There has been concern about the system of publicly funded social care in England for over 20 years. Written by Simon Bottery, Michael Varrow, Ruth Thorlby, and Dan Wellings, a new joint report from the Health Foundation and the King’s Fund provides extensive analysis of social care funding pressures and options for change. A Fork in the Road: Next Steps for Social Care Funding Reform pulls together new financial modelling, public perceptions work and policy analysis to identify the problems with adult social care in England and outline options for its reform.
The report argues that additional revenue will need to be raised for adult social care services even without a major change in the model of delivery. Social care is facing high growth in demand, which is projected to rise by around £12bn by 2030/31, growing at an average rate of 3.7% a year. At the same time, it projects growth in spending on social care of just 2.1% a year. This would leave a funding gap of £1.5 billion in 2020/21 and £6 billion by 2030/31, at current prices.
The key findings of the report are as follows:
- Maintaining the current system, which sees fewer people receiving publicly-funded care every year, will lead to a funding gap of £6 billion by 2030/31.
- Returning access to pre-austerity (2009/10) levels would increase this gap to £15 billion. More fundamental reforms, whilst still expensive, would cost less than that and would offer the chance of a fairer and less complex system, providing support to more people.
- Implementing a ‘cap and floor’ model similar to the Conservative Party proposal at the 2017 general election would cost an extra £12 billion, whilst introducing free personal care for all older people with needs above the current threshold would increase the funding gap to £14 billion.
- Public perceptions findings from the National Centre for Social Research’s British Social Attitudes survey reveal extremely low understanding of how social care operates, with 34% believing the Government pays. When asked who should fund social care, 41% felt it should be entirely tax-funded.
- With taxation the most likely option for boosting social care funding, the findings of separate deliberative work carried out by Ipsos Mori show most people would prefer a dedicated tax to stop the money being diverted elsewhere. Options that include the possibility of people selling their homes to cover care costs, as exists now, were found to be deeply unpopular.
The report concludes that although sustaining the current system will be expensive, wider reform might cost even more but may be better value. ‘Doing nothing’ is not a safe option and is no longer the easiest one. Demographic pressures, growing public concern and a system at ‘tipping point’ all mean action is politically essential. To support reform, people need a better understanding of the problems, but the authors argue that politicians are not best placed to provide it. Instead, a coalition of organisations, with cross-party support where possible, is required.
Anita Charlesworth, Director of Research and Economics at the Health Foundation, said:
“We have reached a fork in the road and reforming social care is now urgent. Despite the obvious challenges, the Government’s green paper must build wide consensus on which direction reform should take, and lead to real progress and improvement. More and more vulnerable people will suffer if bold action is not taken to sustain this vital public service.”
Simon Bottery, Senior Fellow at The King’s Fund, said:
“The case for change is overwhelming – patching up the current system would be costly and would not tackle its fundamental flaws. As the Government prepares its forthcoming Green Paper, at least two alternatives should be on the table – a better means-tested system and one offering free personal care, which would cost similar amounts to implement. However, there is no silver bullet – the road to reform will be difficult and costly, whichever option is chosen.”