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Paying for social care: Beyond Dilnot

Successive governments have tried hard to find a more sustainable andfairer way of funding adult social care but with limited success. There hasnot always been clarity about the questions to which funding reform is theanswer. The government’s decision to implement the proposals of the Dilnot Commission, now incorporated in the Care Bill currently before parliament,is a significant stepping stone to wider reform, but will not on its own solvethe social care funding challenge.

Who pays for what across health and social care is confusing and incoherent.Reform has been made harder because of the fragmented way the social caresystem has evolved, leaving a system that is criss-crossed with fault linesbetween NHS and local authority social care, private and public funding,and private and public delivery.

The government’s proposals for funding reform are an importantachievement against the odds in a daunting fiscal and economic climate.They establish a symbolic policy milestone – that the government should place a limit on how much people have to pay: the NHS has always offered protection from catastrophic costs in relation to health care, and these extend the same protection to social care. The proposals also make it easier for people to plan ahead.

The combination of a cap on care costs and an extended means test will see more people benefit from public funding. Although the cap is slightly higher than originally proposed by the Dilnot Commission, future governments have the option of lowering it to increase coverage as fiscal circumstances improve.

But implementation of the reforms will be challenging, with high risks of confusion, complexity and complaints; it will involve new roles and substantial extra work for local authorities when they are facing the most severe financial challenge in their history. Without a major and sustained public relations and awareness campaign, there is a real danger that many will see the reforms as a worse alternative to what they perceive as existing now, not as an improvement to the current system.