Reform of long term care for elderly must not be postponed, Dilnot says

BMJ 2011; 343 doi: (Published 21 December 2011) Cite this as: BMJ 2011;343:d8284
  1. Nigel Hawkes
  1. 1London

Delaying the reform of long term care for elderly people in England until 2025 would be “completely unacceptable,” says Andrew Dilnot, chairman of the government commission that recommended changes to the present system.

The suggestion that there might be a delay sprung from reported remarks by Jeremy Hughes, chief executive of the Alzheimer’s Society, who said that it might take until 2025 for all aspects of the changes to be in place. Mr Hughes is one of six “discussion leaders” from the care and support sector invited by the Department of Health to provide advice that will feed into a white paper expected next spring.

The Treasury is reluctant to commit itself to the scheme devised by Mr Dilnot and his co-commissioners, Norman Warner and Jo Williams, because it would cost £1.7bn (€2bn; $2.7bn) a year to implement (BMJ 2011;343:d7689, 28 Nov, doi:10.1136/bmj.d7689). The commission proposed that an individual’s outlay for long term care—at present essentially unlimited—should be capped at £35 000 and that if costs exceeded this the state should step in.

So when Mr Hughes’s remarks were reported in the Daily Telegraph in a way that implied that the whole scheme might be delayed until 2025, which was not the implication of his original remarks, and no denial emerged from the government, the advisers became anxious. They responded with a letter to the Times, signed by Mr Hughes and three others, insisting that delay in reforming an unsustainable system would be “reckless” and would betray the needs of people who will need care later in life.

The suggestion that they had accepted the possibility of a delay was “a false portrayal of our work” and of the coalition government’s agreement that reform was urgent, the letter writers said. “The care system is funded in the wrong ways, resources are inadequate and misdirected and the legal basis for care is outdated,” they said, and while accepting that it would take time to complete the reform, they rejected the idea that starting it should be delayed.

Mr Dilnot said in an interview on Radio 4’s Today news programme, “The government has to be committed to this—2025 would be completely unacceptable. The government promised us a white paper by Easter of next year. Any such delay would be a betrayal of people’s trust.”

A Department of Heath spokesman said, “We will publish our plans in the spring which will set out how we are going to reform the social care system.

“Millions of people rely on the care system. That is why we are acting as quickly as possible on this difficult issue.”

Funding the scheme remains a major stumbling block at a time of austerity. Mr Dilnot, an economist who was recently appointed chairman of the UK Statistics Authority, said, “We have to find the money from somewhere. We can’t pluck it from a tree. Either government has to spend less somewhere else or increase taxes.”

One possibility is for pensioners to pay more through taxes, as they will be the group to benefit most, an idea suggested by the Dilnot commission. Andrew Lansley, the health secretary, has not ruled out that option.


Cite this as: BMJ 2011;343:d8284

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