Andrew Dilnot’s proposals for reforming the system of adult social care in England are “fundamentally flawed”, according to a recent report from United for All Ages, a social enterprise which works to increase intergenerational cohesion across Britain.
The report’s authors warn against “sleepwalking” into accepting the recommendations of the Dilnot Commission as if there were no other options, which they feel would have significant negative consequences for both older people and the nation as a whole.
The Dilnot recommendations have proved controversial ever since they were first published in the Fairer Care Report back in July 2011 (a summary of them can be found in a previous IF blog written by Antony Mason). Despite being the subject of widespread debate and criticism, they have attracted significant government support, and it seems likely that they will form the basis of any eventual reform of the care system, although a deadline for when new legislation could be implemented has repeatedly been delayed by ministers.
The United for All Ages report identifies a number of significant flaws with Dilnot’s recommendations, which can be broadly summarised as follows:
- The system of everyone having two separate capped liabilities (one for care costs and another for accommodation costs within care homes) will be extremely complicated to implement.
- The amounts people have to pay under the proposed caps (£32,000 and £10,000 respectively) are still too high for anyone who doesn’t have insurance.
- The proposals effectively prioritise subsidising care costs for wealthier older people, rather than actually injecting new funding into the system.
- Dilnot’s proposals do little to address unmet needs, or how the system will have to expand in the future to cope with increasing demand.
- The proposals rely to a large extent upon people choosing to take out insurance to cover their personal care liabilities – but it seems unlikely people would be willing to do this.
- They suffer from a lack of vision: they say little about how to encourage people to take preventative measures against needing care in the first place, or how to join up health and care services, which would be funded in a totally different way.
- The proposals are socially inequitable; they emphasise protecting the assets (especially housing) of wealthier pensioners at the expense of the general taxpayer.
- No consensus exists on how to fund the Dilnot proposals, which would require at least an additional £2 billion a year from the treasury, during a period of government cutbacks
Addressing the flaws
The main recommendation that this report comes up with to address these flaws is that the government should treat old age care as a public good, and make it fully taxpayer funded. The report argues that not only would this be fairer on older people and their families, but it would also derive practical benefits from enabling the integration of health and care services, saving money for the taxpayer.
This is an interesting solution (which has also been proposed by the National Pensioners Convention, among others). However, it has some significant flaws of its own. Most importantly, an entirely taxpayer-funded care system would be many times more expensive than the Dilnot proposals, and the government has proved reluctant enough to fund them. Our estimates suggest that the annual cost could be as much as £40 billion a year.
A bill of this magnitude would imply a significant new transfer of wealth from the younger generation to the elderly through the tax system. It would probably be met through a combination of three unpalatable scenarios: drastically increasing overall taxation, diverting significant amounts of spending from other areas of the budget towards caring for the elderly, and/or adding a large additional burden to Britain’s national debt. It’s no wonder the government has always baulked at the prospect of going down this route with old age care (especially when the bill is almost certain to go on rising into the foreseeable future).
This debate also comes back, ultimately, to questions of moral responsibility. United for All Ages argues that no one knows if they are going to need old age care, just as no one knows if they are going to become ill or not, so citizens should be covered by the same social safety net which looks after people when they are ill.
This seems reasonable, but on the other hand, you could also argue that people have some kind of responsibility for how long they are going to live, so would it be right for people who need care to have it funded by others who might not live as long as they do? The fact that life expectancy and health in old age both tend to correlate with wealth only muddies this moral argument further.
Ultimately, the Dilnot proposals definitely have their flaws, but a fully taxpayer-funded care service is clearly not on the cards. We desperately need a more equitable solution to the growing problem of old age care, and the Dilnot proposals do at least offer one way forward. Perhaps the best you can say for them is that they still seem to be the least bad solution, for now.