Money: Can we afford our moral obligation to old people?

The Royal Commission on Long Term Care has produced a powerful moral argument in favour of a commitment by the state to offer free personal care for old people on the same terms as health care under the NHS. It is hard to dispute that the victim of Alzheimer's disease should have the same claim to care as a cancer sufferer. The average cost of care in a nursing home is already pounds 18,000 a year, but it can be much more and ruinously expensive.

People going into a home would still be expected to pay for their food and accommodation as long as they could afford it. That would come to about pounds 6,300, roughly half the total cost of a place in an average residential home,a third of the cost of care in a nursing home.

It would be easier for the next generation to afford the cost of private insurance to pay for food and accommodation alone, but that would not be much help for the current generation of old people. Many elderly people could still be forced to sell their own homes to meet their bills.

The crucial issue is the cost to the Exchequer. The majority of commissioners believe the extra cost would be little more than pounds 1bn a year initially and the likely escalation would be largely taken care of by economic growth overtime.

But the two dissenting members - out of 12 - argue that if the costs of personal care are free for all, many more families will put elderly relatives into a home or move them from residential to nursing care.

Combined with an ageing population, they believe that the cost of the scheme would rapidly become excessive and a future government would welsh on the promise, as the last government was forced to do with Serps.

The dissenters think that the most the Government could be expected to do is to pay for strictly nursing care, delay the start of means testing for the first three months in care, introduce a loan scheme to pay the initial costs, and allow old people to get some state help well before their assets fall to the current threshold of pounds 16,000; moves that could be implemented at half the price of the report's full recommendations.

But the absence of unanimity will delay any reforms, and even then the cheaper option is likely to appeal irresistibly to the Treasury and the Prime Minister.

n Isabel Berwick is on holiday.