Jeremy Laurance: Why help the rich at the expense of the poor?

'Whatever the reason, the demand for free, long-term care for the elderly is a non-starter'
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The Independent Online

Some 175,000 people voted in the BBC's NHS poll on Wednesday to offer the Government their view on where its priorities for the health service should lie. The NHS may not have the pulling power of Pop Idol, which notched up more than eight million votes in its final programme, but it was a respectable result for an estimable experiment in public-service broadcasting.

A few carping critics have pointed to "disappointing" audience ratings for the night – starting at four million and slipping to two million by the time the proceedings were wrapped up at 11pm. Your NHS was never going to rival EastEnders for viewing figures, but this was more like an evening-long edition of Newsnight, and even the regular 50-minute edition rarely betters two million.

So what was the people's verdict? Shorter waiting lists? Better cancer care? Cleaner hospitals? No, none of these. By a large margin, top of the poll came free long-term care of the elderly. Over 73,000 people chose this as their top priority for the NHS, amounting to more than 40 per cent of all the votes cast. Second, trailing a long way behind, came more pay for NHS staff, attracting 28,000 votes, 16 per cent of the total.

Now this is a curious outcome. Nobody needs reminding that the NHS is in dire straits, short of doctors, nurses and beds, with crumbling hospitals, outdated equipment and inadequate support in the community. Yet the top two priorities selected by the BBC's voters would involve the expenditure of billions of pounds without providing a single extra operation, course of cancer treatment or district nurse.

How can this be? Perhaps it reflects the viewer profile for public service broadcasts of this kind – dominated, I would guess, by publicly-minded denizens of middle-class, middle England. They may have ageing parents themselves and be wondering what the future holds. Or they may have children starting careers in the public services, and be worrying how they are ever going to afford their first home.

Whatever the reason, the demand for free, long-term care for the elderly is a complete non-starter. It cannot, nor should it be, the business of a Labour government to protect the assets of the better off at the end of their lives so that their fortunate children can inherit them intact when there are so many unmet needs of the poor, the sick and the destitute.

That is what this campaign is about – saving the homes of a well- off minority so they may be passed down to the next generation, against the interests of the poorer majority whose care will not be improved one iota by the huge investment required. To make nursing and personal care free for all those who currently pay was estimated at £1.1bn by the 1999 Sutherland report on long-term care of the elderly, rising to £6bn by the middle of the century.

The Sutherland report contrasted patients with cancer who got free care on the NHS and patients with Alzheimer's disease who were charged hundreds of pounds a week for care in a nursing home. It contrasted people who had worked and saved all their lives to buy their own home only to see it swallowed up in care charges at the end of their lives, with those who saved nothing and got their care free. Here was frank injustice, the report said, and it must be ended.

But the dismal condition of most state-financed care homes and the abysmal pay of most care workers are greater injustices which make it impossible to deliver the quality of care that old people need and deserve. Seven out of 10 residents of old people's homes already have free care, and three out of 10 who can afford it pay charges. Investment in better services for the poorer seven must take precedence over protecting the assets of the better-off three.

In Scotland they have bought the Sutherland argument and nursing and personal care (bathing and dressing) are to be free from next July. But in England the Government opted for a compromise, declaring before last June's election that nursing care would be free but personal care would be paid for, subject to a means test, as before. Winning free personal care is now the number one priority for the BBC's voters.

Not the least bizarre aspect of this campaign is that there is much support in certain quarters for introducing charges to boost the NHS's revenue. But here we already have a charge which, though high, makes no material difference to the person paying it (because once they have moved into residential care they no longer have need of their own home), yet it has provoked a barrage of protest.

If the charges the Government makes for long-term care, from those who can afford it, were new, the protesters would have a case. The principle of free, universal care for those who need it, which underpins the welfare state, would have been further undermined.

But these are not new charges, and care has never been universal (think of prescription, eye and dental payments). Charges for long-term care have existed since the NHS began. To remove them now, when they only affect the better off, and only the next generation of the better off, and when so many other more pressing priorities compete for the Government's attention, would not only be folly – it would be unjust.