An estimated 35 percent of people using adult social care in England pay for it themselves. They are known as ‘self-funders’. This is approximately 350,000 people, some of whom live at home and some in residential care. Many of these people will never have any contact with social services. They remain an invisible part of the system, although they are essential to its operation and provide a significant subsidy to state-funded care. These aren’t the super-wealthy. They are people with assets above £23,250 – a means-test threshold that has been unchanged since 2011. For people seeking permanent residential care, this also includes the value of their homes. There is currently no upper threshold of liability, meaning that care bills can run into hundreds of thousands of pounds.
The Care Act 2014
The Care Act 2014 was supposed to bring these people to the attention and responsibility of the local government. Rather than being left to find their way around the care system largely unaided, self-funders were to have access to assessment and planning to meet their needs. For the first time, there would be a cap on care costs so that no one would pay more than £72,000 for their care.
Our article on what happened to self-funders after the Care Act recently won the best article award from the Social Policy Association. Written with Jon Glasby (Director of IMPACT) and Steve McKay (University of Lincoln), the article highlighted that the Care Act has not achieved the hoped-for transformation in the experiences of self-funders. The care cap was postponed and then abandoned in 2017 and most local authorities continued to ignore or be unaware of self-funders.
Choice and control for self-funders
We gathered the data for our article before the pandemic. The strains on the social care system have only intensified in the intervening period. Particularly disappointing has been the failure of the government to implement another set of reforms that would have helped self-funders. A cap on care funding was yet again passed into law in 2021, and due for implementation in 2023. This has now been postponed until 2025, and – with a general election falling in between – it may well not be implemented at all. This is unfinished business since the report of the Royal Commission on Long Term Care in 1999 and desperately needs to be resolved.
Enhancing Choice and Control is one of the themes of IMPACT. These principles have been at the core of adult social care policy for two decades, but we need to keep pushing to make them a reality on the ground. Crucially we need to make sure that self-funders are part of this ambition so that those with the means to pay are not left adrift to find their way alone through choppy waters.
Associate of the Health Services Management Centre at the University of Birmingham, and a Visiting Research Fellow with the Institute of Public Care, Oxford Brookes University.
Professor of Public Policy and Public Management at the University of Birmingham.