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Ten Reminders Why Dilnot's Cap On Care Costs Won't Solve Care Crisis

31/03/2017 11:41
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Back in 2010 the coalition government asked Andrew Dilnot to lead a commission on care funding. He duly reported in 2011 with his proposals including a cap on the cost of care.

The government - rightly in my opinion - then in 2015 decided not to implement the cap, set at £72,000, and 'postponed' its implementation until 2020.

Now the government is to publish a green paper on care this autumn. Some are suggesting that this is an opportunity to revisit the Dilnot proposal for a cap on care costs.

Here are ten reasons why this would be a bad move:

1. Would the cap make the care system easier and simpler?

No. It would make the current complex care system even more complicated - with two caps, a confusing means test, new eligibility criteria, qualifying care and multiple assessments.

2. Would the cap prevent older people having to sell their homes?

No. The £72,000 proposed cap would be on qualifying care costs only. In addition older people living in care homes would face large bills for the so-called 'hotel' costs eg food, accommodation, daily living expenses, plus any top-ups for care costs. An older person would probably have to live in a care home for five years before reaching the cap (the average stay is just over a year). So older people could be faced with bills of £200,000 plus for all their costs and still have to sell their home - either while alive or after death to fund a deferred payment.

3. Would the cap tackle underfunding and improve care?

No. The plans would not bring extra cash into the care system - they substitute private spending by some (mainly wealthy) individuals with public spending - and they would do nothing to promote better quality care through better training, pay and conditions for staff.

4. Would the cap meet growing unmet needs?

No. The cap would not meet current unmet needs (over 1.2 million older people are not getting the support they need) let alone growing demands of our ageing population in the future
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5. Would insurers provide products to meet the cap?

No. There has been no evidence that insurance products will emerge to help older people pay their £72,000 care costs; if they did the only winners would be a new financial industry with millions more insurance transactions. But the major insurers say the cap is set far too high.

6. Would the cap support prevention?

No. It would not promote prevention - it is all about how crisis care, mainly towards the end of life, should be funded. We need a fundamental shift towards ageing well as well as better care for those who need it.

7. Would the cap support the integration of care and health?

No. The cap would not promote integration of care and health and community initiatives to support older people at home and prevent high level needs. It would create a new, separate funding stream mainly to pay for expensive residential care.

8. Would the cap benefit those most struggling to pay for care?

No. The cap is primarily about protecting the inheritances of wealthier families while impoverishing older people with low/mid value homes.

9. Would the cap help people on low-mid incomes?

No. The plans would leave many more older people struggling on their own, relying on family carers or using their own resources to pay for care. Even poorer older people with assets less than £118,000 (a threshold proposed by Dilnot) would find that the tapered means test would require them to make substantial contributions towards their care costs.

10. Does the cap treat all ages the same?

No. The plans were ageist, discriminating against older people. We welcomed Dilnot's proposals that disabled working age adults' care and support should be funded through taxation and believe that this should be the basis of care for older people as well.

In forthcoming blogs I will focus on alternatives to funding a simpler, fairer and sustainable care system.

Stephen Burke is director of United for All Ages and Good Care Guide

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