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Free care for all over-65s would remove fears about savings for millions and put dementia patients on same footing as those with cancer

Introducing free social care for everyone over 65 would save the NHS in England £4.5 billion a year by enabling more elderly people to receive care in the community, according to a leading think tank.

Millions of people should be spared the risk of high costs in old age by providing social care free at the point of need, just like health care, IPPR recommends in a report published today.

Under IPPR’s proposal, older people who could afford to would still pay for their own accommodation costs but not for personal care, no matter where they receive it. The reform – similar to the system already in place in Scotland – would more than double the number of people receiving state-funded care.

The report argues that the change would:

  • Create parity between cancer patients, whose care is all free from the NHS, and those with dementia, many of whom must pay for all their care.
  • Increase the number of people with access to state-funded care from 185,000 to 440,000 (if it was delivered and fully taken up today), reducing unmet need and relieving pressure on unpaid informal carers.
  • Help shift hospital patients back into the community, and deliver a higher quality and better integrated service, resulting in potential savings to the NHS of up to £4.5bn per year.

Acknowledging the extra investment needed to provide free social care, the report notes that spending on adult social care for the over 65s would rise from £17bn a year today to £36bn in 2030, before NHS and other savings are factored in. However, £11 billion of that increase would arise even within the existing system because of the growing elderly population, and there would be benefits to the wider economy, including jobs for the estimated 70,000 new full-time workers needed to meet current demand.

The report argues that free social care for the elderly should be funded from higher taxes, with a rise of two percentage points in income tax needed. Recent polling in England by the charity Independent Age, cited in the report, found 74 per cent of adults supported free personal care for everyone who needs it, with 69 per cent willing to pay more tax for this.

IPPR also calls for simultaneous reforms to the way social care is commissioned and delivered in order to provide a more “joined-up” system of health and social care provision for older people with complex needs. It suggests a system of integrated health and care commissioners under which GPs, nurses, mental health workers and social care workers would work locally in integrated teams.

The report follows three decades of indecision over social care reform by a series of recent governments, and comes ahead of a long overdue consultative Green Paper on social care, originally promised for early last year.

It comes as spending on social care has fallen by more than 10 per cent over the last decade as a result of the squeeze on local authority budgets. The report cites 1.4 million over-65s with unmet social care needs, increasing strains on quality and safety as measured by the CQC, and the growing problem of private sector care providers at risk of closure – a problem reported by two thirds of councils over a six-month period.

Harry Quilter-Pinner, Senior Research Fellow at IPPR and lead author of the report, said:

“If you develop cancer in England you are cared for by the NHS, free at the point of need for as long as it takes, but if you develop dementia you’re likely to have to pay for all your own social care - running up potentially catastrophic costs in the last years of your life. This makes no sense.”

“By investing in personal social care so it is free at the point of need for everyone over 65, we can provide a better and more integrated care system, one that’s fairer to us all and saves the NHS £4.5 billion a year.”

Dean Hochlaf, IPPR Researcher and co-author of the report, said:

“Over the next decade the number of older people in the UK is set to grow substantially. This will bring with it more people facing diseases of ageing such as dementia, as well as higher levels of frailty. We need a social care system that is fit for purpose.

“Adding a penny or two to tax is a small price to pay for creating a simpler, joined-up system in which we collectively contribute to the costs that many of us and our relatives will otherwise face.”

Sir David Behan, chair of Health Education England and former chief executive of the Care Quality Commission, said:

"In 1948, politicians were brave in making the NHS free at the point of need and funded out of general taxation. We need our politicians today to be just as courageous and do the same for social care. After all, the hallmark of a civilised society is how well we treat the most vulnerable, including our elderly parents and grandparents. At the moment we are failing them but it doesn't have to be that way."



  1. The IPPR paper, Social Care Free at the Point of Need: The case for free personal care in England by Harry Quilter-Pinner and Dean Hochlaf, published today, is available at:
  2. The NHS savings figure (£4.5bn per year by 2030) from the introduction of free personal care is derived from a number of sources. The most significant is reform of NHS continuing healthcare – no longer needed as all people would receive free social care – which could deliver an annual saving of up to £2 billion a year, rising to £3.3 billion by 2030/31. Further savings would come from reducing admissions to hospital (£270 million per year); from matching the Netherlands which is the best performer in Europe for end of life care in the community (£267 million per year); and from reducing both delayed transfers of care and unnecessary hospital stays by those who are medically fit for discharge (£670 million per year).
  3. Details of Independent Age’s polling can be found here:
  4. IPPR is the UK’s pre-eminent progressive think tank. With more than 40 staff in offices in London, Manchester, Newcastle and Edinburgh, IPPR is Britain’s only national think tank with a truly national presence.