For the first couple of years after Tony Knight and his wife, Kath, moved to the Isle of Wight in 2016, everything was perfect.
“We got a lodge in the open countryside. We took our first cruise from Southampton, and we were thinking, ‘this is what retirement should be like’,” says Tony, 78.
“Then we got hit with a bombshell.”
Tony would only recognise the early signs in hindsight, but Kath began mispronouncing words and losing her peripheral vision. When it got dark, she started arguing with her reflection in the windows.
In May 2019, she was diagnosed with vascular dementia.
Tony was looking after her at home – but when the Covid lockdown hit, her condition deteriorated rapidly. During a two-week respite stay at a care home in February 2021, Kath broke a care worker’s wrist.
For the three and a half years since, Kath has lived in a specialised care home on the island’s west coast. The cost is £6,000 per month, or £72,000 per year.
The Knights are living on the front line of Britain’s social care lottery.
Demand for adult social care is spiralling as Britain’s population gets older and more sick. But jumps in bills and wages mean the costs of delivering care have soared and local authority finances are crippled.
Nowhere is this more evident than on the Isle of Wight. The island off the south coast of England is the nation’s care bill capital.
The local authority spends more per head – around £630 in 2022/23 – on adult social care than any other English council, according to analysis by Grant Thornton.
It is an issue that successive governments have failed to properly address for decades.
But there was one small ray of hope for families facing the prospect of massive care bills: in October 2025, the long-delayed Dilnot reforms were due to introduce a cap on the lifetime care costs any person has to pay.
At the end of July, as part of her bid to plug a £22bn blackhole in the nation’s public finances, Chancellor Rachel Reeves scrapped them. Now, the future of adult social care funding is in a policy vacuum.
The issue is particularly acute on the Isle of Wight, where a large proportion of the population are retirees. There are 140,000 people living on the island and 29.2pc of them are aged over 65.
Across the UK the share is just 19pc, but it is growing fast. By 2072, the Office for National Statistics expects the number will hit 27pc.
The Isle of Wight right now is a microcosm of the UK’s future. What can the island tell us about the future of Britain’s adult social care catastrophe? And who should foot the spiralling costs?
Unfair healthcare
Britain’s adult social care system is overwhelmed.
In 2022/23, the number of requests hit a record high of 2m, an increase of 11pc compared to 2015/16, according to the King’s Fund. Yet despite the increase in demand, the number of people actually receiving funded support fell by 2pc over the same period.
The costs are becoming enormous, both for the public finances and for individuals. Between 2018/19 and 2022/23 council spending on social care surged by 29pc.
The annual sum is now around £28bn. But the money is still not enough - 400,000 adults are still waiting for care or an assessment of their needs, according to the Association of Directors of Adult Social Care Services (ADASS).
The bottom line is that Britain’s health and social care system was not designed for the needs of today’s population.
“Dementia is something that didn’t really exist when the NHS was set up,” says Joe Robertson, the newly elected Conservative MP for Isle of Wight East, who used to work at Dementia UK.
Today it affects around a million people in the UK, according to the Alzheimer’s Society. By 2040, it will be 1.4m.
At the same time, mental health problems have surged and the system is grappling with the ripple effects of NHS backlogs.
The squeeze throws an integral unfairness of the system into sharp relief.
“There is a fundamental distinction, which is that if you go to see your GP about cancer treatment, they are not going to ask you about the value of your house to determine whether or not you’ll get treatment,” says Simon Bottery, senior fellow of social care at the King’s Fund.
“If you go to your local authority because you need social care support for dementia, that is exactly what happens.”
But even the existing funding system is falling apart. Local authorities do not have enough money to meet the new demand. In addition to the financial means test, councils are raising the bar in terms of what needs they will provide care support for, says Bottery.
“There is a time bomb of people who will be left without healthcare support,” says Robertson. “In my opinion it is the biggest issue of our age.”
‘There’s no point saving for retirement’
Tony and Kath have been married for 58 years, but Kath cannot remember.
“I tell her I love her constantly, but I know Kath doesn’t really understand. Dementia robs us of our memories together, it’s not the same when you’re remembering on your own,” says Tony.
On top of this, Tony has had to navigate the social care funding system.
At the moment, anyone with assets above £23,250 has to foot their entire social care bill themselves. Savings, property, investments and pensions are all included, as well as other state benefits such as disability claims.
It also includes someone’s main home, unless the person’s husband, wife or certain relatives still live there. Local councils can also choose to leave the value of a home out of the financial assessment on a case by case basis.
The existing means test has been unchanged since 2010. If the assets threshold had been adjusted for inflation since then, it would have been £7,080 higher in 2022/23.
“A lot of people have to sell their homes,” says Joanna Smith, manager at Healthwatch Isle of Wight. Only once the cash from a sale has been depleted to £23,250 would the council step in.
In Kath’s case, shequalified for local authority support, but it was not enough. For the first couple of years of her care, Tony had to pay £1,500 per month to top up the payments.
“There is no point in saving for retirement as any savings are stripped from you,” he says.
