Who will pick up the tab?

Ever since the fabled household means test of the 1930s depression years, the means test as a way of rationing public expenditure on welfare has been the object of near-universal loathing.

The various means tests which apply to social care charges are no exception. The long-running crisis at the boundary of health and social care, the point at which free health care ends and means-tested social care charges begin, continues unabated in spite of the involvement of the courts, the ombudsman and the government.

Unsurprisingly, a new campaign has been launched to protest against social care charges. The protesters have refused to pay, objecting to what they see as the NHS’s arbitrary decision to deny their eligibility for continuing care. A typical example is Ian Perkin, whose mother is in the final stages of vascular dementia and who has been told that she is only in need of social care. It is difficult to imagine the contorted arguments that have brought the health trust to this conclusion, even harder given the voluminous guidance that has appeared since the beginning of the decade. Praise would be due here for the Scottish system of free personal care, except that has plunged into a crisis of its own.

Bust budgets in primary care trusts, heading for a £1bn deficit by the end of the financial year, are inevitably the root of the problem in England. Councils, some of which are themselves running record deficits on adults’ services, have been left to pick up the tab for continuing care. Worse still, the National Service Framework for Long-Term Conditions has loaded extra costs on to local authorities.

In one sense, long-term conditions and continuing care ought to be a welcome challenge for social care. The subject gets its own chapter in the health and social care white paper, which sees it as part of a glittering future for community services where the two sides work harmoniously under a system of integrated care plans. Wisely, the white paper also promises a national framework for NHS-funded continuing care and nursing care. If the former is to have the ghost of a chance, the latter had better do what its predecessors have utterly failed to do and make a difference.

See Directors fear spread and Free personal care