Dilnot commission: Report calls for free care for younger disabled people


Care should be free for all people with “eligible” needs who become disabled before the age of 40, according to a commission set up to recommend changes to the funding of long-term care and support in England.

The Commission on Funding of Care and Support concluded that the current adult social care funding system was “not fit for purpose” and was “confusing, unfair and unsustainable” and needed “additional resources” from the government.

The commission’s headline conclusions have been warmly welcomed – despite disappointment with some details – by a wide range of disabled people’s, disability and older people’s organisations.

Among the recommendations of the commission – chaired by economist Andrew Dilnot and set up by the coalition government – was that all those who enter adulthood with a care and support need should be eligible for free state support, rather than facing a means-test.

Dilnot said he and his commission colleagues Dame Jo Williams and Lord [Norman] Warner were “absolutely clear” that such people should not have to pay towards their care and support, because they have not had the same opportunities to build up savings and fund their own care as non-disabled people.

Most of the media attention has been on the commission’s recommendations for funding care for older people, which would see a cap of between £25,000 and £50,000 – probably around £35,000 – set on the amount any individual should pay towards their lifetime adult social care costs.

Dilnot also suggested that the means-tested threshold – the level of assets above which people are liable for their full residential care costs – should be increased from £23,250 to £100,000.

He said the commission’s proposals – based on a cap of £35,000 – would cost the government about an extra £1.7 billion a year, although this would rise in future years. The state currently spends £14.5 billion per year on adult social care in England.

Those who become disabled after the age of 40 would be expected to make some contribution towards their lifetime care costs, with the cap rising at about £10,000 per decade.

This would mean that those who develop an “eligible need” after the age of 40 would be expected to pay no more than £10,000 over their lifetime; those who become disabled after 50 would pay lifetime costs of up to £20,000; and after 65, £35,000.

The commission’s report also calls for a national, consistent and transparent system of setting eligibility criteria and assessing care needs, in a bid to end the “unacceptable” situation where a disabled person in one local authority can secure support that is not available to someone with the same needs in a neighbouring area.

But there was disappointment that the commission concluded that – at least in the short-term – only those with substantial or critical needs should be eligible for such council-funded support, while those with lower needs would not.

Dilnot’s report also calls for “portability” of assessments of disabled people’s support needs, which would mean that anyone moving to a new local authority area should continue to receive all of their eligible care needs until the new council reassessed them.

Portability is a long-established campaigning priority for the independent living movement, and there was further disappointment – but not surprise – that the commission failed to go further and recommend that disabled people’s complete care packages should be portable.

Baroness [Jane] Campbell – who has described the lack of portability as “one of the most fundamental wrongs in the social care system” – has introduced a private members’ bill into the House of Lords that would do just that, providing continuity of support for disabled people who choose to relocate to another local authority area.

Among other recommendations, the commission’s report says universal disability benefits – disability living allowance, and its proposed replacement, personal independence payment (PIP), as well as attendance allowance (AA) – should continue, although AA should be rebranded to clarify its purpose.

Crucially, the report also says that such benefits should remain available to those with lower care and support needs, which clashes with government proposals to focus PIP on those with higher needs.

The Department for Work and Pensions declined to comment on this recommendation and referred the inquiry to the Department of Health.

Dilnot’s report also calls for the government to develop a new strategy to provide reliable, easy-to-understand advice and information about support services and funding.

And it says that people in residential care should contribute a standard amount – between £7,000 and £10,000 a year – to cover their food and accommodation costs.

Meanwhile, the Commons health committee announced that it would be conducting its own inquiry this autumn to “follow up” the work of the Dilnot commission.

7 July 2011

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