“My wife and I paid tax and National Insurance all our lives. I was an employer, so I also paid employer contributions for other people.
“Yet we were still wanting for help when it came to a genuine illness. If she’d had an illness like cancer there is so much more help and funding. But dementia is perceived to be an old person’s disease.”
Finally, a year ago, Kath qualified for continuing healthcare, meaning her care is now considered a health need and is fully funded by the NHS rather than the local authority. Tony no longer has to pay any fees.
Getting this funding is extremely difficult and getting much harder.
According to ADASS, 56pc of the people who applied for it in 2023 failed to get it. In 2024, the figure jumped to 76pc.Increasingly, people who had previously qualified are also being reviewed and having their funding cut.
‘Social care just got left out’
The Conservative government had been due to introduce a new £86,000 lifetime cap on care costs for anyone in England, based on recommendations made in 2011 following an independent review by Sir Andrew Dilnot.
The Tories had also said only people with savings and income above £100,000 would have to self-fund care costs.
Originally due to take effect in 2023, the policy was delayed until 2025 owing to funding constraints.
The Tory government had estimated the proportion of older people in care receiving state support would increase from around half to around two-thirds as a result of the proposed reforms.
At the time, the Government estimated the annual cost of the reforms would rise to £4.74bn by the start of the next decade.
Reeves’s decision to halt the already long-delayed Dilnot reforms on affordability grounds has let down another generation of families, according to the man behind the report.
Sir Andrew, an economist, says he is “genuinely puzzled” why so little progress has been made after more than a decade grappling with the issue.
A Department of Health and Social Care spokesman said the Government has been forced to make difficult decisions because the reforms were not funded and would therefore have been impossible to deliver by October 2025.
“We are committed to reforming the adult social care sector and building a national care service to deliver high-quality care across the country,” they said.
But for Sir Andrew, the root of the problem extends much further back than the last government.
“Part of it I suppose is that whereas British arrangements for dealing with things like old age, ill health, sickness and disability were put in place in the post-war period, social care just got left out,” he says.
“We created the NHS, we created the state pension, we created unemployment insurance, but social care got left with local authorities. And so it’s just an issue that’s been left on the margins of society.”
We’ve been here before. Almost 30 years ago, Labour’s manifesto promised “to work out a fair system for funding long-term care for the elderly”.
Tony Blair then established a Royal Commission on social care when he became prime minister. It recommended that all nursing care should be free and that other care such as bathing, dressing and feeding should also be free according to need.
The report recommended the measures be funded through general taxation, suggesting that the extra costs were affordable.
However, the recommendations were dogged by a split in the commission after two of its members, Lord Lipsey, a journalist and now Labour peer, and Joel Joffe, then-chairman of Oxfam, argued the bill for the taxpayer would be much larger.
Lord Lipsey says one of the reasons why the first Royal Commission failed was that “it was stuffed with people who had no economic knowledge”.
Led by Scottish academic Lord Sutherland, the dozen commissioners included Britain’s first black QC, a former chairman of the London Stock Exchange, and agony aunt Claire Rayner. “There was little recognition that there could be a constraint on public expenditure at all,” he says.
Three decades on, and Lord Lipsey says he’s not surprised that no solution has been found. “The dilemma at the heart of this is that the state of social care is in many ways very poor.
“You’ve got a shortage of beds, difficulty in looking after people with dementia, and for me, the complete underpaying of care home workers which is a national disgrace. So that all needs money.”
The Labour government ultimately rejected the idea of free personal care in England and made only minor changes to the means testing of personal care following the report.
Fast forward to 2024, and Sir Keir Starmer’s Labour manifesto included a similar promise. Itacknowledged that the social care sector needed “deep reform” and said it would set up a National Care Service and that it wanted to move to a “more preventative system”.
Detail on this vision is so far scant, but it is expected to be enshrined in a new Royal Commission on the future funding model led by Baroness Casey.
However, Sir Andrew describes another inquiry as just “more dithering”. A commission will take years to complete. He adds: “I’m not sure that more reflection is needed. Decisions are needed.
“The real question we have to answer is what’s the balance of responsibility between the individual and the state? And how are the funds going to be delivered?”
Lord Lipsey believes people who can afford to pay for social care should pay more. “If you are unlucky enough to need care and if you also have financial resources, it can stretch your financial resources. And yes it reduces the amount of money you can leave to your children.
“But to me, it’s vastly more important that older people receive good decent care from reasonably remunerated people.
“To Sir Andrew Dilnot it’s more important that rich people don’t lose their resources because they’re unlucky enough to have to go into a care home.”
Sir Andrew denies this is the case. “Many people have thought that the objective of the cap is to protect people’s inheritances. In my view, the objective is to get people tospendtheir inheritances.”
He argues that the lifetime cap would stop people from hoarding their money.
Either way, Sir Andrew says Britain’s rising health and social care bill will dramatically increase pressure on the state. “Unless other areas of public spending are reduced significantly, I think it’s likely that overall tax revenue will need to rise.”
One option, says Sir Andrew, would be to make pensioners pay National Insurance.
