Social care reform: the real cost of 'free care'

‘Free personal care’ is the headline under Burnham’s newly proposed National Care Service. But what would that actually mean if you move into a care home or nursing home in England? What you would really end up paying for may surprise you. It certainly doesn’t mean a bill of £0. In fact, you could still face costs of more than £1,000 a week.

To understand why, it is worth looking at Scotland, which currently offers free personal care, unlike the rest of the UK. Following his conference speech, Burnham’s care funding proposals were compared by experts to the existing scheme north of the border. In Scotland, there are two non-means-tested care payments:

• £260.30 a week for personal care; and
• £117.10 a week if nursing care is also required.

The cost of ‘bed and board’ is not covered but is subject to a means test. Broadly speaking, anyone with capital above £36,750 receives no further financial support from the Scottish government. Between £36,750 and £22,750, the means test permits a state contribution. Below £22,750, the state will meet the B&B costs, but only at an agreed standard level of:

• £930.45 a week for residential care; and
• £1,074.13 a week for nursing care.

These are not maximum rates, so anyone paying towards their own nursing or care home costs could end up paying more. Despite the funding of personal and nursing costs, on average, people living in a Scottish residential home still pay £1,160 a week towards non-personal care and living costs, rising to £1,410 in a nursing home, according to the Nuffield Trust.

The Prime Minister’s proposals are similarly limited to covering only personal care because of cost. The Health Foundation estimates that a free personal care system for England along Scottish lines would require funding of about £7.5 billion a year by 2035/36, against £18.5 billion for the all-costs-covered option. Even at £7.5 billion, it is not certain that the Prime Minister’s plans to ‘adjust’, or ‘water down’, the triple lock will deliver sufficient cash in 2025/26.

All of which yet again highlights the importance of planning for these later life costs, regardless of the good intentions of political leaders.