All older people should be guaranteed basic level of care

All older people should be guaranteed basic level of care, report says

Michael Day

The controversial policy of means testing elderly people who need long term care must end, says a new report. Under radical proposals set out by Sir Derek Wanless, the number of people in England required to sell their homes to pay for personal care would be slashed—but at a price.

Sir Derek, who produced the 2002 Treasury report calling for a massive rise in NHS funding, now advocates a near doubling of social care spending over the next 20 years, from 1.1% to 2% of gross domestic product (BMJ 2002;324:998, 27 Apr). This would result in a tripling of the budget in cash terms from £10.1bn (€14.5bn; $17.5bn) in 2006 to about £30bn by 2026.

But Sir Derek said that the plans, published in partnership with the King’s Fund, would guarantee all elderly people a basic level of care, regardless of their ability to pay. People would still be able to top up the service they receive out of their own pockets—with every £1 they put in matched by an equal contribution from the state. In total, the plans envisage the state paying for 83% of the social care bill.

Currently, people with assets of £20 500 or more have to pay their care home fees, forcing many of them to sell their homes. Sir Derek said that the current system meant that only very poor or very dependent people were getting adequate help: "People in moderate need or those in moderate ill health are not getting enough help or support."

In Scotland free personal care has been provided for older people since July 2002, when Scotland broke away from England’s policy of means testing.

Jonathan Ellis, the policy manager at Help the Aged, urged ministers to follow Sir Derek’s advice: "This review will serve well to increase already mounting pressure on the government to finally put its money where its mouth is in the delivery of health and social care.

"Doing nothing is not an option. The government can ill afford to stand back and allow older people to continue to suffer a confusing and unfair health and social care system. Putting an end to the complex and undignified means testing system would remove many of the barriers obstructing older people’s access to high quality care and support."

The Department of Health responded by saying that it would set up a task force, including Sir Derek, to examine the proposals.

Helena McKeown, the chairwoman of the BMA’s community care committee, said that the report showed that access to social care services had serious gaps. "With the number of over 65s set to rise, politicians of all parties must take heed of this report’s worrying findings," she said.

The Conservative shadow health minister Stephen O’Brien said that people were still being forced to sell their homes to pay for nursing home care up and down the country. "We welcome the proposals to restrict means testing, which is not only demeaning but . . . means that those who have taken care to provide for themselves in old age are in no better a position than those who have not done so."

The report, Securing Good Social Care for Older People: Taking A Long Term View is available at www.kingsfund.org.uk/publications.