Think tank calls for ‘equal access’ national assessment amid substantial variation between similar local authorities in number of people accessing long-term social care

In light of its findings, the think tank called for an “equal access” national assessment, national (rather than local) funding for social care, “clear individual entitlements” to social care support, and a cap on lifetime care costs.

The King’s Fund analysis found that more than half (59%) of local authorities had access rates publicly funded to long-term care that were at least 20% above or below those of their nearest 'statistical neighbour' (councils with similar social and economic profiles), for working-age and/or older adults.

The data showed that variation between statistically similar councils was up to 101% for working-age adults and up to 60% for people over 65.

For example, in Thurrock, 7,680 older people per 100,000 accessed long-term care. In contrast, its nearest 'statistical neighbour', Medway had only 4,810.

The think tank noted: “Meaningful comparison between local authorities must happen between those that have a similar socio-economic profile.

“[…] Reasons for variation are likely to be due to a combination of factors including different levels of need, levels of wealth, the model of provision and levels of council resource, caused by differing abilities to raise money from council tax.”

The think tank observed that while all councils must assess people's needs for care using national eligibility criteria, in practice there is enough subjectivity in the assessments to mean that people with the same level of need might experience different outcomes in different local authorities.

In July, Prime Minister Andy Burnham confirmed he would bring forward the date for Baroness Casey’s commission to report back with a plan on how to deliver the National Care Service, accelerating this from 2028 to next summer.

Setting out a path to “fix social care”, the Prime Minister warned that social care reform is essential not only for those actively needing support, but also for the long-term future of the NHS.

Simon Bottery, co-author of the work and Senior Fellow for Social Care at The King's Fund, said: “A national care service, which the Prime Minister has promised, must be genuinely national and ensure that all people, wherever they live, have the same access to social care support.

“Our new proposals for an ‘equal access’ national assessment would help prevent this issue of unwarranted variation and ensure that access to social care support is not decided by your postcode.

“But reform must go further than that and ensure that there is universal access to at least some publicly funded support, with a cap on the cost people are expected to pay to ensure that no one faces huge lifetime care bills. Currently, one in seven people aged 65 will spend at least £100,000 in lifetime care costs.

“We must also introduce fairer, national funding of social care, with greater choice and control for people and their families over how their care needs are met.

He added: “The Prime Minister and Baroness Casey's commitment to reform is clear, but we are still awaiting the concrete policies that will turn this vision into a reality. To achieve that, their proposals will need to focus not just on who pays but on how the wider system operates on the ground.”

Lottie Winson