Opinion: Caring for our elderly

Old womenBy Professor Stephen Pudney, Director of the ESRC Research Centre on Micro-Social Change (MISOC), Institute for Social and Economic Research

26 January 2011

Not another review! We’ve already had the 1999 Royal Commission, the 2006 King’s Fund review, the 2009 Department of Health Green Paper and White Paper of 2010. We can now expect a report from the Adult Care Funding Commission chaired by Andrew Dilnot, which will investigate the funding options for social care at all ages.

Can it really be this difficult? Well, yes it is difficult, but the understandable reluctance of elected governments to get to grips with costly long-term issues does not make things easier. What is clear is that with the number of over-65s needing social care expected to rise from 2.6 to 4.1 million over the next 20 years, we need to turn our minds now to the sort of disability care system that will be needed to cope. It’s important to keep an open mind, without loading the policy debate against particular ideas. For example, the emotive branding of one funding option as a "death tax" during the last election was not a helpful contribution.

Before demanding radical reform, it’s a good idea to examine how the present system works. Our present system involves two types of support: A disabled person can apply for home services or residential care from their local authority; and there are also centralised cash benefits (Attendance Allowance or Disability Living Allowance) to help meet the extra costs that disability brings. These parallel systems have separate application and assessment procedures.

The key issue is targeting - in other words, do people in need of support generally receive it and does support normally only go to those who are in need?

The debate on targeting often relies on weak and even anecdotal evidence. Recent research based on detailed information from the Family Resources Survey covering thousands of older people suggests that disability-linked cash benefits are quite well targeted. There’s no convincing evidence of them being claimed by large numbers of people without significant disabilities, although it has been estimated that there could be as many as two million people potentially eligible under current rules who don’t receive them.

Despite the fact that you don’t have to be poor to be eligible, in practice benefits tend to go to people who would be poor without them because people on low incomes are more likely to be severely disabled and thus more likely to apply for benefits. Research suggests that if the existing system of disability benefits were replaced by one restricted to people who are both disabled and poor, the savings would be moderate (around £1.7-3.5 billion a year, compared to a current budget deficit of £105 billion) but still leave large numbers of disabled older people facing life on low incomes.

We know less about the targeting of publicly-funded local care services. There are big differences across the UK in the way that need is assessed, and how home and residential care services are delivered and charged for. "Local services to meet local needs" might be an attractive idea to some, but it is less transparent and consequently harder to ensure that adequate standards are met everywhere.

The alternative to a dual system is a unified system with a single needs assessment, opening the door to whatever support the disabled person is judged eligible for - in other words, a National Care Service. Survey evidence suggests surprisingly little overlap between the two current systems: only two-thirds of over-65s receiving local authority home care services also report receiving disability benefit, and, of people receiving disability benefit, only one in seven also received care services. So each system tends to miss a lot of people with care needs.

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