Improving equity and sustainability in UK funding for long-term care: lessons from Germany

This paper argues for a transformation of arrangements for accessing and allocating public resources for long-term care in the UK. Currently these arrangements are fragmented, inequitable and not always well targeted. While not necessarily advocating a social insurance approach, the experience of Germany nevertheless shows how simplicity, transparency and equity of access can be combined with strong cost control levers and political sustainability. An opportunity to transform ways of accessing and distributing public resources for long-term care arises with the piloting of ‘individual budgets’ in 13 English local authorities from 2006. The paper argues that the principles underpinning individual budgets should be extended, with the UK government taking a strong national lead.