'Fairer care funding', or the 'Dilnot Report'

In July 2010, following a commitment by the coalition government in Our programme for government, the independent Commission on Funding of Care and Support, chaired by Andrew Dilnot, was set up to consider the issue of sustainable long-term funding for the social care system. The other two commissioners were former health minister Lord Warner and the former chair of the Care Quality Commission, Dame Jo Williams. The commission reported back in July 2011.

The commission published its recommendations for a reformed social care system in Fairer care funding (or the Dilnot report).

Dilnot concluded that the adult social care system was not fit for purpose and required more funding – both from individuals and the state – for it to be sustainable. The report further found that the system was confusing, unfair and unsustainable. As a result, 'bad' user experiences were occurring and rising care costs, alongside limited financial support, had caused anxiety and uncertainty for users. The report highlighted the need to find a fairer way of sharing the costs and responsibilities for the provision of adult social care services.

Recommendations

Dilnot recommended the following:

• there should be a cap on lifetime contributions of an individual at an amount between £25,000–50,000. The figure of £35,000 was considered a fair amount. The intention was to protect users from 'extreme' care costs. If costs exceeded the cap, then full support from the state should be available
• means-tested support for people of lower incomes should continue
• the asset threshold for those in residential care should increase from £22,500 to £100,000. However, people in residential care should contribute a standard amount for general living costs, such as food and accommodation. An estimated figure was between £7,000–10,000 per year
• those who are born with a disability or develop a care need before adulthood should be automatically entitled to financial support for their care and support from the state
• the provision of universal disability benefits should continue
• eligibility criteria for care support should be standardised nationally, with an objective eligibility and assessment framework
• the government should undertake an awareness campaign to encourage people to plan ahead for future possible care needs
• the government should develop a new information strategy to improve the clarity and utility of information for users and carers. Dilnot recommended imposing a statutory duty on local authorities to provide information, advice and assistance
• there should be improved assessments to review the impact of caring responsibilities on individuals. The government should review the possibility of greater and more effective integration between adult social services and other services
• universal benefits, such as attendance allowance, should be realigned to the social care system and the purposes of such benefits should be made clearer.

Funding

Dilnot estimated that his recommended changes to the funding arrangements for adult social care would require additional government expenditure of £1.1bn, if the cap was set at £50,000, with a service user contribution of £7,000 towards personal living costs. The additional funding required would be £2.2bn if the cap was £25,000, with the same contribution of £7,000 towards living costs.

Reaction

The Dilnot recommendations polarised opinion. Organisations such as the Association of Directors of Adult Social Services (ADASS) welcomed the recommendations 'without reservation', claiming that the report was a move towards enabling the social care system to become 'fit for purpose in the twenty-first century'. However, the government's initial response was cautious: Health Secretary Andrew Lansley thanked Dilnot for the contribution in the House of Commons, but held back from committing to the recommendations, describing them as the 'basis for engagement'.

The Care Act 2014 legislated for many of the Dilnot Commission's recommendations, including the principle of a cap on care costs. However, although the government originally planned to introduce a cap set at £72,000 from April 2016, it announced delays to implementation in 2015 and, ultimately, plans for a cap were scrapped.