With respect to old age: long-term care – rights and responsibilities (1999)

The Royal Commission on Long-Term Care was set up on 4 November 1997 to review options of funding for long-term care of older people and make recommendations on how costs of care should be met by individuals and the state.

Chaired by Sir Stewart Sutherland, the commission recommended that the costs of long-term care should be split between personal care costs and living and housing costs. The costs of personal care should be met by the state and living and housing costs should be subject to means testing and jointly funded between the state and individuals. The commission also recommended that a national care commission should be established to oversee the care system and promote the interests of older people.

The commission defined ‘personal care’ as direct personal support, which included: personal washing, bathing, dressing, eating and drinking; helping with bowel and urinary management; support to manage prescriptions and medications; and support to ensure the safety of people. However, the commission excluded house cleaning, shopping and companionship from their definition of personal care. People requiring help with costs of assistance with domestic tasks and accommodation and housing should be subject to means testing.

The commission made a number of recommendations, including the following. 

  • When an elderly person was admitted to residential or hospital care (often likely to be during times of crisis) the value of their capital should be disregarded for three months, after which an assessment should take place on the appropriateness of residential care.
  • The capital upper limit should be raised from £16,000 to £60,000. At the time of the report’s publication, people with capital of over £16,000 were compelled to sell their homes to fund their residential home fees. Those with under £10,000 received maximum state support, and those with between £10,000 and £16,000 received partial support.
  • Nursing care should be made free, whether delivered in homes or in hospital.
  • The provision of direct payments should be extended to people aged 65 years and over (as per the government’s commitment in the Modernising social services white paper).


However, the commission’s recommendations were not unanimously agreed. Two commissioners submitted a note of dissent, disagreeing with the recommendation to make access to personal care services free. The commissioners objected to this on the grounds that it had major cost implications for the taxpayer and personal care should be chargeable (access to personal care services was means tested at the time).