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Since July 2002 Scotland has shown its caring side with a policy that is the envy of the rest of the UK. For since then, older people have enjoyed free personal care, a level of provision that has defined social care north of the border.

For England and Wales there is one certainty when the new government is formed after the general election on 5 May: unless there is a huge political upset and the Liberal Democrats come to power, neither Labour nor the Conservatives will be bringing the Scottish model down south.


Nevertheless, there are differences in approach.

If Labour is returned for a third term, free personal care will continue to be unavailable to over-65s who have assets worth more than £20,000. For the majority, costs will continue to be met by the recipient or the local authority through means testing.

According to community care minister Stephen Ladyman, Labour does not believe that universal free personal care is the "best use of limited resources". He says: "It would consume most of the additional resources we are making available to allow older people to remain longer in their own homes."

Labour claims this will improve general standards of care for all older people. However, there are caveats to its pre-election pledge that all pensioners would be in control of a personalised budget of up to £10,000 to pay for their personal social care by the end of the decade.

First, this is not new money, but a re-organisation of existing funds into one pot. Second, older people who need social care will still be means-tested and it remains unclear as to how this will relate to the size of the personalised budget an individual would receive. Third, the success of this scheme would depend on the quality of services that older people could access with their personalised budget. More detail would be known about this policy after the pilot schemes that Labour plans to introduce early into a third term have been completed.

In line with its wider commitment to the partnership ethos, Labour prefers to look at the system of health and social care as a whole. Paradoxically, on paying for services, the availability of free nursing care means the distinction between the two sectors will remain. In principle, some commentators see this as illogical. Others find it hypocritical that a party insisting that integration between health and social care is essential to deliver the best care still clings to that distinction. This undermines the strategy, they say, and appears to be motivated purely by economics.

Like Labour, the Conservative Party does not plan to introduce free personal care for all over-65s, but retain it for those with assets of less than £20,000. However, rather than have them sell their homes, a Conservative government would encourage people to take out insurance policies against the first three years of care, after which the state would meet the costs.

But is this a realistic attempt to deal with cost, or a cynical attempt to make the public believe that the party is dealing with the needs of the over-65s without making a financial commitment? Figures suggest that most people are not in long-term care for as long as three years. The average is about two and a half years and, when the odd exceptional case is considered, the median figure is much lower.

The Conservative Party estimates that 12,500 people a year would be funded by the taxpayer under its scheme - incurring additional costs of about £500m a year (an additional 20 months of care at a maximum of £25,000 a year for those who now pay their own fees).

Cynics might also claim that the prime motivating factor behind Conservative policy is to boost the insurance industry. Although the possibility of paying out premiums for many years' worth of individual care has deterred some companies from involvement in this market, it becomes more attractive if a three-year cut-off point is introduced. Moreover, homes do not have to be sold and legacies remain untouched.


The three-year partnership scheme covers care in residential settings only, but proposals explaining how a Conservative government would seek to support voluntary carers are imminent. It is expected that at its heart is the party's belief that family members and friends should be supported more while caring for older relatives.

Of all the major parties, only the Liberal Democrats are committed to introducing free personal social care for all over 65s. Unlike Labour and the Conservatives, the Liberal Democrats are prepared to raise taxes to meet the cost in the form of a 50 per cent tax band on incomes above £100,000.

It could be said the Liberal Democrats can afford to be idealistic, as opposed to the more serious contenders for office, but much can still be learned from the party's ideas. People living with long-term illness or disability want the NHS and social services to fit around their lives. What is more, it might be difficult for someone to understand, let alone accept, that while they have to pay for one type of care other types are free - or that the nature of their condition might determine the cost of their care.

Liberal Democrats also plan to go further than Labour - integrating, rather than simply fostering, closer working relationships between those responsible for the commissioning of social care and health within local government. This would involve big organisational change, not to mention winning over the hearts and minds of those responsible for implementing and delivering the new policies. For people who have been used to working in a certain way for so long, such a change might prove difficult and a new layer of red tape could appear.

In contrast, the Conservatives plan to instigate an immediate review of all long-term care regulations, says shadow health minister Simon Burns, with a view to attacking this sort of bureaucracy.

"We will abolish regulations which do nothing to enhance the quality of care," he says. "No longer will care homes close against the will and instinct of their owner because they cannot afford the adjustments required to meet over-prescriptive regulations dictated from Whitehall. No longer will care home owners and staff have to spend their time filling in forms and doing paperwork when they could be caring for their residents."

Although laudable and always popular, the idea of mass attacks on red tape overlooks the crucial distinction between wastage and need. Which quangos and other administrative organisations are to be cut? How will departments be streamlined? Will the inspection and regulation process itself be loosened? If so, how can we be sure that care homes provide a quality setting and are not run simply to make a profit?

If a future government wants to make a difference, rather than cutting bureaucracy to make things cheaper or increasing it so it can apparently do more but usually does less, how about simply refocusing it? So, rather than a bureaucracy that has the needs of providers, local authorities, government or itself as its underlying motivation, it actually focuses on improving the quality of life for the resident.