Intended for healthcare professionals


Consider funding social care like the NHS, say policy experts

BMJ 2018; 361 doi: (Published 15 May 2018) Cite this as: BMJ 2018;361:k2159
  1. Gareth Iacobucci
  1. The BMJ

Long overdue reforms to social care in England should create either a better means tested system or one that is more like the NHS by being free at the point of use for those who need it, policy experts have advised.

In a joint report1 analysing options for changing the way social care is funded, the Health Foundation and the King’s Fund say that England is now at a clear “fork in the road” with regards to how to reform the sector.

Noting the lack of progress on reform from the current government, it says that ministers must not shirk big decisions in the upcoming social care green paper, published this summer. It acknowledges that all options for reform will be financially costly, but says the government must seek consensus quickly and assess all viable options.

If no changes are made to the current system, the report estimates that the funding gap in the sector will reach £6bn (€6.83bn; $8.1bn) by 2030-31. This figure would increase to £15bn if levels of access and quality last seen in 2009-10, before the current period of austerity, were restored.

The authors also identify substantial cost increases that will arise from enacting fundamental reforms. For example, introducing free personal care for all older people with needs above the current threshold would cost an additional £14bn. And implementing a cap on the lifetime costs of care to protect people from having to sell their homes would require an extra £12bn.

They also highlight that demand for both health and social care will rise dramatically over the next 30 years, with the population over 75 set to double over the course of this period.

Under the current system, only people with assets below £23 250 qualify for any publicly funded social care. But the report notes the low public understanding of how the system operates, with 34% of respondents in the British Social Attitudes Survey believing the government pays for social care. Once people were made more aware of how the current system actually works, the report notes “a strong feeling that what is currently in place is not fit for purpose and needs to change.” This was particularly true with regards to the notion of people selling their homes to cover care costs.

Anita Charlesworth, director of research and economics at the Health Foundation, said, “Reforming social care is now urgent. Despite the obvious challenges, the government’s green paper must build wide consensus on which direction reform should take, and lead to real progress and improvement. More and more vulnerable people will suffer if bold action is not taken to sustain this vital public service.”

Simon Bottery, senior fellow at the King’s Fund, said, “The case for change is overwhelming—patching up the current system would be costly and would not tackle its fundamental flaws. As the government prepares its forthcoming green paper, at least two alternatives should be on the table—a better means tested system and one offering free personal care, which would cost similar amounts to implement. However, there is no silver bullet, the road to reform will be difficult and costly, whichever option is chosen.”


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