Submission to the Royal Commission on the funding of Long Term Care 1999

(Greater Manchester SHA)

  1. We regard the funding of long term care as the collective responsibility of a civilised society. Those of us who are well paid should contribute through progressive taxation which is fairer and more cost effective than individual insurance.
  2. We consider that the provision of nursing care to people in nursing homes is just as much the responsibility of the National Health Service as it is in hospital or for people in their own homes and it should be free, just as medical and paramedical care is free.
  3. The provision of housing costs should be the responsibility of users with the assistance of meanstested benefits if necessary, just as it is for other citizens. In this context we have no problem with the notion that people may have to sell their homes if they are no longer suitable for their needs and that the proceeds should be used to meet the cost of alternative accommodation. But we do not think that this capital should fund nursing care. We are concerned, however that the present arrangements contribute significantly to the social exclusion of older people. Meanstested benefits, however they are organised, inevitably penalise thrift, and reduce the understanding that the welfare state is a binding contractual arrangement which is important to ensure that the costs to the working population are seen as acceptable. This is an important part of the lifetime redistribution of wealth.
  4. It is particularly important to ensure robust means of quality control in the area of residential care and nursing homes in which many users are not able to express views of their own. These should include advocacy schemes so that users are, as far as possible, enabled to express their own choices. Registration and inspection services should be adequately resourced and would be more effective if one team inspected all types of establishment. There should be contractual mechanisms to ensure user involvement in decision making.
  5. Most care is and will probably continue to be provided informally, mostly by families, and it is important that the burden of care which falls largely on the female relations of the elderly and disabled population should not carry with it unnecessary disadvantage. The level of Invalid Care Allowance is so low that only people with other sources of income can possibly live on it. The fact that it is less than Retirement Pension or Incapacity Benefit serves to emphasise its low status. Carers should be valued and supported and encouraged. They provide a higher quality and cheaper source of care than residential homes. Invalid Care Allowance should be increased and Carer Premium should be available to pensioners. Many carers find that when they cease caring they cannot find work and in their turn they have a depressed pension. The social exclusion which they suffered while caring is perpetuated. Measures should be instituted to tackle these problems. National Insurance Credits should be granted to carers, rather than the present arrangements of the Home Responsibility Protection scheme, which protect carers less than unemployed or sick people.
  6. Local authorities and the NHS should give a higher priority to the provision of support services, particularly respite care and holidays with paid alternative care, for carers.