Care Fees and Long Term Care
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THE
BASICS | THE ISSUE EXPLAINED
70,000 HAVE TO SELL HOMES | TORIES
REJECT "CRADLE TO GRAVE" CARE
SCOTLAND COMMIT TO FREE ELDERLY CARE
| IN SICKNESS & IN WEALTH
HUGE OPPOSITION TO CARE CHARGES
Alice was
already in a care home and wanted to stop her remaining estate from
vanishing
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Concerned
about long term care planning and long term care insurance?
The following articles have been
selected from Society Guardian
The
Basics
Monday
March 19, 2001
• New Labour sets up Royal Commission on Long-Term Care for the Elderly,
chaired by Sir Stewart Sutherland, in December 1997.
• Commission recommends free nursing and
personal care.
• Government agrees to free nursing care but
personal care will be means tested and paid for by service users in
England and Wales.
• Scottish executive agrees to fund both
nursing and personal care in Scotland.
• Independent care home owners say they are
going out of business - fees paid by local councils are unrealistically
low, they argue.
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Long-term care
for the elderly:
the issue explained
Monday March 19, 2001
New Labour came into power promising a royal commission into long-term
care for the elderly. Matters were in a mess.
The previous Tory government had been beleaguered
by stories of elderly people having to sell their homes to pay the fees
when they went into nursing or residential homes. Newspapers ran articles
on elderly homeowners, who had paid tax and national insurance all their
lives, and who could now no longer pass the homes they'd worked hard to
buy on to their children. It was very bad publicity for a government
ostensibly committed to hard-working people and the very British
"right to buy" your own home.
And it was a nightmare for many elderly people
who didn't have sufficient funds to pay for their care. Those who were
cared for in hospitals received free care. But those with conditions such
as Alzheimer's disease who were cared for "in the community",
including in residential or nursing homes, were means-tested and often
ended up paying for their care.
After coming to power, New Labour quickly set up
a commission in late 1997, headed by Sir Stewart Sutherland, principal of
Edinburgh University. The commission took a year to report.
But the government attracted criticism by
delaying its response - it took nearly as long to answer as it did for the
commission to hear from interested parties, gather all the evidence,
examine the current set-up and future options, weigh up the pros and cons
and come up with proposals. Critics felt that ministers had kicked the
issue into the long grass in order to avoid a big public spending pledge.
Sir Stewart and all but two of his fellow commissioners recommended that
nursing and personal care be funded from general taxation and free at the
point of delivery - wherever that "delivery" took place - at a
cost of roughly £1bn a year.
Finally, the government agreed to fund nursing
care - but only that given by a qualified nurse, as opposed to, for
example, a healthcare assistant. Personal care, such as help with washing,
using the toilet, eating and dressing, would still be subject to means
tests and paid for by a client who was judged to have enough money to do
so.
Campaigning groups for the elderly were
disappointed at this halfway measure. But they were cheered north of the
border when the Scottish executive agreed that personal care would be
free, as well as nursing care. This was in spite of the pressure said to
have been exerted on Scottish Labour leaders by Labour at Westminster.
Now, there will shortly be a situation where
older people living just miles from each other in English and Scottish
towns will face very different funding arrangements.
And then there's the revolt by independent care
home owners. For some time, they have been complaining that local
authorities have been keeping the rates they pay for care home places -
where they, rather than the individual residents, pay them -
unrealistically low. The home owners have lobbied parliament, harangued
local councillors and a few have even talked of refusing more council
placements.
Some critics argue that it's not the public
sector's job to subsidise private care companies - and that private care
home owners should have thought about this when they set their own prices
low in order to win the business from the councils, during the era of
market testing and compulsory competitive tendering. Others say that money
needs to be spent increasingly on supporting older people in their own
homes, not in institutions.
But some care home owners take pride in their
work and offer good quality services - and are horrified that they might
be driven out of business by apparently uncaring councillors and a
government seemingly deaf to their demands. Small, local care homes will
go out of business, they say, to be replaced by big care conglomerates
running large homes akin to the huge, old long-stay, geriatric
institutions now frowned upon and closed.
It's not quite got to the point where frail or
confused elderly people are turfed out of their care homes because of a
lack of funds. But the battle is hotting up.
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Survey shows
70,000 pensioners had to sell homes to pay for care
Wednesday May 30, 2001
More than 70,000 pensioners were forced to sell their homes last year to
pay for the cost of personal care in residential and nursing homes, a
survey of social services departments shows.
The Liberal Democrat party, which carried out the
survey, said the figure represented a near doubling of the 40,000
pensioners in the same position when a similar survey was carried out in
1995.
