Unequal funding for the care of the elderly was today condemned as a "national disgrace" by Britain's leading doctors.

The four presidents of the Royal Colleges of Physicians in London, Edinburgh and Glasgow and of the British Geriatrics Society say the Government's failure to respond to last year's report from the Royal Commission on Long-term Care is causing continuing hardship and anxiety among older people.

In a letter to the British Medical Journal, the presidents cite a survey of members of the British Geriatrics Society carried out in January who were asked about the care of a person partially paralysed in all four limbs with double incontinence and great difficulty in speaking and eating.

Most said they would not be able to offer or recommend NHS nursing care for such a patient, because of a shortage of resources, but the responses varied widely across the country.

"This lack of equity is a national disgrace, disenfranchising the most needy people from the care they have every right to expect through the NHS .... We strongly urge the Government to fund long-term care properly and respond positively to the recommendations of the commission," the letter reads.

In its report published last March, the commission said personal and nursing care, which is currently means-tested, should be paid for from taxation, while the "hotel" costs of board and lodging should be paid by individuals themselves (or by social security for those too poor to afford it). The recommendation was designed to eliminate the injustice of situations where an elderly person treated in hospital receives free nursing and personal care but has to pay as soon as he or she is transferred to a home.

Critics of the proposals, including two members of the commission who produced a minority report, argued that the cost of making all personal and nursing care free would be more than £1bn. They claimed such a move would mainly help middle-class older people anxious to avoid paying for care in order that they could pass on their wealth to their children.

Ministers have since hinted that they may consider making only nursing care free, which, if tightly defined, would cost less - some estimates have suggested £600m. An announcement is expected in the summer.

The authors of the BMJ letter say: "Until the issue [of funding] is resolved, the distortions caused through friction between different authorities and budget holders will impede the introduction of a fair and satisfactory system of long-term care."

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