31 March 2006
Government should increase spending on social care for older people by more than 50%, the long-awaited Wanless review of the future of care funding has recommended.
The centrepiece of Sir Derek Wanless's proposals is a scrapping of the controversial means-testing system for personal care, under which individuals can typically be liable for charges of up to £200 per week for services such as washing, feeding and help with mobility.
Describing the current system as 'unsatisfactory', 'confusing' and 'inequitable', Wanless proposed a 'partnership' approach to care, in which a minimum guaranteed level of care should be provided free to all.
That level would be enough to subsist on, but individuals could then choose to top up their levels of care with their own funds. Their contributions would be matched pound for pound by the government, up to an ideal 'benchmark' 33% above the free minimum. The care packages of poorer income groups would be topped up through benefit payments.
Overall public and private spending at 2005 prices would then be £13.7bn – £1.3bn more than currently. But the proportion of that amount coming from public funds would radically increase – by £3.5bn, from £6.2bn to £9.7bn.
Speaking a day before the launch of the review on March 30, Wanless said: 'We haven't recommended [100%] free personal care. But this is more ambitious than a lot of free personal care models.
'People will know where they are when they are saving; it offers value for money, is fairer and can be fine-tuned.'
He added that the model also gave more safeguards against the 'squeezing' of the definition of 'personal care', sometimes seen in international comparisons where those services were provided for free.
Care services minister Liam Byrne welcomed the review and announced the formulation of a 'zero-based review' to examine the funding of social care from 'first principles' in the run-up to next year's Comprehensive Spending Review. The review team will include Wanless.
Niall Dickson, chief executive of the King's Fund, which commissioned the Wanless review, commented: 'If you consider that a year ago the government were telling us that the amount given to social care was “just right”, not too much, not too little, but “just right”, we now have a significant advance.'
The 'benchmark' level of care recommended by the review team was set through a cost-benefit analysis similar to those undertaken by the National Institute for Health and Clinical Excellence when assessing which drugs should be available on the NHS.
The level of care would be higher than that currently provided but would stop short of meeting all the 'independence and wellbeing' aspirations outlined by the Department of Health in recent years.
Although the Wanless recommendations involve a 'radical' increase in public funding, the review found that a substantial proportion of the £3.5bn increase could be funded through a redirection of certain non-means tested benefits, particularly the current Attendance Allowance and Disability Living Allowance – which cost £3.7bn in 2004/05.
The review found that redirecting two-thirds of those benefits (£2.5bn) would not have a negative impact on recipients.
That would leave a £1bn gap between current public spending and the funds needed to implement Wanless's recommendations.
A further £0.8bn would need to be found, however, to fund top-up payments to enable the very poorest to buy care above the minimum.
PFmar2006
