Government will not back down over free personal care for all elderly people

The UK's minister for community care, Stephen Ladyman, has insisted that the government will not extend free personal care to all elderly people in England and Wales. The remarks were made at a meeting of the House of Commons select committee on health, as part of its investigation into the current state of continuing care in the NHS.

Dr Ladyman said that people demanding a move towards the Scottish system, which provides subsidised places in nursing homes and free personal care for everyone aged over 65, as recommended for all elderly people by the Royal Commission on Long Term Care (BMJ 2000;321:317), were guilty of a “callous misinterpretation of policy.”

He said, “The Liberal Democrats misled the public on this issue. In England we have a sustainable system which helps the poorest and sickest.”

The Department of Health estimates that an expansion of the Scottish model of care provision would cost the NHS an extra £1.5bn ($2.9bn; €2.2bn). “Bear in mind that by 2050 there will be four times as many people needing care—and at a higher level of intensity,” Dr Ladyman told MPs.

Nevertheless, he stressed that the department's forthcoming green paper would recommend “radical transformation” of the continuing care sector, “with the aim of supporting patients to live independent lives.” He criticised the Scottish system for encouraging elderly people to be sent to nursing homes or long stay hospitals, where care is cheaper, rather than being encouraged to live an independent life at home.

However, Dr Ladyman admitted that the system currently used in most areas of Britain to assess patients' eligibility for funded health care had been failing and that “people have suffered as a result.” He announced that the health department would be conducting a wholesale review of the way in which the needs of elderly people are assessed.

Speaking to the select committee, representatives from the Health Service Ombudsman's Office described the current procedure as “flawed.” In more than half the cases reviewed by the office, they said, decisions had been founded on inadequate documentation and poor consultation with friends and relatives, leading many people who should have received funded health care to foot the bill themselves.

Trish Longdon, a deputy health service ombudsman, also expressed disappointment at the way in which the department had dealt with complaints from patients whose applications for funding had been wrongly turned down. She was “very concerned” that the department had repeatedly failed to meet its own deadlines for processing the complaints, and she announced that the office would be investigating applicants' claims that they had been inadequately compensated for their losses. The health department repays health costs owed to the patient or their estate but does not compensate for distress or inconvenience.

Dr Ladyman reiterated that the department would not be making payments for anxiety and distress. “We must bear in mind that this is coming out of the NHS budget. That means my local hospital and your local hospital.”

But he said that, apart from this issue, “everything is up for discussion” over the next 12 months, as the health department re-examines the current funding structure. In particular it would be looking in detail at the criteria used to assess patients' eligibility for funding and ensuring that staff who conduct assessments are adequately trained.