Splitting hairs on care

This week’s unprecedented second report by the Royal Commission on
Long Term Care highlights the double standards of the Westminster
government’s treatment of older people compared with other groups
such as children and in its consideration of social care compared
with the NHS.

The continuing refusal to accept the principle of state-funded
personal care for older people in England is anathema to any notion
of promoting wellbeing as opposed to just providing a safety net –
a principle established for children by the recent green paper.

Drawing a distinction for funding purposes between nursing and
personal care is not only hair-splitting, it is intrusive and
undignified. Intimate personal care is intrinsic to health and,
from the older person’s point of view, inextricable from other care
they receive.

The present system of definition runs counter to the principle that
individual need is at the centre of service delivery. It puts
professional boundaries at the centre instead by defining what
should be free on the basis of who provides it (nurses).

The problems in the system of care for older people are of course
wider than this issue, and some of them loom large on the
government’s radar: delayed discharges, for example; and the
financial problems facing care homes. Long-term financial
starvation of social care is the main factor undermining the system
as a whole, with the only remedy being a Wanless-style review of
present and future funding needs.

But the funding system established in England because of the
government’s refusal to accept the commission’s original
recommendations in 1999 is also, ironically, a major contributor to
the problems that vex the government today. Proper funding of
personal care would certainly expedite the transition from
hospital, for example.

The government appears to think it can get away with underfunding
personal care by presenting it as separate from the free NHS. But
in this case, successive opinion polls have shown the public do not
make that distinction. The government itself, in all its
pronouncements apart from this one, acknowledges – indeed argues
forcefully – that such distinctions are meaningless to service
users.