A personal perspective by Steve Milsom, Honorary Secretary, Cymru Older People’s Alliance
Paying for Care has not been resolved over 25 years despite the clear evidence of it being a major societal problem. Successive Governments of all colours have set up Commissions, produced Reports, white papers, even draft legislation but just kicked this “too difficult” issue further down the road each time. Andrew Dilnot [the Dilnot Commission] said in 2011 that it’s the most pernicious system across the UK Welfare State and last year said that it is a “tragedy” the latest social care plans have been scrapped. This is the only public service where you need to sell your house to access help! This is a complex and challenging problem but is something that impinges exclusively on older people and their families.
A lack of resolution or even any real plan for one – beyond vague promises for a National Care Service – puts a blight on millions of lives and their ability to plan their future care and having to pay £000s a week for 2 years or more for care. This is unjust. It also counters improvement of intergenerational fairness. There are various specific aspects of the Paying for Care system that should be considered for action as part of a full policy reform implemented urgently by UK and Devolved Government:
- Free Personal Care has been long promised but not delivered. A system based on rules already in place in Scotland should be introduced
- Capital Limits should be increased as recommended by Dilnot and leave individuals with at least £100,000
- Quality of Care Lack of funding is resulting in unsustainably low levels of fees paid to care homes by Councils. It is one of the major contributory factors to poor levels of quality in care homes. The current model of service provision cannot be sustained without additional public funding
- Dementia v Stroke Those with Dementia must unfairly pay care costs for up to 6 years or more whereas those with other health conditions such as a stroke or heart problems get free NHS care.
- Continuing Health Care cliff edge The Guidance on Continuing Health Care (CHC) and the rules on who qualifies and in what circumstances is complex and “professionalised” in a way that makes it almost impossible for older people and their families to understand. A simpler and more transparent and consistent system of assessment and qualification for CHC is needed.
- Self-funders are cross subsidising Council funded clients’ fees currently funded at an unsustainably low local authority rate despite an announced move to a Fairer Cost of Council Care.
- Earnings v Pension Guidance treats earnings more favourably than many other income types—earnings are fully disregarded in financial assessments, while pension income is counted (subject to some disregards/minimum income guarantees);
- Top Ups rules are applied inconsistently by Councils and can unfairly ask families to pay large weekly sums for their relatives for Assessed Care Needs
- Deferred Payments The requirement for some older people to sell their family home to move into care is a huge blow to older people. Deferred Payment Schemes are inconsistently publicised and vary in practice from Council to Council so that older people are treated differently depending on where they live.
A clear Government plan for Paying for Care, developed together with older people, is required now – not in 5 years’ time. We want interim measures to improve fairness of paying for care. Planning and implementation of reform will inevitably take some time so the process should start as soon as possible.
We must have a fair, equitable and transparent system that is based on a principle of collective societal responsibility for social care funding, with liability for funding shifting quickly from the individual to society. Reforms must go hand in hand with a new and sustainable model of adult social care funding that leads to access to high quality care and support at the point of need and without waiting lists.
Steve Milsom
October 2025