An alternative approach is to ensure that everyone who is eligible, based on their needs, should get state-funded personal care that is free at the point of use.
This would be provided free regardless of an individual’s means and whether it was received by an elderly person in their own house or a residential care home.
Scotland has implemented such a system.
However, it’s important to note that personal care takes in things like helping frail elderly people wash and dress and go to the toilet.
But it does not include accommodation, food and everyday living costs which are subject to means testing.
The Health Foundation think tank estimates that implementing a Scottish-style system in England would cost £7.5bn a year by 2036.
Like Scotland, Japan and Germany have systems which base entitlement to personal social care mainly on people’s care needs rather than their ability to pay.
Japan and Germany though have a mandatory long-term care insurance system which is funded through contributions from workers and employers.
Both countries also do not usually cover the full cost of personal care so individuals are responsible for some of the expenses.
4. National care service
Some have suggested that the government should set up a national care service in England, similar in ambition to the NHS.
This would mean all personal care would be free at the point of use while establishing national standards and care entitlement criteria.
The Health Foundation has estimated the cost of creating a universal and comprehensive social care system in England would be around £19bn a year extra by 2036.
When Andy Burnham was health secretary in Gordon Brown’s Labour government in 2010 he produced a plan for a national care service.
It was suggested this would be paid for through a compulsory contribution from people’s estates after they’d died.
But the idea was branded a “death tax” by Labour’s opponents. The party lost the 2010 general election and its proposals went no further.
In the 2024 general election Labour again proposed a “national care service” without providing details or how it would be funded.
And after the election then-Prime Minister Keir Starmer effectively kicked the issue into the long grass by commissioning Louise Casey to investigate social care reform and report back in 2028.
It’s worth bearing in mind that these four approaches above are not mutually exclusive.
Previous reform proposals have often combined more than one of them – such as a cap on lifetime costs and a more generous means test.
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