It is not very clear what the Government is intending to do about funding long-term care for the elderly and disabled, which is shaping up to be one of the biggest political problems of the next decades. The King's Fund health think-tank claimed yesterday it had been briefed that Labour planned to scrap the current means-testing system, which requires old people to sell their homes to pay for residential care. But ministers were more circumspect, with the Chancellor, Alistair Darling, hinting only that reform is needed.
If he is unsure what that should be, then let us tell him. Our national failure to support frail and vulnerable people is one of the great unacknowledged scandals of our time. As the years pass, we have ever more old people and yet we do less and less for them. The same is true of families with disabled children, nearly half of whom receive no public support at all.
The situation will only get worse. Elderly people are living longer. Disabled people now expect to live full lives. Scotland has reached a distinct and admirable solution: the state will pay for residential care for the elderly, just as it does their hospital care. Helping someone go to the lavatory or wash – whether in hospital, residential care or their own home – is a form of nursing care, they argue, and should be provided free of charge, paid for through general taxation.
This flagship policy is expensive. At present 4 per cent of Scotland's elderly population live in a care home. Over the next two decades that number is set to double. Already the system is being squeezed; three-quarters of Scotland's councils have waiting lists of up to four months because the system is under-funded.
Government ministers said yesterday that they are open-minded about the outcome of the consultation they will be launching with a Green Paper. But they also made clear that the Scottish option is not on. In England and Wales, by 2050, according to last year's Wanless report, there will be twice as many people aged over 85 as there are now. (A potent argument, incidentally, for allowing more not less immigration at the present time.) We will then need to spend four times more on long-term care for older people. To make care homes free for all would, ministers claim, take up all the additional public spending now available.
But this is by no means self-evident. France and Germany spend more than double what we do on caring for older people. The fact is that the current means-testing system has caused misery to older people and their families. It is not at all clear how the kinds of "partnership model" ministers were floating yesterday – with a basic universal entitlement together with a top-up paid by individuals, or by the state in the case of the poor – get around this.
In any case there is more to the problem than how to fund care homes. The wider issue is how the state can help older people remain independent and active in their own homes, for as long as possible, in a way that offers them dignity and respect.
To do that, ministers must reverse the pernicious cuts that have been made in such services. They must provide more home-helps, not fewer. They need to reverse the preposterous cuts in services like chiropody which slowly render some old people immobile and eventually force them into care homes. They need to chastise the 150 local authorities who have so recast their definition of needs that even those who need help getting out of bed in the morning now find themselves excluded from services. State resources must be directed to where they can have the greatest impact on wellbeing – and where they support, rather than undermine, the dignity of those in the last age of life.Reuse content