Key messages

• means testing remains a central mechanism for determining eligibility for publicly funded social care in England
• the system can create financial barriers for individuals seeking care
• middle-income individuals may face the greatest financial pressure because they often do not qualify for support but cannot easily afford care privately
• regional variation in costs and service provision contributes to uneven financial outcomes
• alternative funding models, including insurance-based approaches or savings incentives, have been proposed as potential reforms.

Policy implications

• reform of the means-testing system may be needed to reduce financial barriers to care
• clearer eligibility rules and thresholds could improve transparency and understanding of the system
• policymakers may need to consider alternative funding approaches to improve long-term sustainability
• financial protection mechanisms could reduce the risk of high out-of-pocket care costs.

Gaps

• the analysis focuses largely on economic modelling and system design rather than lived experience of service users
• limited qualitative insight into how individuals and families navigate the means-testing system
• further research is needed on the real-world impacts of proposed funding alternatives.

Commentary
Mayhew’s work examines how the structure of means testing shapes access to adult social care in England. The analysis highlights how eligibility thresholds and financial assessments determine who receives publicly funded care and who must pay privately.

A central finding is that the current system can place particular pressure on individuals with moderate assets. Those with lower incomes may qualify for public support, while wealthier individuals may be able to self-fund care. People in between these groups may face substantial costs without assistance.

The research also points to variation in how financial thresholds interact with local service costs. Differences in care markets and local authority funding can lead to uneven financial experiences for individuals depending on where they live.

From a care inequities perspective, the study highlights how financial eligibility rules shape who is able to access care and under what conditions. Means testing can create uneven burdens across different income groups and regions, influencing both the affordability of care and the willingness of individuals to seek support. In some cases, uncertainty around costs may discourage people from accessing services, potentially leading to unmet needs and greater reliance on informal care.

Overall, the analysis contributes to debates on the sustainability and fairness of social care funding in England. It suggests that reforms to the financing system may be necessary to reduce financial inequities and improve access to care while maintaining long-term system sustainability.