Getting social care is ‘like being in a shop with no prices’, Andrew Dilnot

Getting social care is “like being in a shop with no prices”, according to the author of a major review of social care which concluded costs should be capped.

Sir Andrew Dilnot said that although people know how much they will pay each week or month, they have no idea how long they will be paying for.

The former head of the UK Statistics Authority, who was chairman of the commission on long-term care which reported in 2011, told a group of MPs that as a consequence most people seek the cheapest possible care which “means the market doesn’t work”.

Sir Andrew’s review found there should be a cap on social care costs.

He told MPs in the Health and Social Care and Local Government Committees: “Providers of care have been put in an extraordinarily difficult position by the lack of a coherent funding structure available.

“Being a consumer of care is a bit like being in a shop with no prices, because although you know what the price will be per week or per month, you don’t know how many weeks or months you are going to have to go on paying for.

“So you don’t know the price of what you are being asked to pay for and the consequence of that is that with the exception of a very small group of very, very wealthy people, almost all consumers are seeking to buy the cheapest they possibly can and that means the market doesn’t work.

“It is very difficult for providers to invest and innovate which means we get much less innovation than we should do.

“We have a sector where almost everyone employed in the sector is paid at minimum wage so the sector doesn’t work as an industry very well despite the wonderful care that is being provided by many of the people working in it.”

Sir Andrew added that the means-tested system is underfunded when demand has grown.

He added: “So we have not enough money for the means test, we have a structure which doesn’t allow people to take control of their own lives and as a result of all of that we have a sector which is hamstrung in being innovative and providing better services.”

When asked about the cost of care Sir Andrew said: “I would distinguish between where we might expect to look for the funds for a means-tested system and where we might look for funds for anything beyond that.

“It seems to be that the funding for a core means-tested system shouldn’t look very different from the way we fund the health service.

“A natural source for that would be general taxation. The means-tested system is about looking after people who are not in a position to look after themselves so it does not make sense to make them do it.”

He added: “If we are going to extend beyond the means-tested system – and I strongly advocate that we should – then I think that there is an argument to be looking to the recipient population to pay and the natural thing there is to think ‘well in these circumstances it would be reasonable to expect older people to make some contribution’.

“One way of characterising that sort of change is an extension of the benefits of social insurance – at the moment the main benefit of social insurance in the UK in the social security system is the pension, in the non-social security system it is the health care system.

“This would be introducing a new benefit so introducing a contribution from older people, and here are a number of possibilities, one would be taking money out of people’s estates.

“More naturally in this context, a natural thing would be to have something akin to a National Insurance contribution.”

He said: “It is anomalous that older people don’t pay any National Insurance contribution.

“Older people are people are paying a lower rate of tax on their income than younger people.”

Other possibilities could include changes to Inheritance Tax or changes to entitlement to the Winter Fuel allowance, he added.

“But I do think it is reasonable to think of charging older people in this circumstance,” he said.

He added: “I’m fed up of people talking about the burden of ageing. It is fabulous. We are living longer.

“One of the side effects of that is that the cost of care for older people is going to rise.

“This is going to become a more important sector in this country and around the world than it is now and that’s a great opportunity for us to do it better. It is a great opportunity for innovation.

“The UK could be a world leader in all of this. We just need to step up and do it.”

MPs also heard from the head of the charity Age UK who warned that there is no incentive for people to start careers as care workers because it is “easier to earn money stacking shelves”.

Caroline Abrahams, charity director at Age UK, said: “There are enormous workforce challenges in social care.

“We know that it is very difficult in some areas to recruit and retain staff.

“The terms and conditions are roughly comparable with those in retail and hospitality.

“Some people have said that the introduction of the Living Wage has levelled up these three areas.

“So there is not particular incentive to go into care unless you happen to be highly motivated.

“It is easier to earn money stacking shelves, essentially.”

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