Labour and Tory care proposals were not quite worth the ten-year wait, but they are moving in the right direction
Waiting for political action on care of elderly people is like waiting for a London bus. You wait sometimes patiently, sometimes fretfully, for ten years and then two turn up together.
At each of two recent party political conferences, major speeches – including that of Prime Minister Gordon Brown – made reference to the need to provide personal care for the increasing number of elderly people in our community. This is to be welcomed very warmly.
The Royal Commission on Long-Term Care of the Elderly reported on this topic back in March 1999. Well, it seems that the bus of the Labour Party (albeit a single-decker focused only on domiciliary care) has now turned up. Then another single-decker from the Conservatives (promising only proposals on residential care) has come round the corner. Could a general election be in sight?
The initial importance is that this topic is now being debated. Since demographic change marches inexorably forward, policies must address the consequences.
Brown’s outline proposals were both important and positive, but short of detail. The essence is that Labour plans to take away means-testing for domiciliary care at the point of provision for those in need.
This is a welcome change of direction. However, as we await a fuller account of quite what this amounts to, a number of comments and questions are appropriate.
The first is that the government is right to argue that care at home is the preferred option for most people. The second is that such a policy is financially sensible, for in general it reduces overall costs for everyone.
However, it is incomplete. Although care at home is the preferred option, there are two separate reasons for understanding the limits of this policy. The first is that residential care is the right option for some forms of need. For example, medical complications might require access to specialist care and possibly even equipment. Equally, certain specific frailties can require what is effectively 24-hour cover.
The cost and quality of care for either of these possibilities point to the need for care provision in a residential setting. But what is the relationship between patient and state at that stage? Surely it is not proposed to re-introduce a personal means test as granny is moved from home to nursing or residential centre?
There is a further series of questions to which there are doubtless answers: but those answers need to complement Brown’s conference headlines.
In post-speech interviews, ministers varied in their answers to questions about order of magnitude of need, numbers and costs. The figures seemed to converge on something like this: number of those for whom this policy would be effective – 300,000 to 350,000; overall costs to the Exchequer – circa £700m. Elementary arithmetic averages this out at around £40 per person per week. This would not buy an hour’s care for five days a week. Surely this cannot be the whole story. If it is not, what else do we need to know?
One fair point that was hinted at is that the care would be targeted at those in significant need. This raises three further questions. Where did the figures of 300,000 to 350,000 come from? What percentage represents ministers’ best estimate of significant or greatest need? What assessment criteria would be applied to give exemption from means-testing?
This latter is a difficult matter, for the temptation to vary the criteria or to apply them more or less stringently at local level, according to pressure on local budgets, is huge. In fact, the variation in provision of care from one local authority to another has haunted government attempts to introduce an equitable though more limited policy for the past ten years.
In summary, this is a good if belated start, but it has to be fleshed out.
Lord (Stewart) Sutherland chaired the Royal Commission on Long-Term Care for the Elderly