The party said the survey of 104 councils showed
that "potentially more than a quarter of a million" pensioners
had been forced to sell up to pay for care costs since Labour came to
power.
The Lib Dems used the survey to back their
claims, outlined at a press conference today, that they were the only
major party committed to giving pensioner's the "dignity" of
free nursing and personal care.
Health spokesman Nick Harvey told reporters that
the long-term care proposals would have "relatively modest"
costs, estimated at between £800m and £1.2bn a year.
In England, Labour and the Tories are committed
to providing free nursing care in residential homes - but have refused to
pay for personal care, arguing that the money was better spent on other
health priorities.
In Scotland, all four main parties have backed a
move for the state to fund personal care - such as washing and dressing -
as recommended by the royal commission on long-term care.
Meanwhile, the Welsh Liberal Democrats today
pledged an extra £550m for the NHS in the principality.
They promised to give the Welsh assembly the
extra money to provide 630 more nurses and midwives, 475 more doctors and
295 other health professionals as well as an additional 590 hospital beds
over five years.
The poorest-paid staff would also receive an
extra £1,000 a year, the Lib Dems said, adding that they would also give
the assembly the power to abolish all charges for dental and eye checks.
BACK TO TOP
Tories reject
'myth' of cradle to grave welfare
Wednesday March 7, 2001
The Conservatives yesterday underlined their belief that the cradle to
grave welfare system is gone for ever with proposals to encourage people
to make their own provision for care in old age.
The shadow health secretary, Liam Fox, said that
those who took out insurance for long term care costs would have
"some of their assets" protected rather than being taken by the
state to cover expenses. Families who took responsibility for care of
elderly relatives would be rewarded with tax breaks, Dr Fox told the
right-leaning Politeia think tank.
The proposals, condemned by Labour as covert
privatisation of health and social care, underline Tory determination to
use the tax system to shift responsibilities from the state to
individuals.
Dr Fox said that 160,000 elderly people had been
forced to sell their homes under the four years of Labour government to
finance long term care under a policy that penalised thrift. "They
believed the myth of cradle to grave welfare," he said. "People
working today need to be encouraged to make more financial preparations
for their later years in order not to repeat the experience of many
current pensioners and put all their eggs in the state's basket."
Those who insured themselves would be expected to
meet bills of up to around £20,000, but would then have all costs picked
up by the state, leaving assets to be handed on to relatives, Tory sources
said last night.
The Conservatives are attempting to exploit
controversy over government plans on long term care, which will see a new
division between nursing and personal care. Under the reforms, nursing
care for the elderly will for the first time be free in care homes - a
policy the Tories intend to maintain - but residents in England and Wales
will continue to have to pay their own personal care costs, such as
bathing, dressing and feeding.
In Scotland, where the Liberal Democrats share
power with Labour, both personal and nursing care costs will be free, in
line with national Lib Dem policy and with the recommendations of the
government's own royal commission on long term care.
Campaigners for the elderly, who have condemned
the government's decision not to make personal care free, last night
questioned the Tory scheme. Tessa Harding, head of policy at Age Concern,
said care insurance was "not viable for most people because of the
cost and the difficulty of finding a policy to cover an unknown
future".
BACK TO TOP
Scotland
gives free elderly care the go-ahead
Monday January 29, 2001
Scotland will implement in full the Sutherland report recommendations on
free care for the elderly, first minister Henry McLeish said today in an
unexpectedly firm declaration.
The move appears to end confusion over whether
last week's decision to "bring forward proposals" on free
personal care amounted to a guaranteed acceptance of Sutherland's
recommendations.
"We are embracing the principles of
Sutherland in full," Mr McLeish said, repeating the phrase for
emphasis. He added that implementation of the report's recommendations on
personal care for the elderly in residential homes - such as help with
bathing, eating and dressing - would start in 2002. He also promised there
would be "no backsliding" on the commitment.
The first minister made his comments at a press
conference in Glasgow, which was called to present the administration's
annual progress report on policy pledges. His statement went far beyond
what many had expected after the events of last week, in which a
threatened rebellion on the issue by Liberal Democrats in the Scottish
parliament was bought off by an ambiguously worded emergency statement
from the executive.
There had been speculation that last week's
statement was no more than a commitment to study the idea of free personal
care and thereby sideline the issue until after the general election and
leave open options for a climbdown.
But Mr McLeish said today: "The commitment
is there for all to see. We are embarking on a process which will have as
its destination the implementation of free personal care. I cannot be more
explicit."
He added: "There has been a lot of dancing
on pinheads in relation to this. We are embracing the principles of
Sutherland in full. In that sense there can be no clearer indication - we
mean what we said and we have said what we mean." And he insisted:
"There will be no backsliding. Those who have that view are simply
wrong."
