UK - Wanless review calls for extra money and a new funding system
Keywords: Healthcare funding, Partnership working, Service improvements
Social care for older people in England will require sharp increases in funding to meet the demand for high quality care over the next two decades,according to the findings of a major review commissioned by the King’s Fund and led by former NatWest Group Chief Executive, Sir Derek Wanless.
Simply keeping pace with population changes caused by increasing numbers of older people – and not seeking to improve care services or the way they are funded – would require total spending (public and private) on social care for older people to increase from the 2002 level of £10.1 billion (1.1 per cent of GDP) to £24.0 billion (1.5 per cent of GDP) by 2026. Achieving more ambitious goals for social care would mean increasing GDP to 2.0 per cent by 2026.
The review found very serious shortcomings in social care provision and funding arrangements. It recommends that to enable more people to receive care fairly and cost-effectively, there should be more ambition in the outcomes sought for social care and that the current means-tested funding system should be scrapped and replaced with a partnership model. Everyone in need would be entitled to an agreed level of free care, after which individuals’contributions would be matched by the state up to a defined limit. People on low incomes would be eligible for benefits to fund their contributions.
The review argues that reconfiguring services in this way would be cost effective and could provide more community-based care, including better access for those with moderate needs; better support for carers; and improved services for people with dementia.
These recommendations would take several years to implement. There would have to be substantial growth in the supply of services. And, as well as tackling the complexities involved in changing the funding system, a move to a partnership model of funding would also require a wider review of the benefits system. The new system would replace the need for some existing (non-means-tested) benefits paid to older people with disabilities but there is currently not enough data to be definite about how far this could go.
If this more ambitious level of services was being delivered today under a partnership funding model, significantly more older people in England (up to 450,000 more) would be receiving social care services such as home care, day care and care home placements, at any given time, and to a greater intensity. In present day terms, it would be cost effective for up to an extra £4.2 billion of public money to be spent annually on more social care for more older people. Assuming up to £2.5 billion could be offset by savings in the benefits system, the additional overall public spending would be an annual£1.7 billion.
The report, Securing Good Social Care for Older People: Taking a Long-term View, sets out the review’s vision of a social care system providing comprehensive, high quality care. It provides an analysis of how social care might be funded in the long term and seeks to trigger a wide-ranging debate on the future of social care and the pace at which the necessary radical changes can be taken forward. The review follows Sir Derek’s two reports for the Treasury on future health care spending in the UK and on public health in England.
The review concluded that the vast majority of older people would be better off under a partnership model or free personal care. The latter would be most expensive in terms of public funding and also puts the onus on social services in terms of what care is provided.
On balance, the review came down in favour of recommending the partnership model. Its advantages are:
It provides a guaranteed minimum level of care, making the system universal and inclusive.
A significant increase in the number of older people taking up services compared to now – up to 450,000 people – due in part to the reduction in charges as well as attracting those put off by the idea of means-testing.
It provides incentives for people to save for their social care needs in older age as almost everyone would be required to make some form of contribution. Fewer people would need to sell their assets to pay for care than under the means-testing system.
As there is a charge under the partnership model, people will feel more empowered to express choices.
It produces best value-for-money and is sustainable – the system will cost more than means-testing but it provides significant additional value by providing better care packages for more older people.
It provides clarity about what care people can expect, how much they are entitled to receive, and also how much they have to pay.
Welcoming the review, King’s Fund chief executive Niall Dickson said:“This report reveals in great detail how many older people in this country are being let down. The existing system is neither effective nor fair. This is not only damaging thousands of lives, but it is also wasting resources by failing to help older people lead independent lives without the need for more expensive support.
“Let’s be clear this is a very difficult time to be calling for more public expenditure, but this is a major opportunity for the government to look seriously again at what remains a neglected area of public life. It will certainly take time to take social care spending up to the levels envisaged, but we hope that both government and Opposition parties will look at this report seriously and commit themselves to embarking on the reforms it outlines. Older people deserve better support than they are currently receiving and these proposals would go a long way to securing better care for them.”
He added: “The question of how we pay for social care for older people in England has yet to be resolved despite the Royal Commission seven years ago. The partnership model proposed by Sir Derek Wanless may end the stalemate and offer a sustainable way of providing good social care for all.”
For more information and download full document www.kingsfund.org.uk/news/ press_releases/wanless_review.html
