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Context: COVID-19 has disproportionately impacted mortality in English care homes. Objectives: To examine COVID-19 policies for care homes in England and to describe providers' experiences of those policies in May and June 2020. Methods: Mixed methods including policy analysis and an anonymous online survey of English care home providers, recruited using webinars and WhatsApp groups about their experiences of funding, testing, PPE, isolation and staffing until the end of May and early June 2020. Findings: Although social care policies in England have aligned with those advised by the World Health Organization, they were arguably delayed and were not implemented effectively. Testing had taken place in 70% of care homes surveyed but only 36% of residents had been tested, of whom 16% were positive. Managers were unable to effectively implement isolation policies and reported that workforce and funding support did not always reach them. Guidance changed frequently and was conflicting and could not always be implemented, for example when personal protection equipment was extremely expensive and difficult to source. Limitations: Although this was not a representative sample, care homes responded from across the country and we report the most consistent themes. Potentially, care homes that found it harder to implement national guidance may have been more inclined to respond to our survey than those who more easily changed practice, although those with outbreaks may also have had less capacity to respond. Some aspects of policy will have also changed since early June. Implications: Despite policies that were put in place, care homes amongst our survey respondents were still unable to access sufficient funding, testing, PPE, workforce support and practical support to isolate residents by the end of May and early June. Future cross-country policy analyses must examine policy implementation as well as content. Future cross-country policy analyses must examine policy implementation as well as content.

AbstractFollowing 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.

The UK Government recently announced plans to reform the system that determines how much the state contributes to people's long-term care costs. The reforms will start in 2016 and introduce a lifetime cap on the costs an individual will need to pay towards 'eligible' care and support needs. They will also increase the upper capital threshold above which care home residents are ineligible for local authority help with their care home fees. This increase will extend the possibility of state support to those care home residents who are currently excluded from state help because they have capital, usually including the value of their home, above the current capital threshold of £23,250. The lifetime cap is expected to be £75,000 in 20171, and the upper capital threshold in residential care will be increased to £123,000. This paper examines projected costs and distributional effects of these plans compared with the current system. It also contrasts these costs and distributional effects with the central recommendation of the Commission on the Funding of Care and Support (Dilnot Commission) which was set up by the Government and reported in 2011. The Commission's central recommendation was for a cap of £35,000 and upper capital threshold of £100,000 in 2010 prices. We also consider two variants on the Government's plans which would give additional help to recipients of residential care with capital below the proposed higher capital threshold (see Box 1 for how these compare with the current system, the Government's plans and the recommendations of the Dilnot Commission).

Many long-term care systems in economically developed countries are reliant on informal care. However, in the context of population ageing, there are concerns about the future supply of informal care. This article reports on projections of informal care receipt by older people with disabilities from spouses and (adult) children to 2032 in England. The projections show that the proportions of older people with disabilities who have a child will fall by 2032 and that the extent of informal care in future may be lower than previously estimated. The policy implications, in the context of the Dilnot Commission's report, are explored.

The future market costs of long-term care for older people will be affected by the extent of informal care. This paper reports on projections of receipt of informal care by disabled older people from their spouses and (adult) children to 2031 in England. The paper shows that, over the next 30 years, care by spouses is likely to increase substantially. However, if current patterns of care remain the same, care by children will also need to increase by nearly 60 per cent by 2031. It is not clear that the supply of care by children will rise to meet this demand.

Service commissioning is now a more formalized activity, and both purchasers and providers employ a variety of tools to inform their decision‐making. The present paper examines whether 'benefit groups' and 'resource groups' can be developed so as to assist these decision‐making processes by using a survey of the characteristics of 2093 adults with intellectual disabilities (IDs) in residential accommodation (mainly National Health Service trusts), and a supplementary collection of data on service utilization and costs (for a subsample of 930 clients). The clients were classified, according to their needs benefit groups (BGs), and the services which they used were classified in terms of coherence as likely packages of care and similar consumption of resources as resource groups (RGs). It proved possible to construct nine BGs and 96 possible RGs which had both intuitive meaning and explanatory power. Statistical analysis showed that the resulting BGs and RGs are meaningful ways of classifying ID and challenging behaviour needs and costs.

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Using two linked simulation models, we examine the public expenditure costs and distributional effects of potential reforms to long-term care funding in the UK. Changes to the means tests for user contributions to care costs are compared with options for the abolition of these means tests ('free' personal care). The latter generally cost more than the former and benefit higher income groups more than those on lower incomes (measuring income in relation to the age-specific income distribution). Reforms to the means tests target benefits towards those on lower incomes. However, the highest income group are net losers if free personal care is financed by a higher tax rate on higher incomes and the effect on the whole population considered.