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Health Foundation and The King’s Fund report lack of progress on social reform

A new report by the Health Foundation and The King’s Fund have highlighted a worrying lack of progress on social care reform, in extensive new analysis of funding pressures and options for change.

The authors point to low public awareness and lack of agreement on what should be done as major barriers to progress, despite political consensus on the need for urgent action.

They conclude that reforming the current system will be expensive, but that if reform is chosen, England is now at a clear ‘fork in the road’ with a choice between a better means-tested system and one that is more like the NHS; free at the point of use for those who need it.

Mind the funding gap

The report finds that the current system, which sees fewer people receiving publicly-funded care every year, will lead to a funding gap of £6bn by 2030/31. Returning to levels of access and quality last seen in 2009/10, before the current period of austerity, would increase the gap to £15bn.

More fundamental reforms would also significantly increase the cost of social care. Introducing free personal care for all older people with needs above the current threshold would be an extra £14bn.

Protecting people from having to sell their homes by implementing a cap on the lifetime costs of care would require £12bn. With the population over 75 set to double, demand for health and care is projected to rise dramatically over the next 30 years.

Public perceptions findings from the British Social Attitudes survey reveal extremely low understanding of how social care operates, with 34% believing the government pays. When asked who should fund social care, 41% felt it should be entirely tax-funded. At present only those with assets below £23,250 qualify for any publicly funded care.

Boosting social care funding

With taxation the most likely option for boosting social care funding, the findings of separate deliberative work carried out by Ipsos Mori show most people would prefer a dedicated tax to stop the money being diverted elsewhere. Options that include the possibility of people selling their homes to cover care costs, as exists now, were found to be deeply unpopular.

Anita Charlesworth, director of research and economics at the Health Foundation, said: “We have reached a fork in the road and reforming social care is now urgent. Despite the obvious challenges, the government’s Green Paper must build wide consensus on which direction reform should take, and lead to real progress and improvement. More and more vulnerable people will suffer if bold action is not taken to sustain this vital public service.”

Simon Bottery, senior fellow at The King’s Fund, said: “The case for change is overwhelming – patching up the current system would be costly and would not tackle its fundamental flaws. As the government prepares its forthcoming Green Paper, at least two alternatives should be on the table – a better means-tested system and one offering free personal care, which would cost similar amounts to implement. However, there is no silver bullet – the road to reform will be difficult and costly, whichever option is chosen.”

Green Paper on Social Care

The long awaited Green Paper due to be published this summer has been delayed until the autumn. One suspects because of the difficulty in arriving at a financially acceptable and political solution.

The government is considering the introduction of an inheritance exempt Care Isa in a bid to halt the social care crisis. The proposal is being assessed as part of the government’s social care Green Paper

Under the scheme, the Care Isa would be in capped in line with care costs, with the funds remaining being passed onto the family when the holder dies.


The authors of this report shed light on the lack of public awareness and agreement on what should be done as major barriers to progress. Historically, all the major political parties have recognised the need for social reform but failed to reach any agreement on how it should be achieved. Much is being talked about what might be included in the forthcoming Green Paper including funding levels for social care and a possible ISA to help contribute towards it. It remains to be seen if the promise of the Green Paper will fare any better than the initiatives that have gone before it.

Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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