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04 / Who pays what for their social care?

Updated: Dec 1, 2023

“Unlike the NHS, social care is not free at the point of use” (Health and Social Care Committee, 2020, p.7)

Something that is rarely brought to your attention as a homecare worker is the fact that some of the clients you visit have to pay for their own care, whilst others do not. The cost of care is often the starting point of wider conversations about social care, so it is helpful to understand how this system works.

If a person needs assistance in day-to-day life, their local authority will carry out an assessment of their social care needs as well as of their finances, to work out what - if anything - that person must pay towards the cost of their social care. If they have more than £23,250 in savings, they must pay for their own social care in full (NHS, 2022). These individuals are known as ‘self-funders’. If someone has between £14,250 and £23,250 in savings, their local authority will provide some but not all of the funding for their social care (Age UK, 2021). If they have below £14,250 in savings, the local authority will fund the full cost of their social care (Age UK, 2021).

The hourly cost of homecare varies depending on where people live, but, in general, a self-funding client can expect to pay around £20 per hour of homecare (NHS, 2022). In my area, that rate is more like £30 an hour. Self-funders are usually charged more per hour of homecare than those whose care is funded by the local authority. This is because local authority budgets are extremely limited, so homecare providers have been forced to offer care for these clients at a discounted rate.

That social care is not provided free at the point of need causes significant distress to both those in need of care and their families (Health and Social Care Committee, 2020). Rightly or wrongly, it is a social norm in the UK for people to want to leave behind an inheritance for their loved ones when they pass away. Sometimes, people go without the care they need because they see its cost as prohibitive, a decision which compromises their quality of life and their dignity. When someone does not receive the care they need, this is known as ‘unmet need’ and it is becoming more and more of an issue as demands on social care continue to rise.

The more complex a person’s needs, the higher the cost of care becomes:

“According to the Alzheimer’s Society, the total cost of care for people living with dementia is typically £100,000, but that cost can rise to as much as £500,000. Two-thirds of this cost is currently being paid by people with dementia and their families, either in unpaid care or in paying for private social care. The risk of that level of cost is high; one in ten over 65s will pay more than £100,000 for their care” (Health and Social Care Committee, 2020, p.25)

The way forward

The government has announced that, from 2025, the current upper capital limit of £23,250 will be raised to £100,000 (GOV.UK, 2022). This is good news, meaning people with under £100,000 in savings will be “eligible to receive some financial support from their local authority” and “will never contribute more than 20%” of their savings towards the cost of their care per year” (GOV.UK, 2022).

In addition to this, a lifetime cap on care costs of £86,000 is set to be introduced, such that the most any individual will have to pay for their social care in their lifetime is £86,000 (GOV.UK, 2022). These new policies are steps in the right direction, however, £86,000 is far higher than than the £36,000 lifetime cap originally recommended in the 2011 Dilnot Commission (Commission on Funding of Care and Support, 2011).

To account for the crossover that exists between health care and social care, a 2019 House of Lords Economic Affairs Committee paper backed calls for the introduction of free personal care (House of Lords, 2019). Personal care covers aspects of social care such as helping a person wash, use the toilet, apply creams, change continence products and get dressed. In Scotland, personal care has been free since 2002, showing that such a change is possible (MyGov.Scot, 2019).

Of course, an alternative to all of the above would be to provide social care for free at the point of need, like the NHS. In order for this to ever become a reality, more money for the public purse would need to be raised via taxation.

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