Care costs in England should be capped, says social care adviser

Care costs should be capped at £45,000 a year in England and more cash ploughed into provision for the poorest in society, according to Sir Andrew Dilnot, who has advised successive Conservative governments on reform.

The measures to bring care funding closer into line with the NHS would cost an extra £3.1bn a year – a 14% increase on councils’ social care budget – Dilnot said in evidence on Tuesday to the House of Commons health and social care committee.

The committee, chaired by the former health secretary Jeremy Hunt, has restarted its inquiry into funding social care and its workforce amid the coronavirus pandemic, during which 20,000 people died in UK care homes from confirmed or suspected cases of Covid-19.

Dilnot proposed a version of reforms in 2011 when he chaired the government’s commission on funding of care and support. But David Cameron and Theresa May failed to enact his recommendations. Boris Johnson said in his first speech as prime minister last July that his government “will fix the crisis in social care once and for all” and at the beginning of this month he said the government was “finalising” its plans.

The committee also heard from care recipients about the “tremendous psychological impact of being charged based on who you are”. They said it cannot be right that care for some conditions is covered by NHS funding and others, like Alzheimer’s disease, must be paid for by the families of those unlucky enough to suffer them.

Uncapped care costs have left families fearing the “catastrophic risk” of losing their assets if a loved one requires long term care, said Dilnot. The current policy of means-testing social care and charging anyone with more than £23,250 in savings was also inadequate and “a stain on us as a nation”, he added and required reform.

“It’s due now,” he told the MPs. “It’s been due for many years … We need to look to the prime minister, to the Treasury and to the wider parts of society and say this is a really, really important challenge for us.”

Dilnot’s plan to cap care costs is just one of several being proposed to reform social care. Another has been advanced by Lord Forsyth of Drumlean, a Conservative peer and campaigner for social care reform, who wants the government to spend £10bn to deliver free personal care. A version of this already applies in Scotland where the system covers the first £200 a week of care costs.

The former cabinet minister chairs the House of Lords economic affairs committee which last year concluded severe underfunding of social care was “a national scandal”.

He told the committee: “I do not understand how it can be right that someone with motor neurone disease is not treated in exactly the same way as someone with cancer.

“The hardship and stress it puts on families is something that I find intolerable. The Treasury must have its dead hand removed from this and get on with what everyone has been saying now for the best part of 20 years and in a situation which everyone thinks has got many times worse.”

Since 2000, Japan has operated an insurance-based system in which citizens only have to pay 10% of care costs at point of use. Yasuhisa Shiozaki, the country’s former minister for health, labour and welfare, told the committee it was used by 5 million people and was “accepted as social infrastructure”.

He said 90% of costs were covered equally by receipts from VAT and insurance premiums, which over-40s have to pay. These premiums increase as people get older and according to income level. They currently stand at about £40 to £50 a month for seniors.

Deborah Gray from Wiltshire, who has to pay £52,000 a year in care home costs for her 68-year old husband, Atherton, who has Alzheimer’s disease, told the committee “the unfairness of the treatment of someone with dementia makes me really, really, angry”.

“If my husband had a tumour the NHS would pay for his care, but because he has dementia it does not,” she said. “He has seizures, he has falls, he is doubly incontinent and he doesn’t recognise his own children. It’s a disease. Dementia is not just a matter of ageing.”

Kevin Caulfield, a senior council officer who has been disabled 22 years after a neurological condition, described the “demeaning” financial assessment process that people with illnesses that were treated by the NHS need not face.

“The underlying message of being a burden, being expensive, are all negative messages,” he said. “These are all issues that disabled people have been raising for 20 years or more.”

The hearing came as Care England, which represents the largest private care providers, warned that “adult social care can no longer remain an addendum to the NHS”.

Prof Martin Green, Care England’s chief executive, said: “The government cannot again invest vast amounts of its organisational capacity into the NHS while neglecting adequate consideration of the adult social care sector. Nor should care providers ever be pressurised to admit untested individuals in order to preserve the structural integrity of the NHS.”