The decision has put Mr McLeish squarely at odds
with Westminster, which has warned that there is "no chance" of
implementing the Sutherland report recommendations in England.
The Liberal Democrats now plan to table an
amendment to the health and social care bill, currently going through
parliament, which will "keep the door open" for the government
in England to adopt Sutherland at a later date.
Mr McLeish's statement came as leading government
adviser on long-term care Dr Chair Patel, the chairman of private health
provider Westminster Health care, said the government should look at
providing free personal care for the elderly in England and Wales.
Dr Patel told the Financial Times that such a
move would become affordable as growing home ownership and higher pensions
among the elderly meant that in future more people would be caught by the
means test and would pay towards personal care.
BACK TO TOP
In
sickness and in wealth
We
already spend billions of pounds every year on private healthcare. So what
does the recently announced 'concordat' really mean?
Justin Keen
Monday November 6, 2000
The Guardian
Last week the government proudly announced a new "concordat"
between the National Health Service and the private sector - interpreted
by cynics as a way of ensuring there will be spare beds about this winter.
The phrase "private health" conjures up pay beds and Bupa but in
fact the non-NHS sector - what people pay for out of their own pockets -
is a lot bigger than that. In 1997 non-NHS healthcare spending was just
over £8bn. Paid for by taxes, the NHS spent £40bn in 1997-98 so
"private health" comes to around 17% of total UK health
spending.
Some £2.1bn was spent on insurance, by private
individuals and by companies on behalf of their employees. Just under £2.5bn
was spent on pharmaceuticals. This figure rises to around £4bn if we add
other over-the-counter healthcare products.
Payments made by private individuals for health
fall into three broad categories. The first is cash outlays on drugs and
patent medicines, dentistry (more than £300m a year) and glasses, contact
lenses, eye tests and other optical services (more than £500m). Payment
for complementary therapies such as osteopathy and acupuncture is at least
£450m a year according to research by Kate Thomas of Sheffield
University. Private individuals pay £500m each year directly out of their
pocket on hospital treatment. Self-payment has been growing in recent
years, and some 20% of operations and treatments are now paid for directly
rather than through insurance.
Perhaps long-term care for the elderly or
disabled should be added in. Spending on personal healthcare by people
living in their own homes or in nursing or residential homes is hard to
assess but it is likely to run into the hundreds of millions. Private
expenditure on chiropody alone is some £70m a year.
A second category of payments are those made to
third parties, the largest of which buys private medical insurance for
individuals and families. This is worth about £1.1bn a year. Some 2.8m
people are covered, which is 3.8% of the population. Some 6m people have
health cash plans, which are a cross between low-cost insurance and
savings products, designed mainly to help pay for lower cost items such as
dental charges, and modest lump sums for hospital stays (whether in
private or NHS hospitals). Total contributions to these plans are
relatively modest, at around £200m a year. There are two additional types
of private payment in this category: the first is gifts to charities which
end up helping the NHS - they total over £150m a year, according to a
recent National Audit Office report; people buy lottery tickets and the
National Lottery contributes some £50m a year to the NHS; the third is
money paid over directly to the NHS. The great slogan coined for Labour's
invention in the 40s was that the health service was free "at the
point of delivery". It was never entirely accurate even then and
since 1951 patients have had to pay explicit user charges. Today the bulk
of charges are for prescriptions, dentistry and ophthalmic services, and
totalled £800m in 1997-98.
"Private health" turns out to be a lot
more complicated than pronouncements such as Mr Milburn's would imply. He
was really only talking about private hospitals and they account for only
about a quarter of personal private expenditure on healthcare. Most
private health spending is in retail markets, for a wide range of goods
and services. The chart shows how the spending divides up.
Perhaps the government would rather not think
about it. In its National Plan for the NHS in July, the government argued
that private medical insurance is a major cause of inequitable access to
health care. This is right but the government omitted to mention that user
charges for core health services are if anything more inequitable. By
their own logic they should have abolished prescription and other charges.
Labour has reintroduced free eye tests for people aged 60 years and over
but has also actually increased prescription charges. For a government
that has restored equity to the political lexicon, and pledged so much new
money to the NHS, this is an opportunity missed.
To a large extent primary healthcare is private.
That is uncontroversial in the sense that people buy pain relief,
athlete's foot powder and so on from chemist shops: it is difficult to
imagine nationalising over-the-counter pharmacy services. But dental and
optical services have been turned into mixed economies. The Tories started
the ball rolling by increasing charges and Labour has only tinkered with
its inheritance rather than reversed policy - it presumably is relaxed
about the role of the private sector in health care.
