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The Dilnot Report - the 10 key recommendations

6 July 2011

The 10 key recommendations

Following a years hard work, and an extensive consultation, the Dilnot Commission has produced a large piece of work. With its appendices, the report on funding adult social care runs to over 400 pages. However, at its heart there are 10 key recommendations:

1. The "big idea" - a fixed cap

There should be a cap on the amount which anyone should pay for their care in their lifetime, fixed at some figure between £25,000 and £50,000. The report recommends £35,000 (the research behind the report predicts that two thirds of people over 65 will have care needs of less than £35,000). No matter what your means are, once you have reached the cap, you do not have to spend any more on care. The state will pay for care for you. However you can choose to pay more (a top-up) if you wish.

A local authority will calculate how quickly an individual will reach the cap, by assessing the individuals needs, and then pricing the care needed to meet the assessed eligible needs against standard pricing for that care in that area. Therefore if an individual with greater means chooses more expensive care, they will not reach the cap figure more quickly.

This is the reports "big idea". By creating certainty over the financial risk, it should be possible for the financial services industry to create products to cover this £35,000, such as annuities which would increase should a care need arise, or an extension to life cover or critical illness cover.

2. Increased asset limit

Currently individuals in residential care must pay for the entire cost of their care until their assets (including any property) are reduced to £23,250. They then contribute £1 per week for every £250 of assets over £14,250 (known as the taper). Once their assets fall below £14,250, the state pays the entire cost. The report recommends that the £23,250 limit is increased to £100,000, and for the taper to apply to those assets between £14,250 and £100,000. This should reduce the need for people to sell their house in order to fund their residential care, something which research showed the public views as particularly iniquitous.

3. Free state support

Individuals who, by the age of 18, already have a need for care should be entitled to free state support, irrespective of means. The report more tentatively suggests that in fact this immediate entitlement to state funded care should apply to everyone under the age of 40, because it is unreasonable to expect them to start saving for their future care before then. There would then be the following tiered caps:

  • 40 to 50 - £10,000
  • 50 to 60 - £20,000
  • 60 to 65 - £30,000

4. Aligned systems

The current benefit system needs to be aligned better with the system for funding social care. In particular, Attendance Allowance needs to be clarified.

5. Contribution to living costs

In addition to paying for social care (up to the cap), individuals in residential care should pay a nationally fixed sum towards their living costs. The report suggests a figure between £7000 and £10,000. Everyone is expected to pay this. The expectation is that most individuals will be able to pay through their pension income (median net income for single people is £11,284). Where individuals receive benefits, those too should go towards these living expenses. However the Guarantee Credit, the benefit which guarantees everyone a minimum income, is currently set at £7,142. On this, the report simply says "the Government will need to take this into account when deciding how much any contribution should be".

6. A national standard for eligibility

There should be a standard national basis of eligibility, rather than the current system which varies authority by authority. Throughout England, each individual will undergo the same assessment process, and there will be the same severity threshold for an assessed need to be eligible for state support. Assessments should also be portable, and until a receiving authority re-assesses a new arrival, it should continue to meet the assessed eligible needs. The assessments need to be more transparent, allowing individuals to self-assess.

7. Raising awareness

There should be an awareness campaign to make people much better informed, and less anxious about the future. The research supporting the report showed clearly that both ignorance and anxiety were significant obstacles preventing people from planning financially for old age.

8. Local authority responsibility

There needs to be a new strategy for providing information, assistance and advice both to service users and their carers. While the reform suggests that local authorities work together with the third sector on this, as well as with other interested bodies like the Financial Services Authority, the reform wants the buck to stop with the local authority. It supports the recommendation made by the Law Commission in its recent review of adult social care law that a new statutory duty be placed on local authorities to provide this information, assistance and advice.

9. Legal duty for local authorities

In support of another recommendation made by the Law Commission, the report argues for a new legal duty on local authorities to undertake a carer assessment, and then to meet assessed eligible needs, either through support provided to the carer, or to the service user direct. This carer assessment should be simultaneous with, but separate from, the assessment of the service-user. It should also be portable, as service user assessments are recommended to be.

10. Greater integration

The report urges greater integration between health, social care, benefits and housing, with a particular focus on health and social care. It sees pooled budgets, and fully integrated care trusts, as ways to surmount the problems caused by the different funding streams for health and social care. It also supports the idea of palliative end-of-life care being free, and for NHS Continuing Healthcare patients making a contribution to their living expenses.

Much of the initial media comment has been broadly in favour of the reforms, but sceptical about where the extra funding needed will come from. The Dilnot Commission think that in the context of the total spend on adult services, the extra funding required is modest - a mere addition of 0.14 of gross domestic product (GDP) today, rising to an extra 0.22 by 2026. It suggests that government could raise revenue by taxation (either general or targeted) or by spending cuts, but does not express a preference.

Attention new turns to politics and the White Paper, which the report hopes will be published by December, for clues about the extent to which the Government plans to follow the Reports recommendations. However one thing is sure, for all involved in adult social care, whether as service user, carer, care provider, care commissioner or inspectorate, we are all set to see significant change.

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