Nationwide consultation suggests that individuals will help pay for a fairer, clearer long-term care system

The Caring Choices initiative was run by a coalition of 15 organisations (see below) with an interest in the long-term care system, led by the King’s Fund, Joseph Rowntree Foundation, Help the Aged and Age Concern. Born out of widespread and growing concern that the current system is unsustainable, it encouraged and facilitated debate across England and Scotland and through a series of events and an interactive website.

Five areas of broad agreement emerged from the events and a survey completed by event participants and web visitors:

• The present system of funding long-term care is not fit for purpose. People receiving and providing care alike thought the system was unclear and unfair. In particular they disliked the ‘postcode lottery’ giving very different entitlements to people in different areas and the high degree of means-testing that seems to penalise people who have made provision for their old age.
• More money will be required to meet growing need. Between 2002 and 2026, the number of older people requiring care is likely to rise by 50 per cent, and costs per head will also rise. Unless the Government increases its own contribution, the extra costs will fall on care users. Already today, some people needing care are not getting the help they need, as local authorities short of cash focus only on those with the most critical conditions.
• There should be a universal element of long-term care funding. Nine in ten participants supported a system where everyone gets some contribution from the state. Many participants argued for a baseline entitlement available to everyone with care needs, regardless of their income and wealth.
• Funding of long-term care should be shared between the state and individuals. Only one in five participants believed that personal care should be funded 100% by the state. Most favoured a system of ‘co-payments’ whereby a care package is paid for mainly by the state but with a fixed percentage contribution from the user.
• Better support for unpaid carers is crucial. There was strong resentment about the lack of support for unpaid family carers. Carers and care users emphasised that any effective settlement for long-term care funding needs to involve more generous funding of items such as respite care and Carer’s Allowance.

Other areas of debate were much more contested, generating different views on the best options for the future. These included how far state support should be limited to ‘personal’ care (help with bathing, eating, going to the toilet etc) as opposed to wider social care or measures that could prevent or slow down dependency; the role of benefits such as Attendance Allowance; and how far Government should provide help to individuals to enable them to pay their share of care costs, through schemes such as long-term care insurance and equity release. These issues require careful consideration and, ultimately, difficult decisions will have to be made.

Caring Choices does not claim to be a representative survey of public opinion, but it does provide a valuable indication of the thinking of people with a stake in the care system. The conclusions will be fed into the forthcoming Government consultation and Green Paper on the funding of adult social care in England, announced in last year’s Comprehensive Spending Review4 which acknowledged that major reforms to care funding are likely to be needed.

Niall Dickson, Chief Executive of the King’s Fund, said:

“We are at a critical point - in what could be the most important policy shift in this area for many years, the Government accepted in the recent Comprehensive Spending Review that the current long-term care system needs to be reformed. Opposition politicians appear to be of a similar view. I hope the forthcoming Government consultation will draw on the Caring Choices initiative - and the major King’s Fund and Joseph Rowntree reviews before it - to help us finally achieve the fair, effective and affordable system that is so necessary.”

Julia Unwin, Director of the Joseph Rowntree Foundation, said:

“This initiative has produced important new evidence on what kind of funding system will gain the confidence of those most closely involved with long-term care. It shows that people yearn for greater clarity about their entitlements: whichever system we have should do what it says on the tin. At present many older people and carers feel unsupported by a system that too often seems to be working against them, rather than giving them essential support at a time of their life when they are at their most vulnerable.”

Paul Cann, Director of Policy for Help the Aged, said:

“The sad reality is that our care system can’t be relied on to care. Far too often when faced with a life-changing decision after a sudden crisis, people find themselves in the dark with limited choice. Inadequate funding means quality is often unacceptably low. The challenge for Government is a big one – but the steps along the way are achievable if the social care of older people is made a top priority. This issue must be brought into the open and treated with the severity it deserves.”

Age Concern England, Director General Gordon Lishman said:

“The way older people and their families are treated by the care system is a national disgrace. Most people don’t expect the government to pay for everything but they do expect it to make a fairer contribution. More money - from whatever source - will not on its own deliver better results. Older people and their families urgently need a reformed care system that provides good quality support when and where it is required.”