For many of us the end of the year offers us an opportunity to reflect on our successes and failures over the past twelve months.

In the world of health and social care in England the expectations for 2015 were dominated by the hopes and fears associated with April’s implementation of the Care Act. At Independent Age one area of policy we were particularly interested in monitoring was how local authorities would apply new rules concerning care home top-up fees.

What are care home top-up fees?

If a person has been found eligible for local authority funding for a care home place, the council must provide them with at least one choice of care home that meets their needs and that is available at the amount of money they have offered. If they prefer a more expensive care home to the one the council has offered, they should still be able to move there if someone will pay the difference. In 2014 across the UK it is estimated that 48,000 care home placements involved a third party top-up – 24% of all people receiving local authority funding. 

Why should we care about care home top-up fees?

The law is clear that care home top-up fees should only be paid voluntarily. However, there have been cases in which families and friends are only being presented with care home placements which require a top-up. We call this the ‘Secret Subsidy’. Secret, because families are not told being made aware of their legal rights about top-ups and that a top-up should only ever be a free choice. A subsidy, because there is evidence from care homes in particular that top-up fees are increasing as the rates councils pay for care decreases.

Freedom of Information – 2013

In 2013 Independent Age sent a Freedom of Information to all local authorities in England asking them about the extent and level of top-up fees and their policies and practices for handling them. The results were very concerning with many local authorities failing to record, monitor and regulate top-up fees.

Freedom of Information – 2015

The Care Act introduced tighter rules regarding how local authorities administer care top-up fees including an annual review of arrangements and more transparency. In Autumn 2015 we submitted a Freedom of Information request to all local authorities in England designed to investigate compliance with these rules.


 The findings indicate that there has been some progress since the introduction of the Care Act. A total of 48% (58 out of 122) of local authorities have written agreements in place for all top-up fees entered into since April. Whereas in 2013, only 28% (36 out of 129) even had information about all top-up fees in their area, according to our previous research.

Despite this more progress needs to be made:

  • 35% (36 out of 103 who responded to this question) of local authorities reported that they have not presented all third parties with a written agreement on entering into a top-up arrangement – a requirement in statutory legislation
  • 37% (34 out of 93 who responded to this question) of local authorities could not demonstrate they had procedures in place to review top-ups at least annually – a recommendation in statutory guidance
  • 41% (32 out of 78 who responded to this question) of local authorities reported that at least some third party arrangements did not involve the local authority – a recommendation in statutory guidance

In total 53 local authorities were failing to demonstrate good practice against at least one of these measures. This represents 43% of the 122 local authorities who responded to our Freedom of Information request.

Moving forward

We are pleased that local authorities seem to have engaged with the changes in the Care Act and that the majority of people entering a top-up appear to be receiving a written agreement. However, we welcome renewed determination by all local authorities to ensure they are compliant with the new rules and that top-ups are being managed effectively. We would recommend that local authorities carry out an annual review of their performance in managing care home top-ups. If councils do not take action Independent Age would recommend that the Local Government Association or Parliament investigate why problems are still persisting. As the Care Act approaches its one year anniversary it is only right that councils are held to account. A New Year. A new start. 

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