He says: “At the moment, pensioners do pay tax. They pay income tax and they pay indirect taxes. But they don’t pay the National Insurance contributions.
“I think if a government does decide to have a tax that is used explicitly to pay for [social care] in part, then it does seem reasonable to have pensioners covered by that tax, just as those of working age are.”
Lord Lipsey also believes higher taxes are inevitable, though he would revalue and reform council tax in England.
Ticking time bomb
Ben Buckett, 75, has lived on the Isle of Wight all his life. When he got too old for factory work he got a job as a kitchen porter, working long past state pension age – until he had a stroke three years ago.
Buckett looked into getting support then, but paying for a visiting carer would have cost £300 per week. “I wouldn’t have been able to afford it.” He went without.
Buckett has an alarm cord that he can pull in his home in an emergency, and he has family support. But his decision shows the wider risks that come with a creaking system.
Thirty years ago, elderly people got funding to move into care homes when they had some health problems and were socially isolated, says Healthwatch’s Smith.
“Today, most people going into care homes that are funded have very complex needs like dementia or intravenous feeds.”
The people who are not entitled to support have three options. They can pay for their care themselves, rely on friends or family or go without, says Bottery, of the King’s Fund.
There is already a risk that many people are going without care that they need, says ADASS president Melanie Williams. Without support, these people’s needs eventually bounce on to wider health services, such as GPs and A&E.
Getting help from friends and family also has an economic cost.
Across the country, an extra 700,000 people have begun providing informal care since the pandemic began, bringing the total to 5.2m, government data shows. Many of these people need to quit their jobs or cut their hours so that they can care for their parents or partners.
For those who pay for themselves, selling their home is the norm. Alternatively they enter into deferred payment schemes with their local authority, meaning the council pays the costs upfront and the debt is repaid on the sale of the property.
Isle of Wight Council helps around 20 people each year via these schemes. There is no limit on how much people will have to pay for their own care. “They can end up with bills of £100,000 or £300,000,” says Bottery.
But there is an even bigger problem coming down the track, says Richard Quigley, the Isle of Wight’s first ever Labour MP, who has been elected in the constituency on the west side of the island.
Britain’s housing crisis means that future generations of retirees will not own homes that they can sell, Quigley warns. “Where’s the money going to come from to pay for care? That responsibility will fall to local authorities again. There’s a time bomb ticking away.”
Shortage of beds
TheSpringfield Nursing Home in Shanklin began life as a hospital. “We have residents who were born in this building,” says Emma Davis, the home’s manager.
Now, the island does not need the building for births but elderly care, and the home is racing to keep up with demand – it is full, with a waiting list. This autumn it will open a new 16-bed wing tocater for people with dementia.
Care homes are a paradox. Demand has boomed, local authority spending has surged, but fewer and fewer care homes can break even.
Hartford Care estimates that the wholesale cost of one person’s residential care is £1,228 per week.
The funding offered by local authorities for referrals varies from £600 per week to £1,300. At the lower end, this would mean the care home would make a loss of £628. At the higher end, they would just about break even. Often the company has to turn away referrals.
Finding staff is also a big problem for the sector. In 2021/22, the care home vacancy rate hit 10.7pc, the highest rate on record since at least 2012/13. This eased slightly to 9.9pc in 2022/23, but is still extreme.
As a result, the number of care home places is falling rather than rising.
In 2022/23, the number fell by 2,000 to 455,000. Back in 2012, there were nearly 12 care home places for every 100 people aged over 75, according to the King’s Fund. In 2022/23, there were fewer than nine.
Although local authorities are spending more on social care, the cash is being spread more thinly. At the same time, the wholesale cost of care has soared, driven up by higher energy bills, wage rises and post-pandemic jumps in insurance.
On the Isle of Wight, hiring problems are compounded by geography.
“The island is characterised by a constrained labour market and higher cost environment,” says Laura Gaudion, director of adult social care at Isle of Wight Council.It is largely rural and connected by bus. Commuting by ferry from the mainland is expensive and unpredictable.
Another Labour manifesto promise was a fair pay agreement for social care workers, which will set a new minimum wage for adult social care work. This is the one social care reform that Labour will definitely progress, says Bottery.
But increasing care worker wages would be a double-edged sword. Although it would plug vacancies, it would likely necessitate care home fee increases.
“Unless more funding goes in, you can’t see any way that this sort of policy could be implemented,” says Bottery.
Labour’s plans for a Royal Commission may simply be down to tactics on the wider cash question, he adds. “It is potentially a vehicle to start warming up the public to the idea that actually, to reform this, we are going to have to spend more money, and that is going to cost us.”
The consensus is that the system needs an injection of at least £3bn a year just to run properly, even before looking at specific reforms.
For one 80-year-old pensioner, wearing a shirt and tie to push his wife in a wheelchair along the seafront at Shanklin, the fiscal storm feels far away.
His wife has dementia andcannot wash or dress herself, but she can still make him laugh. “She says the funniest things. The other day she said: ‘I just said something, but I didn’t say anything’.
“I said: ‘You should have been a politician.’”
