Revisiting the National Care Service White and Green Papers ahead of #Dilnot

At the end of March 2010, a White Paper on adult social care was published called “Building the National Care Service”. This was the result of the Big Care Debate and a Green Paper published in July 2009.

Ahead of the publication of the Dilnot Commission’s report on the funding of care and support, I thought it would be useful to revisit the key pledges made in the White Paper, concentrating mainly on the financial proposals it contained.

(Please note: I’m not making reference to the free personal care to people in their own homes part of the White Paper, since this was a bit of political opportunism just before the general election.)

Potential costs of social care

The average expected lifetime cost of care for a female 65-year-old is £40,400. Average expected lifetime cost of care for a male 65-year-old is £22,300. Average expected lifetime cost of care for all is therefore £31,700 (p125).

Around 20% of people will need care costing less than £1,000 during their retirement. Conversely, around 20% of people will need care costing more than £50,000 during their retirement. Some 5% of people will need care costing more than £100,000 (p45).

The Green Paper contains more detail on the potential cost profile (p98) as follows:

• 22% of people will need care costing £0-£1,000
• 26% costing £1,001-£25,000
• 30% costing £25,001-£50,000
• 16% costing £50,001-£100,000
• 6% costing £100,001 or more.

Potential funding models

The pay-for-yourself option of funding care was ruled out on the basis it was unfair that individuals who could not afford to pay for care would go without. Similarly, funding care from general taxation was ruled out on the basis it would put too high a financial burden on the decreasing proportion of the working-age population (p126).

The Partnership option meant that everyone who qualified for care and support would be entitled to a set proportion (for example, a quarter or a third) of their assessed care and support costs paid for by the state. People who were less well-off would have more care paid for (for example, two thirds) while the least well-off would have continued to have all their care paid for free (p126). The rest would be paid for by the individual. This option received 35% support in the consultation process (p127). According to the prior Green Paper, a 65-year-old may need to pay on average between £20,000-£22,500 under the partnership option. The system would work for people of all ages (p17 of Green Paper).

The Insurance option would have built on the partnership option, offering everyone the opportunity for people to cover the additional costs of their care and support through insurance, if they wanted to do so (p126).  This option received 22% support in the consultation process (p127). According to the prior Green Paper, a 65-year-old may need to pay on average between £20,000-£25,000 under the insurance option. The system would work for people over retirement age (p17 of Green Paper).

The Comprehensive option would provide free care when people needed it for those who qualified for care and support, with everyone paying a compulsory contribution (p127). This option received 41% support in the consultation process (ibid). According to the prior Green Paper, a 65-year-old may need to pay on average between £17,000-£20,000 under the insurance option (p17 of Green Paper).

Preferred option and its implications

The White Paper rejected the Partnership and Insurance options, and opted for the Comprehensive option (p128). Partnership was rejected because it still left people exposed to “catastrophic” care costs (p128). Insurance was rejected because evidence from other countries suggested voluntary insurance schemes had low take-up (p129).

Accommodation costs were not considered in these recommendations (p137). A proposal was put forward for a “universal  deferred payment” system for accommodation costs in care.  This built on the fact many Councils already offer deferred payment schemes, but that this wasn’t universally available (p137). Its purpose was to stop the requirement for people to sell their homes to meet their accommodation costs, meaning that people with high incomes or savings would not necessarily have been eligible for the deferred payment scheme (p137).

Everyone would have been required to make a fair contribution to the social care system. The best method for achieving this would have been determined by a commission established to help reach consensus on the right ways of funding the system. The recommendations, if accepted by Ministers, would have been implemented in the Parliament from 2015 onwards (p10).

Disability benefits and eligibility

Any changes to Disability Living Allowance and Attendance Allowance were ruled out (p123).

Eligibility for the National Care Service will have been consistent across the country and enshrined in law. Assessments would have been portable across different areas and would have moved to be joined up across social care and disability assessments (pp88-89).

Reflections

Looking back at the Green and White papers it’s interesting to see that, though the way in which social care would be funded was set (i.e. the Comprehensive option), the exact limits for individual contributions were not given. Only a broad range – of £17,000-£20,000 under the Comprehensive option – was given, and the rest left to a commission to sort out.

It will be interesting to compare and contrast the recommendations of the Dilnot Commission with those broadly outlined by the Green and White Papers published during 2009-10.

It’s also intriguing to hypothesize if Andrew Dilnot would have been asked to convene his eponymous Commission come what may, irrespective of the result of the General Election in 2010.

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