'With respect to old age: long-term care - rights and responsibilities'

In November 1997, keeping to its manifesto commitment, the Labour government set up the Royal Commission on Long-Term Care to:

• review options for the funding of long-term care of older people
• make recommendations on how costs of care should be met by individuals and the state.

The commission, chaired by Sir Stewart Sutherland, published its report in March 1999.

Recommendations

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 by 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, dressing, eating and drinking, help with bowel and urinary management
• support with managing prescriptions and medication
• support to ensure the safety of people.

However, the commission excluded house cleaning, shopping and companionship from their definition of personal care. They recommended that 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 3 months. After this time, an assessment should take place on the appropriateness of residential care.

The capital upper limit should be raised to £60,000 from £16,000. 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. Those with between £10,000 and £16,000 received partial support.

Nursing care should be made free, whether delivered in homes or in hospital (at the time, nursing care in a nursing home was means-tested, breaching the principle that healthcare should be free at the point of use).

The provision of direct payments should be extended to people aged 65 years and over. This reflected the government's commitment in the Modernising social services white paper.

Impact

The commission's recommendations were not unanimously agreed. Two of the commissioners, David Lipsey and Joel Joffe, 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). The dissenting note also strongly argued that the then £1bn cost of introducing free personal care would be better spent on improving and developing services.

These two positions on funding led to years of ongoing debate up to, and including, the Dilnot Commission.