So, a somewhat ‘grey’ budget swiftly followed by ‘black Friday’ has been and gone and it seems we will all have to wait until next summer before we know whether we are any nearer a long term, sustainable solution to providing the care that our ageing population is increasingly going to need.
The question of how to pay for care has generated substantial political, policy, media and campaigning activity over the past 20 years. Successive governments have published several hundred thousand words on the subject in terms of formal consultations and policy papers. Indeed, there have been two independent commissions, three consultations, five White and Green Papers as well as innumerable reports from non-government organisations. And we now await yet another Green paper in the summer of 2018.
So what does the journey so far look like? The following (thanks to the Kings Fund, with a few additions from yours truly) provides a summary…
| Year | Initiative |
| 1996 | Labour Government launches consultation on ‘A new partnership for care in old age’. |
| 1997 | ‘I don’t want (our children) brought up in a country where the only way pensioners can get Long Term Care is by selling their home’ – Tony Blair, addressing the Labour Party Conference. Royal Commission on Long Term Care appointed. |
| 1999 | ‘With Respect to Old Age’ Report of the Royal Commission on Long Term Care (the Sutherland Report) is published |
| 2000 | Government response to Royal Commission rejects proposal for free personal care but agrees to amend means test, introduce free NHS Nursing Care in care homes and invest in new services. |
| 2002 | HM Treasury commissions Sir Derek Wanless to conduct independent review of NHS spending. He recommends a more thorough assessment of social care funding needs, but this is not acted upon. |
| 2005 | Green Paper ‘Independence, Wellbeing and Choice’ sets out new vision for adult social care based on independence, choice and control. Changes ‘will need to be met from existing funds’ over the next 10-15 years. Sir Derek Wanless leads review of future social care spending needs for The Kings Fund. ‘Securing Good Care for Older People’ is published in 2006 and recommends partnership funding model. |
| 2006 | Joseph Rowntree Foundation (JRF) report recommends co-payment funding models in which care costs are split 80/20 between state and individuals, and removal of means testing. White Paper ‘Our Health, our Care, our Say’ builds on 2005 Green paper – no specific funding proposals |
| 2007 | 2007 Spending Review ‘welcomes’ assessments of The Kings Fund and JRF reports and commits to ‘undertake work to look at reform options and consult on a way forward’ |
| 2008 | Government runs six-month public engagement exercise on how social care should be funded |
| 2009 (July) | Green Paper ‘Shaping the Future of Care Together’ marks launch of Big Care Debate |
| 2009 (Oct) | Conservative Government pledges to introduce home protection scheme involving voluntary insurance |
| 2009 (Nov) | Government introduces Bill that would offer free personal care at home for those with highest needs |
| 2010 (Feb) | Informal cross-party talks break down following dispute about compulsory and voluntary approaches – the ‘death tax’ row. |
| 2010 (Mar) | Government publishes White Paper ‘Building the National Care Service’ The Kings Fund publishes review and update of Wanless Report ‘Securing Good Care for More People’. It reiterates care for partnership funding model and proposes a staged, long-term approach to reform |
| 2010 (May) | New coalition government says it ‘understands the urgency of reform’ and commits to establishing an independent commission to review options, including voluntary insurance and partnership models |
| 2010 (June) | Dilnot Commission appointed ‘to make recommendations on how to achieve an affordable and sustainable funding system for care and support.’ |
| 2011 (July) | Report on Dilnot Commission ‘Fairer Care Funding’ published |
| 2011 (Sept – Dec) | Government engages with care and support stakeholders about priorities for reform: commits to White Paper and progress report on funding in the spring |
| 2012 (Jan) | Cross party talks begin |
| 2012 (July) | Cross party talks discontinued. Publication of White Paper ‘Caring for our Future’ Progress report on Funding Reform, and draft Care and Support Bill Government says it is committed to principles of Dilnot proposals if a way can be found to fund them |
| 2013 (Feb) | Government announces introduction of social care funding reforms, including capped cost model from April 2017 |
| 2013 (Mar) | Budget brings forward implementation of capped cost model to 2016 with cap to be set at £72,000 |
| 2013 (May) | Care Bill incorporating clauses to incorporate the Dilnot proposals placed before parliament |
| 2014 (May) | The Care Act, including funding reforms receives royal assent |
| 2014 (Sept) | The Baker Commission recommends a new settlement for health & social care, based on a single Integrated budget and funded through taxation and changes to existing public spending |
| 2015 (July) | The government announces that funding reforms (including capped cost model and reform for means testing) will be postponed until April 2020 |
| 2015 (Nov) | In the Spending Review and Autumn Statement, the government announces extra money for adult social care through an improved Better Care Fund and a new power for councils to levy a special council tax ‘precept’ for social care |
| 2017 (Jan) | Fresh calls for a cross-party approach to health and social care funding from both charities and MPs |
| 2017 (Mar) | The Chancellor announces £2bn extra funding for adult social care over the next three years, and a Green Paper later in the year with proposals ‘to put the system on a more secure and sustainable long-term footing. |
| 2017 (May) | Theresa May unveils ‘difficult but necessary’ measure to pay for elderly care as part of election manifesto. Under the proposals, people needing social care at home would have to pay for it until the value of their assets – including their home – reached a floor of £100,000. Jeremy Hunt confirms that the policy is a rejection of both Dilnot’s cap and the £72,000 limit that was going to be put in place by the Conservatives under David Cameron. The policy is subsequently termed a ‘dementia tax’ by Labour and some of the press resulting in the subsequent introduction of a fresh proposal to include a cap at an unspecified level to be decided at a future point. |
| 2017 (Nov) | The First Secretary of State and Minister for the Cabinet Office, Damian Green, announces that the government will publish a green paper on care and support for older people by summer 2018. The paper will set out plans for how government proposes to improve care and support for older people and tackle the challenge of an ageing population |
Well done if you’ve got this far. The above highlights a long journey of intent (I think) towards a destination that seems as far away as ever. Just when is enough, enough? Despite the inevitable drain on government resources that is and will be Brexit, we all need to put pressure on the government to get the proverbial lawnmower out and deliver a Green Paper that offers up an honest dialogue in respect of transparent, long-term, sustainable, integrated solutions to care funding, not just a short- term focus on means-testing. Furthermore, any solutions tabled must address health and social care, property wealth, and the 6.5 milion largely ignored carers who currently prop up the system. We have been promised a ‘full public consultation’ after the Green Paper… I remain the eternal optimist!