Add to all that the private finance initiative (PFI)
for building and in some cases maintaining hospitals and now Mr Milburn's
concordat, and it is hard to avoid concluding that major changes in the
structure and financing of healthcare have already taken place. More are
in the pipeline. It is a pity, then, that the concordat focuses mainly on
hospital and the new way-station services located between a hospital stay
and return home. If a concordat is needed anywhere at the moment it is in
general dentistry, where the government now needs the private sector to
help solve problems of access. A better appreciation of the nature of
private healthcare expenditure and consumption is the starting point for
better policies to engage with it.
Justin Keen is fellow in health systems at the
King's Fund.
BACK TO TOP
Huge opposition
to care charges
Linda Steele
Thursday April 26, 2001
Almost two-thirds of the public believe that people with long-term
illnesses should not have to pay for nursing and personal care services,
according to a leading health charity.
A survey from the King's Fund reveals that most
people back the recommendation of the royal commission on long term care
that neither nursing nor personal care should be means-tested, whether
provided in a hospital, nursing home or at home. The news is a sharp
reminder to the government, in the run-up to a general election, of the
lack of support for its policy of means-testing for personal care costs.
"Our survey shows that both the government
and the opposition are out of step with the majority of people over what
is seen to be fair in long-term care funding," said King's Fund chief
executive Rabbi Julia Neuberger.
"Ministers' arguments that universally free
personal care would only benefit the well-off do not persuade most members
of the public. Redistribution can be achieved much more fairly through
taxation than through means-tests, which older people often find demeaning
and stressful."
Opinion pollsters NOP surveyed 1,000 people over
the age of 25, living in England, in February. More than half those
surveyed, no matter what their earnings, believe that the state should
fund personal care such as help with bathing, eating, dressing and using
the toilet.
Perhaps surprisingly, more than half surveyed
also think that the government should fund accommodation (or
"hotel") costs in nursing homes - which both the government and
the royal commission rejected. The royal commission, chaired by Sir
Stewart Sutherland, was set up by the government in 1997 to look at the
funding of long-term care.
The survey shows that people of all age groups
hold broadly the same view. This represents a shift in public opinion from
previous years, when fewer people were in favour of making long-term care
free of charge.
"One person in four will need long-term care
when they get old. When they do, under current proposals, only very
narrowly defined nursing care will be provided without a means test,"
said Rabbi Neuberger.
"Asking people to provide for such a random
event in their lives as Alzheimer's disease or a bad fall is no more
ethical or rational than asking them to pay for cancer treatment. It is
very likely that such an approach will fail within a few years."
"Regardless of which party forms the next
government, the issue of long-term care funding - and the false
distinction between nursing and personal care - will not go away."
The government countered that it was spending
more on intermediate care to prevent older people going into residential
homes. Money was better spent on improved health and social services,
rather than providing free care, said health minister John Hutton.
"Overall, we are matching the additional
expenditure on services for older people recommended by the royal
commission but we have chosen to devote the lion's share to improving the
range of services available to older people so that they can recover more
quickly and avoid unnecessary admission into care homes. These services
will be free at the point of use," he said.
"We are making nursing care free in nursing
homes from this October, making the funding of long-term care fairer and
more equitable and giving responsibility to the NHS where it should be.
But we can't spend the same money twice."
Charities for older people said the survey showed
the public wanted the government to go further in funding care.
A charity head of public affairs Mervyn Kohler
said: "The King's Fund poll adds to the current momentum to develop a
fairer policy between what care the state provides and what people need
personally to pay for. Our charity and partner organisations are
campaigning strongly to make personal care free."
He pointed out that in Scotland personal care is
to be free of charge from 2002.
A spokeswoman for another age charity said that,
by rejecting the royal commission's key recommendation to fund personal
care at an estimated cost of £1.1bn, the government would force thousands
of older people "in desperate need of care to go through the
undignified and often complicated process of means-testing or otherwise
having to give up their savings to pay for it".
She added: "With just weeks to go before a
general election, politicians have got to start listening to the public's
voice. They must go further than producing a false divide between nursing
and personal care, and instead offer a fairer, clearer system of
funding."
• The results of the survey are contained in A
Fair Deal for Older People? by Chris Deeming, published today by the
King's Fund.
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"Alice's
Story"
Alice,
real name protected, was already in a Care Home as, due to ill
health, she needed long term personal care. Aware that her situation was
putting her hard earned savings and her home at risk she needed to stop
her remaining estate from vanishing in continuing care costs.
She arranged a FREE No Obligation Consultation and set up an immediate
care plan for
a
one off payment.
As a result of which she continued in care for the rest of her life and
protected the remainder of her estate for her children to inherit.
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