The Royal Commission on Long-Term Care misses one crucial point. Nowhere does it refer to the hands-on implementation of its proposals, and it only really examines in depth the financial implications of its recommendations.

Financial provision alone cannot ensure an effective service. Cost-effective spending must be brought about through efficient structures. Continence is one of the reasons most cited for putting elderly people into long- term care. This could be prevented if resources were targeted early at physiotherapy and effective continence care: 70 per cent of continence cases can be cured through physiotherapy.

As the report acknowledges, more people should be enabled to remain in their own homes and receive care there if necessary. Early, cost-effective care can be provided, but only if there is a decent budget which can be used to prevent many elderly people being admitted into residential care because the spending came too late.

Simon Hombersley

National co-ordinator

The Continence Campaign

London W1