Government’s long-term care plans ‘only a short-term solution’, says Sir Stewart Sutherland

Sir Stewart gave his assessment of the Government’s July proposals today in the Hartrigg Oaks Lecture, named after Britain's first ‘continuing care retirement community’, opened two years ago by the Joseph Rowntree Foundation in York.

Sir Stewart applauded the additional £1.4 billion, announced in July as part of the new NHS Plan, which will provide more support for people living in nursing homes and those who need temporary, rehabilitative services when discharged from hospital, before returning home.

He said: “These arrangements will ease the inequitable financial burden on those older people currently required to pay for the nursing care they receive in nursing homes - care which would be free in any other setting. They will save some individuals around £100 per week.

“The planned funding for rehabilitation care in residential settings for some three months after discharge from hospital is also welcome. Flexible use of the extra resources could achieve a great deal (although models of care must be appropriate and skilled staff must be available). Many people will be able to return to their own homes and will not need long-term residential care. There should also be immediate benefits for all from reducing ‘bed blocking’ by elderly people who must currently remain in hospital because there is no suitable support for them outside.”

But Sir Stewart added that it was unclear how these short-term gains could achieve permanent change unless there were extra resources for domiciliary care which many people would undoubtedly require after their period of rehabilitation.

He argued that many Social Services Departments did not have sufficient resources at present to pay for residential care for those ready to leave hospital but unable to look after themselves. “These problems will not go away. After the three months of rehabilitation support, many individuals will require long-term domiciliary or residential care which will not be available at a price that they - or Social Services - can cover.”

Sir Stewart also pointed out that even with the extra resources, older people who have to pay for their care in residential and nursing homes might still need to find around £300 per week. This meant that relatively few people would be able to afford their care costs in the future who could not afford to pay already (usually from the proceeds of selling their previous home).

“The Royal Commission which I chaired, advocated not just nursing care free at the point of delivery but free personal care whether at home or in a residential setting. Without such a measure, problems will persist over the boundaries of health care and social care. Problems will continue for older people unable to afford domiciliary care, with Social Services having to encourage older people to go into residential care so that their individual homes can be sold and the resources released to pay for care costs.

“Anomalies created by separate funding regimes - where health care is free and personal care is means-tested - will be perpetuated. And the anxieties experienced by so many older people and their families will not be relieved. It does not seem probable that the measures announced so far - helpful as they are within limited parameters - will achieve the flexibility, effectiveness, quality of service and affordability which would flow from removing the sharp but artificial division between health care and personal care.”