Scrapping the cap on care costs is “another example of social care being tossed aside”, according to the architect of the reforms.
Economist Sir Andrew Dilnot told BBC Radio 4’s Today programme that the government’s decision meant that society had “failed another generation of families”.
A commission led by Dilnot, which reported in 2011, drew up proposals to insure people against very high costs for their social care, including two key elements:
- A cap on their lifetime liabilities for personal care, after which these costs would be picked up by the state.
- A much more generous system of means-testing, enabling people with assets of up to £100,000 to receive some state-funded care, up from £23,250.
While successive governments have agreed to implement a version of the reforms, they have then either ditched or delayed them.
Reversal of election commitment
During the election campaign, the now health and social care secretary Wes Streeting said that the Labour Party was committed to implementing the changes – slated for commencement in October 2025 by its Conservative predecessor – because he wanted to give the sector “certainty” about the future.
However, this week chancellor Rachel Reeves cancelled the policy, which would have set an £86,000 cap on personal care costs, in order to save £1.1bn by the end of 2025-26. This was so the government could deal with what she said was a significant unexpected overspend on government expenditure left by its predecessor, a view rejected by the Tories.
Following Reeves’ announcement, Dilnot told Today: “I think it’s a tragedy and it’s also very disappointing given what was said in the election campaign.”
Social care being ‘tossed aside’
He added: “To rip this up is unbelievably disappointing for hundreds of thousands of families who need care, for the people who are providing it, for those who are trying to make decisions about it. It’s another example of social care – something that affects people at some of the most difficult points in their lives – being given too little attention, being ignored and being tossed aside.”
According to an impact assessment published in 2022, around one in seven older people will face personal care costs in excess of £100,000 during their lifetime. Illustrating the benefits of the proposals, the assessment said that:
- A person with £145,000 in chargeable assets and an income of £239 per week could deplete 84% of their assets after five years in residential care under the current system, whereas under the reforms, this would drop to 57%, a saving of £40,000.
- A person with £55,000 in chargeable assets and the same income could deplete 57% of their assets after three years’ domiciliary care under the current system, compared with 30% under the reforms, a saving of £15,000.
‘We have failed another generation’
“We have to recognise that we have failed another generation of families,” Dilnot told Today. “[Funding social care] is something that we truly can’t all do on our own, we do it much better together, like we do with the National Health Service.”
He also rejected the idea that the proposal was expensive, adding that the saving made by Reeves in cancelling the reforms was worth 1/1000th of annual public spending.
“So, the arguments for action for the government here are really powerful, the cost of acting is not great and the transformation of lives of those who need care, their families and those who are providing it are transformative,” he added. “I really hope that after this blip we get back to a serious plan.”
Decision ‘pushes care burden onto individuals’
Charities also voiced disappointment about the impact on older people and their families of the government’s decision.
Emily Hindle, policy manager at Alzheimer’s Society, said: “We are very disappointed at the UK government’s decision not to proceed with the cap on social care costs in England.
“While we appreciate the financial challenge the new government faces, this decision pushes the burden onto individuals who pay around £100,000 for care on average when they are already dealing with dementia’s devastation on their lives.”
For Age UK, charity director Caroline Abrahams said that the decision was “really bad news for all those older people who were hoping against hope for some relief from their sky-high care bills – in the short term at least it seems they are on their own”.
She said the government needed to tackle this issue as “part of a broader package of measures designed to stabilise and reform social care – and sooner rather than later”.
‘No plan to address core issue in adult social care’
Think-tank the King’s Fund said the decision was regrettable and meant that the government had “no plan to address the core issue in adult social care –the growing mismatch between the population’s need for support, and the availability of publicly funded care”.
Its chief executive, Sarah Woolnough, referred to Labour’s commitment in its election manifesto to build a cross-party consensus to reform adult social care, saying that the party needed to “work at pace to deliver it”.
Her equivalent at fellow think-tank the Nuffield Trust, Thea Stein, cited the fact that, under the Conservatives, the charging reforms were delayed in order to plough the allocated funding into meeting day-to-day spending pressures on social care.
“We urgently need to move social care reform from being tomorrow’s aspiration to being today’s priority,” she said. “Care users and their families are feeling the effects of this right now, and the new government needs to make a statement about their intention to improve this dire situation.”
Reforms ‘unfunded’ and ‘ignored disabled people’
The Voluntary Organisations Disability Group, which represents providers of services to disabled people, was more sanguine about the government’s decision, saying the reforms were unfunded and “ignored millions of disabled people drawing on social care” because of their focus on older people.
However, its chief executive, Rhidian Hughes said: “That said, the pressures of increasing unmet need are not going away, and an urgent solution is vital for state-funded social care and support…We need government reform with a significant focus on improving commissioning coupled with an injection of funding to address the growing funding gap.”
