Page last updated at 14:16 GMT, Friday, 1 February 2008

The social care conundrum

By Nick Triggle
Health reporter, BBC News

Elderly woman
Social care differs across the UK

Scotland was widely applauded for introducing free personal care for the elderly in 2002.

But a watchdog has now called into question the wisdom of the policy.

Audit Scotland said councils were struggling to fund the system because it was not properly planned out in the first place.

The truth is it was only introduced because the Liberal Democrats insisted on its as part of the deal to form a coalition government with Labour.

But despite pressure to follow Scotland's lead, the other UK nations resisted - citing money as the primary reason.

Personal care, which includes help with things such as washing, dressing and feeding, is means-tested in England, Northern Ireland and Wales.

Nursing care

People with savings of more than 21,500 have to pay for their own care, while those with less either get it free or, if they are close to the threshold, contribute to the cost of the care.

The only exception is if the need for help is linked to a specific medical condition, which means it is classed as nursing care and provided free under the NHS.

This, of course, is a grey area and many people caring for relatives with Alzheimer's disease would not recognise that distinction.

The result is that people across the UK are dealing with a mish-mash of social care systems - all of which are facing questions about how sustainable they are.

In many ways, the funding and design of the system is a greater challenge than the NHS
Professor John Appleby

Professor John Appleby, chief economist at the King's Fund think-tank, says: "Social care is such a tricky area. In many ways, the funding and design of the system is a greater challenge than the NHS.

"We have an ageing population and what is more people's periods of ill-health are getting longer. They need more and more help, but there are only finite resources."

The Audit Scotland report pointed out that by 2031 the number of over 65s will increase from 800,000 to 1.4m.

This will obviously put incredible strain on the system, which the watchdog points out, is already facing a funding shortfall.

In England, social care came under attack by the Commission for Social Care Inspection earlier this week.


Its report said more and more elderly and disabled people were being totally excluded from care because councils were tightening their eligibility criteria.

So what is the answer?

Scotland insists it is sticking to its system of free personal care.

Although, interestingly, the Lib Dems have now dropped free personal care as a national policy.

Meanwhile, the government in England is due to consult on reforming social care this year.

But sources are already saying there are real tensions among ministers and policy-makers over what is the best way forward.

The King's Fund, in collaboration with the former government adviser Sir Derek Wanless, produced a paper in 2006 recommending a system of co-funding.

Many people don't feel it is fair they should have to pay for care
Gordon Lishman, of Age Concern

The authors said this would work by the state guaranteeing a minimum level of care which could then be topped up by the individual.

But this will be expensive with experts suggesting spending would have to treble to 30bn a year to pay for it.

Even the charities representing elderly people are struggling to come up with solutions.

Age Concern does not believe a free system is sustainable, but does not have a firm policy on what should happen.

Instead, the charity has called for a public discussion on the way forward.

Age Concern director general Gordon Lishman said it was a "huge challenge" for all the nations.

He said the Audit Scotland report showed the free system was not working, but equally many were going without care at all under the tightly-rationed English system.

"Many people don't feel it is fair they should have to pay for care.

"What is urgently needed is a new partnership between the state and individuals."

Minister backs costly care policy
01 Feb 08 |  Scotland
Q&A: Social care
29 Mar 06 |  Health

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