A relatively small spend to make nursing care free would reap dividends

Health secretary Frank Dobson may be delighted at the Court of Appeal's ruling on who pays for long-term care, but it has left everyone else confused. Health authority managers were initially relieved that they will not have to find the money from already hard-pressed budgets to pay for all nursing care wherever delivered, although such a judgement might have forced some tough and long-overdue decision-making in Whitehall and Westminster.

But as the Royal College of Nursing pointed out, the way remains open for many more legal challenges to HAs unless Mr Dobson urgently clarifies the previous government's 1995 guidance on eligibility for NHS continuing care.

Unfortunately, Mr Dobson has little sense of either urgency or adequacy when it comes to longterm care. He has yet to present his response to the royal commission's proposals, published more than four months ago. Commission chair Sir Stewart Sutherland was voicing his exasperation last week that the government was still claiming to be consulting and considering the matter, even though his team spent a year talking to anyone and everyone with an informed interest.

Mr Dobson did respond last week to the Commons health select committee's report on long-term care, but used that classic political rebuff, a lengthy list of what the government was already doing to meet the committee's demands.

The Continuing Care Conference estimates that the cost of making nursing care free in nursing homes at£220m, a small part of the NHS budget. Ministers reportedly want to reassure Labour's core supporters that their policies are relevant to them. Such a modest investment would go a long way to doing that, generate goodwill elsewhere - and help solve a problem with which Mr Dobson is clearly having difficulty getting to grips .