Feature Social Care

No quick fix for long term care

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c814 (Published 11 February 2010) Cite this as: BMJ 2010;340:c814
  1. Sam Lister, health editor, the Times
  1. 1Times, London
  1. Sam.Lister{at}thetimes.co.uk

    The UK prime minister wants free personal care for those with “critical” needs, but the proposed legislation is deeply flawed and hopelessly under-costed, finds Sam Lister

    The shortfalls in long term care for elderly people are, to quote a health minister addressing the House of Commons, “perhaps the most baffling problem in the whole of the health service.”1 The minister went on to suggest that the solution “lies rather in the home than in the hospital,” where a structured system of general practitioner, health visitor, and carer should ensure that people with long term sickness are looked after in their homes rather than being added to the lists of people who are institutionalised. “I think that the House will agree that, ideally, we should try to keep people as long as possible in their own homes.”

    It could have been Gordon Brown or Andy Burnham, England’s health secretary, speaking in parliament this week. In fact, it was Iain Macleod, Winston Churchill’s health minister, addressing a debate on the aged sick in December 1953.1 When Mr Burnham observes that home care for chronically ill people is a nettle that has not been grasped properly in decades, it is something of an understatement.

    No one would question that the provision of quality medical and domiciliary support for people with long term needs, paid for in a way that does not bankrupt them, should be a basic social aspiration. As the BMJ observed six months after the Macleod debate, the “wretchedness of many decrepit old men and women is unworthy of a civilised society.”2 The editorial referenced research from Scotland, carried out just before the formation of the NHS in 1948. Of 300 people being treated at home in Glasgow—for conditions ranging from heart disease and cerebral haemorrhage to diabetes, …

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