While patients with cancer get free NHS care in hospital, others with Alzheimer's disease, looked after in nursing homes, have to pay an average of pounds 337 a week. This inequity must be removed by making all personal and nursing care free, whether provided in hospital or elsewhere, the commission says.
The 12-member commission, established in December 1997 by Frank Dobson, the Secretary of State for Health, in fulfilment of a manifesto commitment, says the question of how the costs of care in old age are to be met cannot be ducked. Sir Stewart Sutherland, the chairman, said: "We have found the current system to be confusing and complex, creating real fear among those approaching old age. This is a scandal and it must be changed."
However, the cost of its proposal, estimated at pounds 1.1bn immediately, rising to more than pounds 6bn by the middle of the next century, has been privately described by ministers as "unaffordable".
The Prime Minister's policy unit and the Treasury believe it would mean raising too much money in taxation to pay for care of the better off. But ministers have hinted that they may be prepared to raise the threshold for savings, currently pounds 16,000, above which old people have to pay for their care. Lifting the threshold to pounds 60,000, an alternative measure recommended by the commission if the Government balks at making nursing care free, would cost pounds 175m.
Mr Dobson said he would look carefully at the commission's proposals but made no commitments. He told MPs: "This is a complex issue and there are no easy solutions. We have to get this right."
The commission was split over the issue of free nursing care with two members producing a "dissenting" note. David Lipsey, public policy editor of The Economist, and Joel Joffe, chairman of Oxfam, argued that it would involve the transfer of huge resources to the property-owning middle-classes that ought to be concentrated on the most needy.
Mr Lipsey said yesterday: "The majority's proposals would mean higher tax bills and not a single penny of that would go on better care for elderly people. It would all be swallowed up in a new subsidy to better-off people and their heirs."
Sir Stewart countered that the commission's proposals would add only 0.3 per cent to the 2.2 per cent spent from taxation on long-term care. This would rise to 0.4 per cent in the long term. "Our proposals will end unfairness," he said.
A central question raised by the commission's 200-page report is whether it is the duty of the state to protect the inheritance of the elderly as well as caring for them, given that children are no longer inclined to look after their parents in old age. The majority on the commission argued it was unjust that people who had saved all their lives should have their savings taken from them in their last months or years because of increasing disability and illness, while those who saved nothing got their care free.
The agony aunt Claire Rayner, a member of the commission, said: "There is enormous anger among those over 70 who have paid all their lives for what they regard as National Insurance and who find when it comes to the crunch that the state is not there to pay for their care. It cannot be fair and no government in its right mind is going to alienate so large a proportion of the population and their children."
The minority argued that requiring the state to protect people's inheritance imposed an impossible burden and that there was an urgent need to provide more help to enable people to remain in their own homes.
One in three women and one in five men over 65 will need residential care at some time in their lives, the report says. A married couple would need to save pounds 85,000 to meet the cost of a residential home for each of them for three years.
There are 480,000 old people cared for in homes, 157,000 of them in nursing homes, of whom 42,500 are paying for themselves. An estimated 40,000 people a year have to sell their homes to pay for their care.
Total spending on the care of the elderly, currently pounds 11.1bn, is estimated to rise to between pounds 28bn and pounds 75bn by 2051.Reuse content