Introduction
1.For many people, help with personal care such as washing, dressing or eating is of crucial importance—because without it, they cannot live independent, dignified or safe lives. People of all ages, with a wide variety of needs, may depend on social care such as this.1 Adult social care can range from weekly attendance at a day centre to a regular visit to help a person prepare and eat their meals to 24-hour care provided in a residential care home. The number of adults of working age who need social care is increasing as medical advances advance life expectancy, although healthy life expectancy lags behind.2 The proportion of adults with care needs increases with age.3
2.However, social care and the mechanisms for funding it are not well understood.4 People are often surprised to learn that, in contrast with health services, social care is not free at the point of delivery—anybody with assets over £14,250 will have to make a contribution, and anybody with assets over £23,250 will have to fund it all themselves until their assets drop to that level.5 People are also often reluctant to think about the possibility that they or their family may need social care in the future, or how they might pay for it.6 It is estimated that 1 in 10 people may face ‘catastrophic’ care costs—of over £100,000—and it is not possible to purchase insurance to protect against this risk.
3.People with assets below the threshold may qualify for free social care. However, even for people below this threshold, not all social care needs are met. In 2014, 85% of older people lived in local authority areas where only ‘critical’ or ‘substantial’7 social care needs were funded, with funding not provided for those deemed to have moderate or low social care needs. The Care Act 2014 has now set a national eligibility threshold at a level where the person’s care and support needs have “a significant impact on their wellbeing”. This is broadly equivalent to the previous ‘substantial’ eligibility band.
4.The demand for social care will continue to increase as the population ages, and as an increasing number of younger people live longer with disabilities. Despite rising demand for social care, public spending on it has fallen in recent years. The number of people paying for their own social care (self-funders) without any assistance from public funding is increasing, and there is also a growing number of people who need care and are not getting it at all—people with unmet care needs. The way in which social care is currently funded also means that the cost burden falls very heavily on some individuals and their families, and not at all on others. There is also clear evidence that some diagnoses are more likely to result in higher needs and therefore disproportionate costs of social care—dementia, for example.
5.There is an urgent need to find sustainable funding for social care—both to increase the funding available for social care, and also to make the system fairer. Failure to do so will undermine the effectiveness of the welcome recent announcement of an uplift in NHS England spending. The Government is preparing a Green Paper on social care for older adults which is expected shortly8. A parallel process is running to address issues relating to social care for working age adults. Separating the issues in this way, and also failing to ensure a joined up or ‘whole systems’ approach to social care reform which takes into account its relationship with the NHS, public health and housing, risks a fragmented approach. Where appropriate, our recommendations consider social care’s wider relationship with other services.
6.Making decisions about the funding of social care is not easy, and numerous previous attempts at implementing reform have failed. Building a political consensus is much more likely to result in real progress, especially in a hung Parliament. We have therefore taken the unusual step in this report of addressing our recommendations to both sides of the political divide, asking that both the Government and the opposition front bench accept them.
7.An equally important step in reforming social care funding is that the public are made fully aware of the issues facing social care, and of the way in which it is currently funded. Decision making about a sustainable way of funding social care should involve the public as well as those who are currently in need of help with social care. Given the importance of public engagement in decision making about this issue, we decided to directly involve members of the wider public—including those who currently use social care—in our inquiry, through a Citizens’ Assembly.
8.A Citizens’ Assembly is a deliberative event, where members of the public from across a range of ages and backgrounds from across the country learn about and consider a subject before reaching agreed conclusions. We are extremely grateful to all those who gave up their time to participate in the Citizens’ Assembly. Its findings are reflected throughout this report.9
9.We also visited Sonnet Care Homes in Braintree in Essex to speak directly to people who use social care and their families, as well as people working in the care sector. The visit provided very useful insights and we are indebted to the staff and residents and families from both care homes for the welcome they extended to us, and for the frankness with which they spoke about their experiences.
10.We received written submissions from a wide range of organisations and are grateful to all those who engaged with our short inquiry in this way. We are particularly grateful to all the individuals who wrote to us sharing their experiences of using social care, and their views on future funding. These responses have been analysed thematically for us by the Parliamentary Office of Science and Technology.10
11.This report begins by setting out the current state of social care. We then present the six principles which we recommend should underpin future decisions about funding social care, and follow this with our specific recommended options. Finally, we discuss the need to consider social care in its wider context, including health, public health and housing, and then we discuss the steps necessary to achieve political and public consensus in this difficult area.
1 Social care is also needed for some children, but is not the subject of this report.
2 Institute for Government, Adult Social Care Performance Tracker, Autumn 2017
3 In the 65–69 age group, 8.2% of people are unable to conduct one or more activity of daily living (ADLs) without help; this rises to 17.6% of the 75–79 age group, and 44% of people aged 85 and over. [Source—PSSRU aggregate model]
4 The King’s Fund and the Health Foundation, A fork in the Road - next steps for social care funding reform, (May 2018)
5 Ibid
7 These are formal categories of need. House of Commons Library Briefing, Adult Social Care Funding (England), (April 2018)
8 Green Papers are consultation documents produced by the Government.The aim of this document is to allow people both inside and outside Parliament to give the department feedback on its policy or legislative proposals.
9 Citizens’ Assembly Report
Published: 27 June 2018