While the charities which campaign on long-term care provision
are united in their demands for national standards and inspection,
of the main political parties only the Liberal Democrats are
prepared to make a commitment
National standards and a national inspectorate to safeguard the
equity of services for elderly people evidently command even less
support in political circles than they do among those working in
community care. Of the three main parties, only the Liberal
Democrats have come close to taking these ideas on board.
At their September 1996 conference they voted for clear national
guidelines on NHS responsibility for continuing care and who is
eligible to receive it. All long-term care services should be
subject to national guidelines, they decided. They did not,
however, come out in favour of a national inspectorate.
In a paper issued by the party this month the commitment to
improving the security of elderly people was reinforced with
additional promises to raise the threshold of capital at which
people start paying for their own long-term care from the present
£16,000 to £24,000. The paper, A Fair Deal for Older
People, also pledged to end the arbitrary and financially driven
cuts in the provision of NHS beds which have so affected older
The proposals remain a framework, and the Liberal Democrats have
pledged to hold a full debate on all the issues surrounding
security in old age, but, says party spokesman Julian Astle, this
will not take place before the election. In the meantime he and
party whip Archie Kirkwood have produced a book of proposals for
reforming the system which will inform the up-coming
Published in January, Long-term Care: A framework for reform
posed the question: ‘do we want to pay for long-term care
collectively or individually?’
The Liberal Democrats argue that collective payment is the only
rational response, and propose a fully funded care insurance scheme
operated at arm’s-length from the government. A basic contribution
would deliver a basic service to each individual, but there would
be options to top up your own private fund to secure a wider range
Meanwhile, the other parties remain strangely quiet on the
thorny issue. The Labour Party has pledged to ‘raise standards and
end the lottery in community care’ by establishing a Royal
Commission to work out a fair system for funding long-term care for
elderly people. Labour would support national guidelines, and
introduce a national long-term care charter outlining what can be
expected from local services.
On inspection, Labour says it would ‘ensure high standards in
all forms of care with independent inspection and registration’.
Note the missing words: ‘national inspectorate’.
The Conservatives have yet to produce anything new on community
care for the election. The existing policy, the one that is causing
so much misery, is for local eligibility criteria with inspection
remaining at local level. The party does not believe national
guidelines will end the inequities that even its own ministers
acknowledge, and says its policy of devolving management to trust
level in the health service renders national guidelines
The charities with a brief to campaign in this area, such as the
Carers National Association, are unable to align themselves with a
single political party. But without exception they are asking for
national eligibility criteria, national inspection and national
standards, better support for carers and families through the
social security system, an end to the situation where 40,000
elderly people have had to sell their homes to pay for long-term
care, and a reinvestment in NHS-funded long-term care.
So far, only the Liberal Democrats have made a serious attempt
to address this agenda.
Long-term care: a framework for reform, from the Institute of
Community Studies, 18 Victoria Park Square, London E2 9PF.