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Sunday, 30 September, 2001, 23:37 GMT 00:37 UK
Long term care: The story so far
Events like the Pamela Coughlan case have been influential
The debate over long-term care has been rumbling throughout most of the last five years.

BBC News Online outlines the main developments in recent years.

The iniquity of the nursing home system was plain to see years before the changes announced by the government last year.

People who had saved prudently throughout their lives found their reward was being forced to pay thousands for their care in old age.

Many were obliged to sell their family homes simply to meet care home bills.

Groups such as Age Concern pointed this out repeatedly, but it was 1997 before significant moves were made towards a solution.

The Royal Commission on Long Term Care

This lengthy investigation was set up in 1997 to examine, chapter and verse, the way nursing and residential home care was funded in the UK.

It took huge amounts of evidence from campaigning groups and other health organisations, and finally presented its report in March 1999.

It verdict, greeted with delight by many groups, was that all care in old age should be paid for by the state.

Accommodation and living expenses should be passed on to the resident, as long as they were assessed to have the means to pay.

It suggested that this was an affordable option for the government.

Sir Stewart Sutherland, who chaired the commission, said: "These proposals target help on people in need of care, a proper objective for a modern welfare state.

"They also represent a new approach to inclusiveness for older people, one which will reap many rewards for society as a whole."

Campaigners then turned back to ministers to await their reaction.

The Pamela Coughlan Court Case

However, in the meantime, the Court of Appeal delivered a ruling seen as highly significant to the long term care debate.

Pamela Coughlan, who had been left severely disabled by a car accident, needed both medical nursing care, and personal care to assist her with washing and dressing.

Pamela Coughlan needs day to day care
Pamela Coughlan needs day to day care
She had been living in an NHS nursing home, receiving free NHS care, but the health authority decided to close the home and move her to a local authority residential home.

She faced losing her entitlement to free NHS care, and being means-tested and charged for accommodation and personal care provided by social services.

The court ruled that Mrs Coughlan was entitled to free NHS care - but not to free personal care. It said the NHS should pick up the tab for the medical nursing care.

This was a mixed result for campaigners, as it decided that the NHS was allowed to shut nursing homes and shift responsibility for care to local authorities.

Then Health Secretary Frank Dobson welcomed the verdict, which applied only in England and Wales.

The NHS Plan

The government's "design" for the future of the NHS was published in July 2000, and included its response to the Royal Commission's recommendations.

To the deep disappointment of pressure groups, it decided to implement it, but only partly.

Alan Milburn
Alan Milburn: Fully free care "too expensive"
From October 2001, the plan said, the NHS component of care would become free for all.

"People should not be asked to contribute towards the costs of their nursing care," it said.

However, it said that making all personal care free was unfeasible.

"Actioning the proposal would absorb huge and increasing sums of money without using any of it to increase the range and quality of care available to older people."

Scottish U-turn

Labour's plans for partial funding of long-term care in England were made to look less than generous by the Labour administration in Scotland, which succumbed to a backbench revolt on the issue in January 2001.

In future, both personal and medical care in Scotland will be funded by the state, giving ministers a financial headache - and campaigners south of the border a lever with which to apply pressure for free care across the board.

See also:

30 Sep 01 | Health
'Free care' plans attacked
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