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Social care commission should consider national system to assess people's needs, says The King’s Fund think tank. 

The Casey Commission, set up by the government to explore social care reform in England, should consider the benefits of moving to a national system of assessing people’s social care needs, such as in Australia, Germany and Japan. This is a key recommendation of a new report from The King’s Fund called 'Fixing social care: the six key problems and how to tackle them.' 

In the current system, each local authority in England carries out its own assessment of people’s needs and finances, using national criteria, and there is wide variation in the number of people accessing care in different parts of the country.  

The report says the Casey Commission should specifically consider the benefits of moving towards national assessment because it might provide greater consistency and would limit the risk of individual authorities ‘rationing’ care because of budget constraints. There may also be the potential for efficiency gains. 

The report also says that more people should be entitled to publicly funded social care. Making the current means-tested system more generous, along with introducing a cap on care costs, is the ‘very minimum’ reform needed but alternatives such as free personal care, as in Scotland, or a ‘social insurance’ system such as Germany, where everyone in need receives support though may have to contribute towards the cost, are potential alternatives.  

The recommendation is part of an analysis of key problems in social care: access, quality, workforce pay, market fragility, disjointed care and the ‘postcode lottery’ in access and performance. It includes an assessment of options for improvement in all these areas.  

Other key recommendations from The King’s Fund include: 

• The cost of providing care should be more of a partnership between the individual and the state than it currently is, with the state bearing most of the cost but the individual contributing if they can afford it. 

• The government’s proposed £500 million as part of the Fair Pay Agreement for the care workforce is a welcome first step on a long-term solution. However, it will not solve long-standing issues of recruitment by itself.  

• It is not sustainable for social care providers to regularly face cost rises that are far in advance of the fee increases they receive from local authorities.  

• A review of NHS continuing healthcare, which plays an overlooked role in social care, is overdue.  

Simon Bottery, Senior Fellow, The King’s Fund and author of 'Fixing social care: the six key problems and how to tackle them', said:  

‘It would be a major change to shift away from the principle that people’s social care needs and finances should be assessed by local authorities. However, it works well in other countries and now is the time to explore whether it would be an improvement here as well. 

‘The Casey Commission should consider this and other ideas in this report. However, there is also much that the government could do in the meantime ahead of the commission reporting, including ensuring that local authorities have the finances they need to run the current system fairly and effectively.’ 

Notes to editors

The six key problems and solutions as identified in 'Fixing social care: the six key problems and how to tackle them' are:  

1. Access: means testing, unmet need and selling homes to pay for care  

2. Quality of care: 15-minute care visits and neglect  

3. Workforce pay and conditions: underpaid, overworked staff  

4. Market fragility: care providers struggling to stay in business  

5. Disjointed care: delayed transfers of care and lack of integration with health  

6. The postcode lottery: unwarranted variation in access and performance  

Paying for it: where should the money come from? 

For further information, or to request an interview, please contact the Press and Public Affairs team on 020 7307 2585. 

The King's Fund is an independent charity working to improve people's health. Our vision is a world where everyone can live a healthy life. Our mission is to inspire hope and build confidence for positive change. We achieve this through expert insights and original research, developing leaders and their organisations, convening, and strategic, collaborative partnerships.