Long term care will “implode” unless personal care comes free

BMJ 2003; 327 doi: (Published 02 October 2003) Cite this as: BMJ 2003;327:770
  1. Katherine Burke
  1. London

    The long term care situation across the United Kingdom will “implode,” unless the rest of the United Kingdom follows Scotland's lead and funds personal care for sick and disabled people, official advisers have warned.

    Nine of the original 12 royal commissioners on long term care for the elderly have called on the English, Welsh, and Northern Irish governments to scrap the “artificial” distinction between nursing and the intimate help some patients need with dressing, washing, eating, or managing their continence.

    Since July 2002, elderly people in Scotland have been getting the personal and nursing care they need free of charge (BMJ 2002;324: 1542), whereas in the rest of the United Kingdom those with assets of more than £12 000 ($20 000; €17 260) have to pay a proportion of the costs, rising to 100% for those with assets of £19 500.

    Administering such means testing costs money, the group pointed out in a 50 paragraph statement on 29 September. They estimate that providing personal care to anybody who needed it would cost a “modest” £1.1bn a year across the United Kingdom—substantially less than the £2bn that Whitehall has already committed to long term care.

    Some patients manage to get their personal care on the NHS because a district nurse delivers it, but the rest must pay privately for the same care from a healthcare assistant—a discrepancy that raises “huge ethical, conceptual and practical difficulties,” say the commissioners. The difficulties were pointed out in their original report nearly five years ago (March 1999).

    The rules on care funding mean that patients with dementia get a raw deal, according to commissioner Dr Iona Heath, a GP in north London and chair of ethics for the Royal College of General Practitioners.

    “It's a disease process, and yet the people who've got it [dementia] are told they need social care—there doesn't seem to be any justice in it,” Dr Heath told the BMJ.

    “People lose their dignity and hope because once they sell their house they can no longer go back to it. The predicament of people with Alzheimer's is truly dreadful. Then to be expected to use all your savings to pay for care.”

    The group is so concerned about the plight of people requiring long term care that it has continued to meet voluntarily four times a year for the past four years to monitor implementation of its proposals.

    Speaking on the BBC's Today programme, the chairman of the committee, Professor Stewart Sutherland, said: “Care need is not the fault of the individual and should be treated in the same way as heart conditions and cancer.”

    The Royal College of General Practitioners has backed the campaign for free personal care. However, the Department of Health has emphasised that only three in 10 older people pay the full cost of their personal care and that free care for all would “only ever benefit the better off.”

    “We could spend the additional £1.4bn the government is making available annually for improvements in service delivery on giving people free personal care, but we would buy not a single extra bed, not a single extra service, nor a single break for a family carer,” said a Department of Health press statement.

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