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Last Updated: Wednesday, 29 March 2006, 23:14 GMT 00:14 UK
Just who will pay for social care?
By Branwen Jeffreys
BBC News health correspondent

Elderly man
Many people have to use their savings to fund care
We are all living longer - but the future is far from rosy.

More of those retirement years are being spent in poor health - reducing our independence and increasing the need for care.

On average a women now spends more than 11 years of her old age in poor health - for men it is more than eight years.

And that is not the only problem.

Our population is ageing, with pensioners becoming a much bigger segment of society.

It is estimated that tens of thousands of family homes are sold to meet the costs of care

That means fewer younger people in work paying taxes to fund our health and social care systems.

This is the double whammy that lies behind the Wanless report.

How can we afford the growing burden of care for a larger number of elderly people, and crucially, who should foot the bill?

Big problems

Charities campaigning for the rights of the elderly say the current situation is confusing and unfair.

The needs of an elderly person can be complex and hard to untangle into neat categories of nursing or social care

In theory, care is free in the whole of the UK if the primary need is for healthcare.

Other types of care are loosely banded together as personal care - otherwise known as social care.

But the distinction between what is nursing and what is not is often fiercely disputed because it determines who pays.

In 1999 the Royal Commission on Long Term Care for the Elderly recommended that personal care should be provided free.

While in Scotland free personal care has been introduced, it was rejected by the government for England.

That means an older person needing care faces means testing.

Variations

Each local authority has its own criteria for assessing what service should be provided free and at what point an individual has to contribute.

For personal care in a residential setting the threshold in England, Wales and Northern Ireland for having to pay towards your care is 20,500 and the value of your home can be counted.

Failing to qualify for funding from either an NHS budget or social services budget often leads to a lifetime of savings being spent.

It is estimated that tens of thousands of family homes are sold to meet the costs of care.

In Wales the Labour Party has done a u-turn on a manifesto promise to provide free personal care at home.

While measures to reduce the impact of charges have been promised, that leaves the situation the same as England.

In Northern Ireland all personal care is means tested under the age of 75. Above the age of 75 some personal care services are free.

MS patient

Many families face a bewildering maze of regulations.

The needs of an elderly person can be complex and hard to untangle into neat categories of nursing or social care.

A recent high profile case has shown how difficult it can be to navigate the system.

In January of this year 65-year-old Maureen Grogan won her fight at the High Court against Bexley NHS Care Trust for full NHS funding of her care.

It was too late to save the family home which had been sold to pay the care bills.

Mrs Grogan is immobilised through multiple sclerosis, and is doubly incontinent.

But NHS assessments had only led to partial funding of her care in a nursing home.

The case has left other trusts reviewing the way they assess cases.

Consultation

According to the Department of Health, new criteria for who qualifies for NHS funding for care are to be put out to consultation in April.

Charities like Help the Aged, and Age Concern will be lobbying hard for clearer guidelines.

It is against this background that Sir Derek Wanless is making his case for substantially increased funding for the elderly.

When he conducted a similar review of the NHS for the Treasury it led to an historic increase in funding for the health service.

This time his report has been funded by the independent think tank The Kings Fund.

That could allow the government to quietly ignore its findings but some campaigners are cautiously optimistic.

The recent White Paper on out of hospital care signalled a shift in priorities to give a greater importance to providing care to people in their own homes.

The Care Services Minister Liam Byrne is also canvassing views on all kinds of social care ahead of the government's spending review in 2007.

It is being described as a once in a decade chance to undertake a fundamental review, and Derek Wanless has agreed to join.




SEE ALSO:
Q&A: Social care
29 Mar 06 |  Health


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