The Long Road to Universalism? Recent Developments in the Financing of Long-term Care in England

Following more than a decade of intense debate, the long-term care system in England may be on the verge of major change. We argue that the current system can be characterized as a residual system where care is free only to those who cannot afford to pay for themselves, with access heavily targeted to those with the highest levels of needs and with no informal care, and with substantial local variation in access and means-testing for home care. It is also characterized by a mixed economy of supply of care and a mixed economy of finance. The government Green Paper has proposed a major shift from diverse local systems to a new National Care Service, with a national entitlement to some public support for all those who are assessed as needing it. The government has also recently announced that it will make personal care at home free to those with the highest needs. If implemented, the proposals included in the Green Paper would, at minimum, introduce a 'quasi-universal' system, in which some level of assistance is provided to all those with eligible social care needs.