- Published
Prime Minister Andy Burnham has said he wants major reform of the social care system in England, calling the current situation "bad for everybody".
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he → publish → everybody
In a speech at a care home on Wednesday he announced that cross-party talks involving the Conservatives and Liberal Democrats would start later.
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talks → announce → Conservatives
Burnham also said he had asked Baroness Casey - who is carrying out a review of social care - to bring forward her report by a year.
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who → say → year
She will now set out her recommendations in 2027.
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She → set → 2027
He confirmed that her review will also look at the question of how to pay for any reforms.
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review → confirm → reforms
BBC Verify has looked at four options for approaching reform and how much they could cost.
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they → look → much
Cap on lifetime care costs
Some people face extremely high costs for care at the end of their life.
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people → face → life
It has been estimated that around one in seven people aged 65 and over face lifetime care costs of more than £100,000.
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people → estimate → 100,000
One proposal is to cap these costs with the government picking up the bill above a certain cash threshold.
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government → cap → threshold
In 2011 a commission headed by the economist Andrew Dilnot proposed a lifetime cap of £35,000.
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commission → head → 35,000
Dilnot estimated his proposed reforms would cost between £1.3bn and £2.2bn a year.
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reforms → estimate → 1.3bn
The cost today would be higher due to inflation and the ageing population.
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cost → age → inflation
The Conservative-Liberal Democrat coalition government, led by David Cameron, accepted Dilnot's recommendations.
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government → lead → recommendations
But after the 2015 general election, which delivered a Conservative majority, Cameron delayed the implementation of the cap to 2020 over what he said were pressures on the public finances.
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he → deliver → finances
In 2017, when Theresa May was in No 10, the Conservatives' general election manifesto proposed a different way to reform social care.
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manifesto → propose → care
This would have included the value of an individual's home in the means test used to decide what state funding they could get for care in their own homes.
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they → include → homes
It did not, initially, include any cap on lifetime care costs, with the manifesto saying this was more "equitable" than the Dilnot plan.
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this → include → plan
The May plan was branded a "dementia tax" by opponents and eventually dropped.
2.
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plan → brand → opponents
In England people can currently qualify for local authority financial support in a residential care home if all their assets - including their home - are worth less than £23,250.
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assets → qualify → home
This is known as a means test - where the level of financial support a person gets is based on the value of their assets and savings.
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person → know → assets
Some have suggested this threshold should be raised significantly so that many more people would qualify for means-tested support.
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people → suggest → support
Boris Johnson's Conservative government in 2021 planned to raise the means test threshold to £100,000.
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government → plan → 100,000
The annual cost of Johnson's reforms would have been £1.8bn a year over three years - although this was expected to rise over time as more people qualified.
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people → expect → time
The Johnson government planned a new Health and Social Care levy to pay for the package, but this was eventually scrapped by his Conservative successors as prime minister, because they wanted to keep taxes down.
3.
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they → plan → taxes
Free personal care
An alternative approach is to ensure that everyone who is eligible, based on their needs, should get state-funded personal care that is free at the point of use.
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that → ensure → use
This would be provided free regardless of an individual's means and whether it was received by an elderly person in their own house or a residential care home.
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it → provide → house
Scotland has implemented such a system.
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Scotland → implement → system
However, it's important to note that personal care takes in things like helping frail elderly people wash and dress and go to the toilet.
But it does not include accommodation, food and everyday living costs which are subject to means testing.
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which → note → testing
The Health Foundation think tank estimates that implementing a Scottish-style system in England would cost £7.5bn a year by 2036.
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implementing → estimate → 2036
Like Scotland, Japan and Germany have systems which base entitlement to personal social care mainly on people's care needs rather than their ability to pay.
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which → have → needs
Japan and Germany though have a mandatory long-term care insurance system which is funded through contributions from workers and employers.
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which → have → workers
Both countries also do not usually cover the full cost of personal care so individuals are responsible for some of the expenses.
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individuals → cover → expenses
Some have suggested that the government should set up a national care service in England, similar in ambition to the NHS.
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government → suggest → NHS
This would mean all personal care would be free at the point of use while establishing national standards and care entitlement criteria.
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care → mean → standards
The Health Foundation has estimated the cost of creating a universal and comprehensive social care system in England would be around £19bn a year extra by 2036.
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cost → estimate → 2036
When Andy Burnham was health secretary in Gordon Brown's Labour government in 2010 he produced a plan for a national care service.
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he → produce → service
It was suggested this would be paid for through a compulsory contribution from people's estates after they'd died.
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they → suggest → estates
But the idea was branded a "death tax" by Labour's opponents.
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idea → brand → opponents
The party lost the 2010 general election and its proposals went no further.
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proposals → lose → election
In the 2024 general election Labour again proposed a "national care service" without providing details or how it would be funded.
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it → propose → details
…and 3 more, not listed.
The Aporia
