Fairer Funding for All – Andrew Dilnot’s report on social care costs from 2011 – was a prime example of an independent report that impeccably answered the question set for it by the government.
But it is not, and never was, a report focused on improving the care system.
The Dilnot Report addressed a specific issue: how to protect people from catastrophic care costs. Or, as Tony Blair would have put it, to ensure we don’t live in a country where people have to sell their homes to pay for care. And its solution was to use taxpayer funds to cap the amount anyone – regardless of wealth – would have to pay.
As the Casey Commission begins its work, we need to be clear-eyed about the limitations of its predecessor Commission: limits imposed upon it by the government of the day.
Social care faces many other challenges, arguably much more deserving of scarce taxpayer funds than sheltering the assets of the wealthy. How do we make the current, threadbare, means-tested system financially sustainable (a step Andrew Dilnot himself has consistently emphasised)? How do we build on it so we can better support growing numbers of people in need, particularly working-age adults? How do we increase social care capacity in high-demand, poorer areas reliant on publicly-funded services – an issue closely tied to immigration and pay in the sector? How do we create viable careers in social care? How do we better integrate social care with NHS services? How do we stabilise the provider market, and encourage innovation in delivery? How do we commission social care services for the long-term? How do we build more homes for older people?
These questions, and more, were outside the Dilnot Report’s scope. But unhappily for those who wish to make progress, implementing the Dilnot Report has become the litmus test of whether a political party is serious about social care reform, to the exclusion of all other aspects. And without limitless funds, parties gravitate solely towards this safest option.
This is the trap the Dilnot Report has inadvertently set for politicians. If they focus taxpayer resources on services rather than asset protection – as Theresa May did in her 2017 manifesto – they face extraordinary political jeopardy. And so, to avoid this, the parties advocate a Dilnot cap or similar asset protection measure as the solution to the social care crisis – as they all did in the 2024 General Election.
History shows that such a position cannot hold indefinitely in government, as the Labour Party discovered three weeks after last year’s General Election. And yes, this is mainly because of the Treasury – but the Treasury is not the wildly nefarious actor so many believe it to be. Although the Treasury’s myopia and optimism bias lead it to believe the current system is adequately funded (despite requiring emergency bailouts every year), it does recognise the impact of long-term underfunding of social care, particularly on the NHS. And this is precisely why it argues doggedly that using scarce public funds for a Dilnot cap rather than for actual social care services is absurd. This argument has prevailed three times in the last 10 years, and it would be madness to go round this loop again.
What politicians desperately need to escape this straitjacket is a resetting of the terms of the debate – so that prioritising services for funding does not leave them vulnerable to care costs being weaponised against them. The Casey Commission could provide a valuable service by crystallising the full range of challenges facing social care, beyond just catastrophic costs, and ideally securing cross-party consensus on the order in which these problems should be tackled.
Achieving consensus on the problems in this way may be an ambitious goal, but it is a plausible one (and seems to be implied in the Commission’s terms of reference). It is certainly far more plausible than achieving a political consensus on the solutions, given the philosophical divide: some view social care as a private, family matter (albeit requiring a safety net for the vulnerable), while others believe it should be fully state-funded and state-provided based on need, not ability to pay. These are irreconcilable positions with no compromise position to be found.
And it is ultimately right that political parties should vigorously debate the solutions to this issue: it is what they are for. But they have to be helped to do so in an informed environment in which we all have a shared view of what the ladder of problems is. Then the electorate can see how far up the ladder each political party is willing to go, and how they expect us to pay.
Because the challenge is not just protecting people from catastrophic care costs – the only challenge put to Andrew Dilnot, and which he answered so well. The challenges are so much more numerous and so much more pressing. And perhaps Louise Casey can help us all make progress by illuminating what they are, and the path we need to take.
Bill Morgan – Member of the Social Care Foundation Advisory Board, and former adviser to the Prime Minister on health and social care.
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