What the commission recommends

A public spending boost to restore free nursing home care and prevent people having to sell up to pay home fees is to be recommended by the Royal Commission on long-term care for the elderly and disabled.

Its report, finalised at a two-day meeting last week, will recommend that some elements of care should continue to be means tested, but at a level that is more generous to people needing it.

The total cost of the proposals from the commission, set up in 1997 by health secretary Frank Dobson to examine short and long-term options for funding care, is estimated at£800m to£1bn a year, including an extra£380m on carers' benefits.

While the commission expects the money to be found from public sources, it expects its proposals to be phased in over a period of up to 10 years, which would reduce the impact on taxation.

All but one of the 12 commissioners have agreed the report in full. A minority report is being written objecting to the key proposal that in future 'personal' care should be free wherever it is provided.

The idea has already been accepted, albeit reluctantly, by the main agencies lobbying for free care, who concede that some element of means testing will continue.

But the big breakthrough is the acceptance that charges should in future cover only 'hotel' costs, and not the 'personal' care which was previously provided free in NHS long-stay wards. Commissioners have agreed there should be a firm division between the two.

Personal care includes washing, toileting and dressing as well as medical and clinical care, and would become a free service in homes under their proposals.

Hotel costs would cover accommodation, food and linen. To make it easier for older people to afford this, and avoid them being forced to sell their homes to pay for it, the commission recommends changes to the present means test.

At present, anyone with savings of£10,000 faces a means test and those with£16,000 have to pay full charges.

The commission recommends a more generous sliding scale. The proposed 'csar' would head a permanent national commission for long-term care, charged with overseeing standards.

A national 'grey csar' should be appointed to head a permanent body to ensure standards of long-term care. Commissioners are concerned that standards vary widely around the country and that provision bears little relationship to need.

A new concept of personal care should be introduced, with the costs being met by the health service. This would restore free nursing and medical care to people who used to receive free care in long-stay hospitals, but now face charges in nursing or residential care homes.

The commission wants substantial improvements to benefits available to unpaid carers, who save the public purse large sums by caring for elderly or disabled relatives at home.