being realised.

    There are ways to improve care – see Ovretveit – Evaluating Health Interventions].

    Of course, there is always the cost of the service to be considered. This will depend on the ability of those responsible for its application, to provide a service which will meet the needs of all those involved in it.

    With reference to the above, I see no reason why
    care should not be free at the point of need.

    C’mon guy’s, use your imagination!