Plans to delay the introduction of a financial cap to protect vulnerable people from massive care costs that are not covered by the NHS have been described as “inhumane” by the architect of the proposals, Sir Andrew Dilnot.
Social-care funding reforms, which were to come into force in October next year, would have set an £86,000 limit on the amount anyone in England would need to spend on personal care in their lifetime. They would have particularly benefited people with dementia or other long-term conditions if they have assets above £23,500, which is the current cut-off point for receiving local-authority support.
Successive Conservative prime ministers from David Cameron onwards have kicked introducing versions of the social-care cap into the long grass. Theresa May notoriously U-turned on social-care proposals in her 2017 general election manifesto before the polls had even opened.
In his Autumn Statement yesterday, Hunt said the reforms – proposed by a government-appointed commission led by economist Dilnot in 2011 – would be pushed back for a further two years. He said the move would provide local authorities with £4.7bn of additional funding for adult social care services.
Hunt was an advocate of the social care cap when he was chair of parliament’s Health and Social Care Select Committee and admitted today that the move was a “source of great regret”.
Addressing MPs yesterday, the chancellor said delaying the introduction of the cap on personal social-care costs until 2025 – and so after the next general election – was in part a response to concerns from councils about putting the new system in place “immediately”.
He said delaying the reforms for two years would result in funding being allocated to local authorities to provide more care packages.
“I also want the social care system to help free up some of the 13,500 hospital beds that are occupied by those who should be at home,” he said.
“I have therefore decided to allocate for adult social care additional grant funding of £1bn next year and £1.7bn the year after.
“Combined with the savings from the delayed Dilnot reforms and more council tax flexibilities, this means an increase in funding available for the social care sector of up to £2.8bn next year and £4.7bn the year after.”
HM Treasury’s Blue Book, which details the measures set out in the statement, said the funding would be allocated at the local government finance settlement through the Social Care Grant.
Steve Brine, Hunt’s successor as chair of the Health and Social Care Committee, welcomed the extra cash for councils, and the additional £3.3bn the chancellor allocated to the NHS in England for each of the two coming financial years.
But he said the funding increase for adult social care still fell short of the annual £7bn uplift that the committee had repeatedly called for, and described the social-care cap delay as “disappointing even if it is well motivated”.
“The result will be that more people face the very real prospect of crippling bills with the cap now not coming into effect until October 2025,” he said.
“Though set at a level far higher than called for by this committee, the cap represents a key plank of social care reform.”
Dilnot was more direct in his criticism of the decision to delay implementing the social-care cap.
“It’s a tragedy,” he said, speaking on BBC Radio 4’s Today programme.
“We have breached a promise that we made to people, but we’re doing nothing about the long-run balance between tax and public spending. This can’t help the government’s long-run financial position at all.”
Dilnot noted that the Autumn Statement had been framed as “protecting the most vulnerable” and “demonstrating the British value of compassion”. He said the care-cap decision was at odds with those sentiments.
“We wouldn’t dream of saying to someone diagnosed with a terrible cancer that they were on their own until they’d spent the last £23,000 of their assets,” he said.
“We wouldn’t dream of saying that to someone with chronic obstructive pulmonary disorder who needed healthcare. Why on earth should we say it to people who need social care? It seems inhumane.”
Interviewed later on the Today programme, Hunt acknowledged that the care cap decision had been a particularly tough one.
“It’s a source of great regret to me as someone who’s campaigned very hard on this issue,” he said.
“This was a difficult choice that I had to make personally, if you like, as well as in the public interest. Because I do believe it’s important that we introduce that cap. I do believe in those reforms that Andrew Dilnot has championed very much.”
Hunt insisted it was still his belief that the care cap would be introduced eventually.
“I believe it will happen if the Conservatives win the next election,” he said. “It’s a Conservative commitment that we will do this.”
Elsewhere in his Autumn Statement, Hunt succeeded in introducing an NHS reform he had sought as Health and Social Committee chair: a long-term workforce plan for the health service. Bizarrely, he referred to himself in the third person in the process.
“On staff shortages, the former chair of the Health and Social Care Select Committee put forward the case for a long-term workforce plan,” Hunt told MPs.
“I have listened carefully to his proposals and believe they have merit. So the Department of Health and Social Care and the NHS will publish an independently-verified plan for the number of doctors, nurses and other professionals we will need in five, 10 and 15 years’ time, taking full account of the need for better retention and productivity improvements.”
Current health committee chair Brine said the decision was “a huge relief”.