The County Councils Network (CCN), which had lobbied for the reforms to be delayed again, said that implementing the reforms in October 2025 “could have had some catastrophic consequences for council finances, health and care systems and individuals who currently receive services”.
Shortages of social workers to implement changes
This was both because of the lack of funding allocated to the reforms, but also the “acute workforce and system pressures” facing councils, said its adult social care spokesperson, Martin Tett.
Analysis by the consultancy Newton for the CCN found that authorities would have needed an additional 4,443 social work staff to implement the reforms – all things being equal – because of the many thousand additional assessments, care plans and reviews required for existing self-funders entering the system.
Tett added: “We must remember that reform to social care encompasses much more than charging reform. We want to work with this government on other key reform agendas, such as addressing the recruitment and retention crisis in the care workforce and on ensuring the day-to-day care services are sustainability funded and reformed in the long run.”
‘Doing nothing comes at a cost’
For the Association of Directors of Adult Social Services (ADASS), president Melanie Williams said: “We are of course disappointed that government has decided not to proceed with charging reform, in particular those changes that would have supported people with the least means to access state-funded care and support. However, the absence of allocated funding for the reforms and sufficient time to deliver them by October 2025, is why we previously called for the timeline for delivery to be reviewed.
“Whilst it is clear that any reform of adult social care will be at a cost to the Treasury, it should not be forgotten that continuing along the same path that we are on also comes at a cost, not only in monetary terms, but most importantly to the lives of people who draw on care and support, their carers and family not able to access the care and support they are need to live the lives they want.”
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all well and fine in theory. Practical wisdom is a gift not many have.
So where the money is going to come from?
No government of any political persuasion will tackle this because they are all wedded to the idea of private equity providers being the best option. They can’t cap the level because they know that when dividend payments are paramount and public providers practically non-existent those companies can raise fees safe with n the knowledge that governments will bridge shortfalls. Dilnot ducked that too. King’s Fund almost say it but doesn’t follow through. Don’t tackle the fundamentals and end up with fudges and broken promises.
When I am old and need care I will not begrudge paying the wages of a carer to provide it in the way I wish. I hear so many families every day referring to this money as “My inheritance” it makes me sick. That money is there for the person’s retirement and care and lets face it if they are left to Adult social care funding they will not be getting nearly enough care, it will be rushed and sub-standard and they will probably have little to no choice over timings. I for one will be spending every pound of my parents money on the care they need and deserve. There simply isn’t enough money left in the social pot to provide quality care to anyone so everyone gets sub-standard care, care workers have no time to spend with people and basic needs are not met. A care cap was always a pipe dream, and would have been impossible to implement. Carers are already underpaid and undervalued putting more pressure on the Adult social Care system would simply lead to more pressure on care companies to charge less, pay their carers less and put more pressure on them.
The key problem is an almost completely privatised care system which puts profits first.
I agree there is a need to reform Social Care but I am sceptical this was going to be the answer especially given those suggesting this reform would benefit the most as have that higher level of income/savings.
There was a focus too much again on wealthy classes rather than the substantial amount of people on lower incomes who need support.
I do still believe if have the money should pay for own social care. There could be other ways of addressing the situation which would impact those people on lower incomes, benefits as many wont have support as they cannot afford it, in terms of contribution levels, what benefits are taken into account, the percentage taken this has increased significantly.
The infrastructure is and was never going to be in place to implement it, pie in the sky really.
A brave government would fundamentally restructure services so private providers were minority providers rather than as they are now dominating the market. A less brave government would introduce a cap on dividend payments and tax offshore hedge funds too. A Labour government in name only will do neither not because they are not brave but because they believe in private provision, unfettered, of social and health care. This is the government that seriously considered bringing Alan Milburn back. Don’t bet against Milburn coming back in the second year of the government when the public have been softened
and resigned to whole scale privatisation of public services.
I agree that time for tinkering on the edges of what is a broken service is long gone. Milburn is a keen advocate for insurance funded health care so irrespective of whether Labour give him a governmental role he will no doubt be advising them on policy in the background. It would not surprise me if a care levy was introduced to be deducted from earnings similar to National Insurance. That doesn’t solve the current challenges but it would enable Reeves to say she is tackling the problem unlike previous Chancellors.
Dilnot proposes insurance based care too. That’s what’s coming and I confidently predict that once we’ve been softened up for that we’ll be told that actually the insurance generated funds are for a top up of care packages and assets, including property, will still be the basis of calculating contributions.
Until the government bites the bullet and taxes the rich ,super rich and big corporations properly and fairly, in other words when these people actually pay their fair share then there will be no fully funded ,efficient public services.