Last Updated on November 10, 2026
A new report argues that Government's proposed National Care Service must address the financial 'injustice' currently faced by self-funders. The care system in England forces over 220,000 people to pay all their adult social care costs, making our country a stark outlier among comparable countries in the new report from The King's Fund.
England uses a 'means test' to decide whether people can receive any state support towards care costs. Those with savings and assets worth over £23,250 have to pay all their own costs, which can run into hundreds of thousands of pounds. There are around 137,000 'self-funders' in care homes in England and over 83,000 using home care – representing a third of care home residents and just under a quarter of home care users.
Most comparable countries do not require anyone to pay all their care costs themselves. Instead, comparable countries provide some funding to everyone in need: a 'means test' is used only to decide how much individuals will have to contribute towards the total bill.
The research, which is a collaboration between The King's Fund, the Global Observatory of Long Term Care and academics in Australia, Japan and The Netherlands, identifies only three comparable countries – the United States, Cyprus and Wales – which operate systems similar to England.
The report highlights the inequity of the current system. Self-funders pay all their care costs and typically pay much more than people who pass the means test and qualify for state support. The large sums they may spend on care prevent wealth from being passed between generations. Self-funders may also receive poorer care because they have to navigate a complex care system without support.
The report argues that England should move towards a universal system of social care support, similar to most other comparable countries, that gives everyone who needs it some degree of publicly-funded support, with users making co-payments to contribute to their care costs according to their income and assets.
It comes soon after the Prime Minister announced an ambition to create a National Care Service, which could be the most significant social care announcement for a generation but is still short of detail.
Commenting on the report's findings, Simon Bottery, Senior Fellow at The King's Fund and lead author of the report, said, 'Other countries let people into the publicly-funded social care system and then use a means test to determine if they should contribute a percentage of the cost. But England excludes some people from getting into the publicly-funded system entirely and makes them pay all their costs. For some, it is a near 100% inheritance tax in all but name. That is unfair and needs to change.
'As England moves towards creating a National Care Service and awaits the recommendations of the Casey Commission, there is a long-awaited opportunity to tackle the injustice faced by self-funders. The Government must not miss this chance to create a fairer care system.'
Deborah Rozansky, Director of Policy, Research and Partnerships at the Social Care Institute for Excellence (SCIE), said, 'This report highlights a fundamental unfairness in how we pay for social care. As fewer people qualify for state-funded support, more are having to meet the costs themselves, turn to family and friends, or go without the care they need.
'Those funding their own care can face significantly higher fees than people whose care is arranged by local authorities. This is often for the same package of care. We must recognise that self-funders are not a single, financially secure group. For many people with modest savings, meeting these costs means making difficult decisions about their care and watching their financial security diminish.
'Equity in social care is complex, and fairness cannot be measured by financial eligibility alone. Our recent research found that while those able to pay for their own care can sometimes secure greater flexibility and more personalised support, this advantage can come at a considerable and potentially unsustainable cost. Equally, those with the fewest resources often face the greatest barriers to securing the support they need.
'A future National Care Service must recognise both realities. A fairer system must protect those facing the greatest disadvantage without overlooking the unfair financial burdens placed on others. Ultimately, everyone should be able to access care that meets their needs, with dignity, choice and control, regardless of their financial circumstances.'
To read the new report, Out of sight and out of pocket: How self-funders pay the price for England’s unfair social care system, click here.
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