Dilnot Commission calls for national eligibility criteria in adult care reforms

National eligibility criteria and portable assessments should be introduced to ensure greater consistency and fairness in adult social care, the Dilnot Commission on Funding of Care and Support has recommended.

In its Fairer Care Funding report, the Commission also called for the government urgently to develop a new, more objective assessment scale as the basis for the future system.

The report said the current adult social care system was not fit for purpose and needed urgent and lasting reform. Its other key recommendations include that:

• Individuals’ lifetime contributions towards their social care costs – which are currently potentially unlimited – should be capped. After the cap is reached, individuals would be eligible for full state support. The Commission said the cap should be between £25,000 and £50,000, but it considered that £35,000 was the “most appropriate and fair” figure;
• The means-tested threshold, above which people are liable for their full care costs, should be increased from £23,250 to £100,000;
• All those who enter adulthood with a care and support need should be eligible for free state support immediately rather than being subjected to a means test;
• Universal disability benefits for people of all ages should continue as now. The government should consider how better to align benefits with the reformed social care funding system. Attendance Allowance should be re-branded to clarify its purpose;
• People should contribute a standard amount to cover their general living costs, such as food and accommodation, in residential care. A figure in the range of £7,000 to £10,000 a year would be appropriate;
• In the short term, it is reasonable for a minimum eligibility threshold to be set nationally at ‘substantial’ under the current system;
• To encourage people to plan ahead for their later life, the government should invest in an awareness campaign;
• The government should develop a major new information and advice strategy to help when care needs arise. This should be produced in partnership with charities, local government and the financial services sector. The Commission backed the Law Commission’s proposal for a statutory duty placed on local authorities to provide information, advice and assistance services in their areas. “These should be available to all people, irrespective of how their care is funded or provided”;
• Carers should be supported by improved assessments which take place alongside the assessment of the person being cared for and which aim to ensure that the impact on the carer is manageable and sustainable. The Commission supported the Law Commission’s proposals to give carers new legal rights to services and improve carers’ assessments; and
• In reforming the funding of social care, the government should review the scope for improving the integration of adult social care with other services in the wider care and support system. “In particular, we believe it is important that there is improved integration of health and social care in order to deliver better outcomes for individuals and value for money from the state.”

The report urged the government both to implement its reforms and ensure there is sufficient, and sustainable, funding for local authorities. “Local authorities will need to be able to manage existing pressures as well as the new requirements resulting from our reforms,” it warned.

“The Commission recognises the government’s commitment to social care in the latest spending review settlement; however, the impact of the wider local government settlement appears to have meant that the additional resources have not found their way to social care budgets in some areas,” the report said.

It added that the resources made available locally for adult social care each year should be transparent. Any periodic review of local government financing should also have regard to the importance of the sustainability of funding for adult social care.

The Commission, led by economist Andrew Dilnot, said its proposals would cost the state around £1.7bn. The report also calculated that no individual would lose more than 30% of their assets, and predicted that new financial services products would emerge to offer people further protection of their assets.

In a letter to the Chancellor of the Exchequer and the Health Secretary, Dilnot argued that extra state resources would be required in this area if greater private resources were to be unlocked.

“Without the state taking on some of the risk, individuals will be unable to use their assets effectively and the involvement of the financial services sector will remain limited,” he said.

The report outlined how demand for social care is significantly outpacing expenditure, with the gap increasing year on year. Dilnot said the issue of funding for adult social care had been ignored for too long.

“We should be celebrating the fact we are living longer and that younger people with disabilities are leading more independent lives than ever before,” he said. “But instead we talk about the ‘burden of ageing’ and individuals are living in fear, worrying about meeting their care costs.

“The current system is confusing, unfair and unsustainable. People can’t protect themselves against the risk of very high care costs and risk losing all their assets, including their house. This problem will only get worse if left as it is, with the most vulnerable in our society being the ones to suffer.”

Dilnot claimed that under the Commission’s proposed system everybody who gets free support from the state now would continue to do so and everybody else would be better off.

“Putting a limit on the maximum lifetime costs people may face will allow them to plan ahead for how they wish to meet these costs,” he argued. “By protecting a larger amount of people’s assets they need no longer fear losing everything.”

A copy of the full report can be downloaded here.

Philip Hoult