Stepping Stones: A strategy for reforming long-term care funding

05 July 2011

This week the Commission on Funding of Care and Support, led by Nuffield Foundation Trustee Andrew Dilnot, has recommended capping the costs and increasing the means-tested threshold of adult social care. 

Response from government has been cautious, but it has committed itself to publishing a white paper early in 2012, and the next two years will be a crucial time for reform. In light of this, The Strategic Society Centre has made recommendations for how policymakers and stakeholders should approach reform as a series of 'stepping-stones' in order to overcome current barriers.

James Lloyd, the Centre's Director, argues that the debate on how to fund older people’s long-term care has tended to emphasise a simplistic menu of options, resulting in polarised positions among political parties, and preventing reform from getting under way. But the outcomes required of long-term care funding reform represent not one reform, but many, which vary in their complexity and the political sensitivities they may incur.

Man watering plant


The Centre's recommendations are published in its report, Stepping-Stones: A Strategy for reforming long-term care funding, which was funded by the Foundation. 

The report reveals how many of the stumbling blocks to reform can be overcome, for example: the transition to a national assessment and entitlement framework; staged evolution in the shape of the state safety-net; and, a gradual transition from voluntary to compulsory contributions.

The analysis in the report shows how:

  • widely different models of long-term care funding require some of the same policy changes and structural reforms to be made;
  • seemingly large and challenging reforms can be broken down to a series of manageable steps; and
  • few models of long-term care funding have to represent fixed end-points and can themselves be implemented and developed as stepping-stones in a longer process.

The report argues that such analysis suggests the need for a ‘stepping-stones’ strategy for reform which:

  • prioritises shared steps required by different funding models;
  • evaluates individual funding models as stepping-stones, not just as end-points; and
  • proceeds immediately in areas where consensus exists.

Download Stepping-Stones:A Strategy for reforming long-term care funding (PDF).