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4 Jul 2011
John Adams, VODG general secretary

Dilnot: a once-in-a-lifetime opportunity and proof that social care funding is a necessity, not a luxury

The final report of Commission on Funding of Care and Support in England throws down a desperately needed gauntlet to government. Ministers must seize the opportunity to radically reform our woefully inadequate social care system.

The year-long efforts of economist Andrew Dilnot, a methodical and engaging thinker whose commission has gone out of its way to listen to stakeholders to produce a considered, evidence-based report, hands the government the necessary tools with which to fix a threadbare safety net.

Fairer Care Funding, the Dilnot commission report, recommends that individuals’ care bills should be capped at £35,000 – at which stage people would be eligible for full state support. This means thousands of people would no longer have to sell their homes when they go into care. The means-tested threshold, above which people must pay for their full care costs, should be raised from £23,250 to £100,000.Andrew Dilnot

The proposals, based on a £35,000 cap, will cost the state around £1.7bn, so while ministers will welcome the report, they will be reluctant to agree to a cash injection at a time of such austerity.

But there is no better time for reform. In the next two decades, the number of people aged 85 and over is set to double to 2.4m while today, a quarter of those aged 65 can expect to pay care costs of more than £50,000. For one in 10, meanwhile, the bill will be more than £100,000.

It’s not just the pressures of an ageing population that should force the government’s hand. Social care is high on the public agenda. The public is aware of the recent troubles at care home group, Southern Cross and the horrific abuse of learning disabled residents at the Winterbourne View care unit near Bristol.

The Dilnot Commission presents a turning point in social care after successive failed opportunities to rebuild the creaking, 70-year-old system (the 1948 National Assistance Act was designed as support at a time when the recipients of care did not live as long and needed only short-term help.) The 1999 Royal Commission into long-term care for the elderly chaired by Lord Sutherland, for example, unsuccessfully proposed the government pay the entire bill for an individual’s personal care.

Richard Humphries, senior fellow at leading health think tank the King’s Fund, suggests that if the overhauling of social care was a song (See 'Waiting for the Dilnot Commission: Four challenges for change'), it would be The Long and Winding Road by the Beatles: “But if the road is straightening out, it’s likely that there are some steep hills to ascend before the destination is reached.” And as Dilnot has said, (See 'Andrew Dilnot urges tight deadline for reform of care in old age'), “it seems to me that the stakeholder community has had a long time waiting for something to happen. So they have played ball and I think they will expect the government to play ball.”

Playing ball means the government delivering twin planks of reform; acting on Dilnot’s recommendations and those of the Law Commission which call for a legislative shake up. Taken together, the Law Commission and Dilnot provide a coherent and convincing way forward – it’s by far the best shot we have at grasping the nettle of a complex issue that has thwarted previous regimes.

And it is not just about government being courageous; the commission’s recommendations make common sense. As the King’s Fund has argued, the notion that the costs of an ageing population are best met through a partnership between the individual and the state, and through a mixture of funding mechanisms, is not so much radical idea as conventional wisdom.

There are, for example, recommendations for action on the postcode lottery in care and the lack of portability of care (where care packages do not follow the individual if they move from one part of the country to another). These are issues that the VODG has long campaigned on, and that the government needs the bravery to tackle.

Today is about more simply demanding more money – vital though additional funding is - it is about urgent reform of a broken system.

The Dilnot commission has taken great pains to build cross-party consensus; ministers  now need to match the warm rhetoric with which they greeted today’s report with swift action. The government must find the courage to put its money where its mouth is, succeed where previous administrations have failed and exploit what Dilnot himself describes as a “once-in-a-lifetime opportunity” to create a fair and sustainable system of social care.

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