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Sir Andrew Dilnot on social care reform: Where did it all go wrong?

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A Bill to reform the social care system was almost passed four years ago, but political intrusion led to its derailment at the 11th hour, a former government advisor has said.

Sir Andrew Dilnot, who was asked to lead a cross-party commission on Funding for Care and Support in 2010, said his proposals for social care funding were finally approved by the Queen in 2015.

But lack of political support from the then Prime Minister and Chancellor of the Exchequer following the 2015 general election led to further delays. 

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Speaking to the King’s Fund in a podcast on finding a solution for social care funding, Sir Andrew said: “Legislation went through, the Queen signed the Bill, and in politics 101 you learn that once the Queen has signed the Bill, you’re over the line.

“There was an agreement at that point to implement recommendations, and then after the 2015 general election the then Chancellor of the Exchequer postponed it until 2020.”

The Dilnot commission recommended a partnership model with a much more generous means test and a lifetime ‘cap’ of between £25,000 and £50,000 on social care costs to ensure the state steps in where people face catastrophic costs that cannot be planned for.

Its recommendations included the need for a public information campaign, but this never emerged.

“It was a recommendation for social insurance, collective provision, with a relatively large excess,” said Sir Andrew.

The commission came about after a long history of delays to social care reform.

There was a Royal commission on long-term care as early as 1998, but the government didn’t accept its recommendations. Then, in the run up to the 2010 election, politics intruded once again.

“The Labour government, with Andy Burnham taking the lead on this as the Secretary of State for Health, had some plans in place for what they wanted to call a National Care Service, and that seemed to be making some progress. But then when the election campaign got going, politics intruded and the Conservative party made a decision to be critical of the Labour party proposals, labelling them as something that would lead to a death tax,” explained Sir Andrew.

“As it was, a coalition government was elected and part of the agreement was a text that made it very clear that the partners felt very strongly that social care urgently needed to be addressed, so they set up a commission.”

In the first 18 months after the Dilnot commission was formed, its recommendations were met with warm words from all parties, who thought a cap on care costs was a good idea, but nothing came of it, and Sir Andrew almost gave up on getting social care reform over the line when he was thrown a lifeline.

“I did what must have been the 100th or 150th talk about it at the House of Lords and three or four peers – all of them Lib Dems – came and said to me ‘why hasn’t this happened?’ and I said, ‘well, because there hasn’t been enough political leadership’.”

“They went off and spoke to Nick Clegg and said ‘come on, this really is something that needs to happen’. Nick Clegg was persuaded, which led to David Cameron being persuaded.”

This was in 2013. Legislation then went through and the Queen signed the Bill just before the 2015 general election, after which it was put on hold by George Osborne.

Reflecting on what went wrong, Sir Andrew said: “The major obstacle is almost always the money, and honestly a lack of strong support from the Treasury and strong support from the Prime Minister.

“In the aftermath of the 2015 general election there was anxiety about the public finances. But honestly, these amounts of money are not very large and I think it was much more about expanding the envelope of government activity than a concern about precise amounts of money that were involved.

“Then we had the complete debacle of the 2017 conservative manifesto when it seemed like a good idea to some people at the time to invent a new policy almost on the back of a cigarette packet, and that ended in terrible disruption.”

Sir Andrew is referring to Theresa May’s proposal to raise the threshold of personal assets at which people are eligible for state help with care costs from £23,250 to £100,000. She argued that a cap on care costs was no longer needed.

“Since then there has been promise of a Green Paper but I think it had become a politically toxic thing for the PM and so we weren’t able to get it over the line,” he said.

Asked by the King’s Fund what critical ingredient was needed to get social care reform over the line, Sir Andrew said: “I think it’s the Prime Minister and the Chancellor of the Exchequer both believing that they’ve got to do it.”

Tags : cap on care costscommissionSir Andrew Dilnotsocial care reform
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