It's your chance to do right by the elderly. They can't wait

This week the Government unveils its plans for old people, who won't be fooled by fine words
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The Independent Online

Nearly 18 months of waiting will come to an end later this week when the Government finally announces its decision on how it will organise and fund long-term care for the elderly.

Nearly 18 months of waiting will come to an end later this week when the Government finally announces its decision on how it will organise and fund long-term care for the elderly.

The Government set up a Royal Commission to sort out long-term care at the beginning of 1998. It delivered its report a year later. And then? We heard nothing for many months, the report seemingly ignored. The commission members have made it clear that the Government has taken an unreasonable amount of time. Age Concern and other charities and organisations involved in the debate know from calls and letters received from older people that change is urgently needed, for the current system cannot meet the needs of older people now, let alone in the future.

The stumbling block for the Government seems to have been the cost of the commission's key proposal, which was to make all nursing and personal care free. This, and the creation of a national care commission to oversee standards and monitor the numbers of people in long-term care, would cost an estimated £1.2bn, a relatively modest amount given the resources currently available through the Spending Review 2000, announced last week.

If only nursing care is made free, some 42,500 people will undoubtedly benefit, according to the commission. It will also solve one of the biggest anomalies of the NHS, which is that if you happen to suffer from cancer, for instance, you will receive your care free. If you suffer from Alzheimer's disease, and you need a high level of nursing care, the chances are you will receive it in a private nursing home setting and have to pay. Nursing home bills average £350 a week, a hefty amount, so changes to this system which mean less financial burden on vulnerable older residents would be welcome. If the Government does, as is currently being predicted, decide that nursing care should be free wherever it is delivered, the news will bring welcome relief to many thousands of people currently living in care, or anticipating the need for care in the near future. But this alone will not solve all of the existing problems.

One of the most thorny questions is how you actually define what nursing care is, and this is an issue that has been exercising the minds of ministers, officials, voluntary sector organisations and health and social care professionals over the past few months. Tasks that most of us would consider to be part and parcel of nursing - help with getting in and out of bed, or to the toilet, or help with eating - are actually provided by healthcare assistants. Many people living in nursing homes do not need the kind of intensive and hi-tech interventions that patients in hospital may need. But they do need more specialist care from trained nurses than would be provided in a residential home.

If nursing care is to be free, the definition must be as wide as possible because older people don't always fit neatly into boxes. But it must also be a clear definition. Long-term care is currently bedevilled by differences of interpretation between NHS and social services about who pays for and who provides what type of care. To introduce any more need for interpretation into the system would be a disaster. We need firm rules, not weak guidance.

So what else is in the offing? Well, there is the concept of intermediate care, providing a bridge between hospital and home. The Department of Health's idea is to end the problem of so called "bed blocking", which occurs when older people are well enough to leave hospital but cannot because the support they need is not available.

Intermediate care seems a good idea. But it will need careful planning and sufficient resources if it is to work well. There have been suggestions recently that spare capacity within the private nursing home sector could be used to provide intermediate care. I have no objection in principle to the private sector playing a role in this way, but for the system to work such homes would need to refocus their resources to provide the rehabilitative care that these clients would need. And can we be sure that there will be enough money and enough nurses to staff these new rehabilitation services?

The Government's response to these and other questions will, we anticipate, be presented this week as part of the Government's 10-year plan for the NHS. The problems that older people experience with the NHS are well known: all too often they endure long trolley waits, not being considered for treatment on the basis of their age or, perhaps worst of all, having "do not resuscitate" written in their medical notes without the appropriate consultation as recommended by the BMA and other bodies. Such discrimination on the grounds of age is totally unacceptable and must be stopped.

So is the Government guilty of ignoring older people? Pensioners in general were conspicuous by their absence from the Chancellor's spending plans on Tuesday. It is difficult to believe he does not have something in reserve to boost the value of the basic state pension before the next general election. But how much longer must we wait to find out the Government's thinking?

Targeting means-tested benefit payments, such as the minimum income guarantee, towards those who need them most is a fine idea. But it is not one that is working in practice. Before the Government launched its recent advertising campaign to encourage people to claim benefits, there were still up to 870,000 pensioners not claiming cash to which they were entitled.

Continuing reliance on means-tested benefits, which we know pensioners are reluctant to claim, is not a satisfactory way of ensuring that older people share in the increasing prosperity of the nation. Age Concern and the Family Budget Unit carried out a study earlier this year which demonstrated that a single older person needs at least £90 a week to achieve a modest but adequate standard of living - to be able to afford to take a short holiday, buy grandchildren presents at birthday and Christmas time, or enjoy a pint in the pub. Surely such aspirations are not unreasonable?

The point that seems to be missed too often is that older people are an enormous resource, and, as our society ages, they will form a growing sector of the population. Not to recognise and utilise such a rich resource is simply short-sighted.

What really needs to happen is for the inclusivity for older people, which the Government says it believes in, to find its way into policy. A rise in pensioner incomes should be the cornerstone of that. But the Government has to start delivering in other areas. Sorting out long-term care would be a great start. We've waited long enough, and we can only hope that our patience is rewarded.

Baroness Greengross of Notting Hill is a crossbencher. Until the end of last month she was director general of Age Concern England.