Key Messages 

• Means testing in adult social care creates financial barriers for individuals, limiting access to necessary services. 

• The current system disproportionately affects middle-income individuals, who may not qualify for support but struggle to afford care. 

• Regional disparities exist in how means testing is applied, leading to inconsistencies in access to publicly funded care. 

• The financial thresholds and complexity of the means-testing process can deter people from seeking support. 

• Alternative funding models, including insurance-based approaches and personal savings incentives, could improve financial sustainability and equity. 

Commentary 

Mayhew’s work provides a critical analysis of means testing in England’s adult social care system, highlighting the inequities and financial challenges it creates. The research shows that means testing disproportionately impacts those with moderate assets, who often face high care costs without financial support. This raises important concerns about fairness, particularly as wealthier individuals may have the resources to self-fund care while those with lower incomes receive state support. The findings also point to regional inconsistencies in how means testing is applied, contributing to postcode lotteries in social care access. Individuals in areas with higher care costs may find themselves financially disadvantaged compared to those in regions where services are more affordable.

A key issue raised is the deterrent effect of means testing, as some individuals avoid seeking care due to uncertainty over costs. This can lead to unmet care needs, worsening health outcomes, and greater pressure on informal carers. The research suggests alternative funding models, such as insurance-based schemes or incentivised savings, could help create a more sustainable and equitable system. While the research provides a strong economic perspective on social care funding, further work is needed to examine the lived experiences of those navigating means testing. Understanding the practical challenges faced by individuals and families could help shape reforms that balance financial sustainability with equitable access to care.