Andy Burnham wants to fix social care - what are the options?
With Andy Burnham saying he wants to bring "substantial change" to social care in England, BBC Verify looks at what could be done.
Prime Minister Andy Burnham has expressed his desire for significant changes to England's social care system, describing its current state as "bad for everybody."
During a speech at a care home on Wednesday, Burnham announced that cross-party discussions, involving the Conservatives and Liberal Democrats, would commence later. He also revealed that he had requested Baroness Casey, who is conducting a review of social care, to expedite her report by a year, with her recommendations now expected in 2027. Burnham confirmed that her review would also address the funding of any proposed reforms.
BBC Verify has examined four potential approaches to reform and their estimated costs.
**1. Capping Lifetime Care Costs**
Many individuals face substantial care expenses in their later years, with an estimated one in seven people aged 65 and over incurring lifetime care costs exceeding £100,000. One suggestion is to cap these costs, with the government covering expenses beyond a specified financial threshold.
In 2011, a commission led by economist Andrew Dilnot proposed a lifetime cap of £35,000. Dilnot estimated his reforms would cost between £1.3bn and £2.2bn annually, a figure that would be higher today due to inflation and an aging population. The Conservative-Liberal Democrat coalition government, under David Cameron, accepted Dilnot's recommendations. However, after the 2015 general election, which resulted in a Conservative majority, Cameron postponed the cap's implementation until 2020, citing pressures on public finances.
In 2017, during Theresa May's premiership, the Conservative general election manifesto proposed an alternative social care reform. This plan would have included the value of an individual's home in the means test for state funding of in-home care. Initially, it did not include a cap on lifetime care costs, with the manifesto arguing this was more "equitable" than the Dilnot plan. Opponents labeled May's plan a "dementia tax," and it was ultimately abandoned.
**2. Raising the Means Test Threshold**
Currently, in England, individuals can qualify for local authority financial support in a residential care home if their total assets, including their home, are valued at less than £23,250. This means test determines the level of financial support based on a person's assets and savings. Some advocate for a significant increase in this threshold to allow more people to qualify for means-tested support.
Boris Johnson's Conservative government in 2021 planned to raise the means test threshold to £100,000. The annual cost of Johnson's reforms was projected to be £1.8bn over three years, with an expected increase over time as more people became eligible. The Johnson government intended to fund this package through a new Health and Social Care levy, but this was later scrapped by his Conservative successors, who prioritized tax reduction.
**3. Free Personal Care at the Point of Use**
An alternative approach is to ensure that all eligible individuals, based on their needs, receive state-funded personal care free at the point of use. This would be provided regardless of an individual's financial means, whether they are elderly people in their own homes or in residential care. Scotland has implemented such a system.
It's important to note that personal care encompasses assistance with activities like washing, dressing, and using the toilet for frail elderly individuals. However, it does not cover accommodation, food, and everyday living costs, which remain subject to means testing. The Health Foundation think tank estimates that implementing a Scottish-style system in England would cost £7.5bn annually by 2036.
Similar to Scotland, Japan and Germany have systems where entitlement to personal social care is primarily based on care needs rather than ability to pay. However, both Japan and Germany utilize a mandatory long-term care insurance system funded by contributions from workers and employers. Additionally, neither country typically covers the full cost of personal care, meaning individuals are responsible for some expenses.
**4. A National Care Service**
Some have suggested the government establish a national care service in England, mirroring the ambition of the NHS. This would entail all personal care being free at the point of use, alongside the establishment of national standards and care entitlement criteria. The Health Foundation estimates that creating a universal and comprehensive social care system in England would incur an additional cost of approximately £19bn annually by 2036.
When Andy Burnham served as health secretary in Gordon Brown's Labour government in 2010, he proposed a plan for a national care service. This was suggested to be funded through a compulsory contribution from people's estates after their death. However, Labour's opponents branded this idea a "death tax." The party lost the 2010 general election, and its proposals did not advance.
In the 2024 general election, Labour again proposed a "national care service" without providing details on its funding. Following the election, then-Prime Minister Keir Starmer effectively deferred the issue by commissioning Louise Casey to investigate social care reform and report back in 2028.
It is worth noting that these four approaches are not mutually exclusive. Previous reform proposals have often combined multiple elements, such as a cap on lifetime costs and a more generous means test.