Government urged to lead elderly care

The government must tackle fundamental policy dilemmas standing in the way of improvements to social care services for the elderly, says a King's Fund report.

Author Janice Robinson said the inquiry had found evidence of deep-seated problems, including a lack of choice for older people, a lack of residential places in inner London, poor-quality home care and funding pressures.

Ms Robinson said there was a 'consensus' about the problems, but no agreement on what should be done about them. Instead, the inquiry had found a 'lot of disagreement and concern' on fundamental policy issues 'that might block progress in the future.'

These included the balance between preventing ill health and providing social care, between supporting people in their own homes and providing residential places, and where funding should come from. 'There is a huge debate about funding and whether older people should pay [for services received], ' she said.

'There is a great division on means-testing, with some people thinking it is not acceptable and others thinking it is perfectly ok for older people with money to pay, and indeed looking for ways of using housing equity [to release cash to spend on services].'

Ms Robinson said 'the government must take a lead' on resolving these dilemmas, in consultation with other groups. A green paper on social care is due later this year, but the King's Fund is worried it may not address some of the policy problems identified by the inquiry.

In particular, Ms Robinson said she detected 'little appetite' to return to the funding issue, aspects of which the government tried to resolve with the Royal Commission on Long Term Care in its first term. The commission recommended all personal and nursing care be provided free - the government has since introduced free nursing but not personal care.

The King's Fund launched a care services inquiry in February, to assess whether the 'care market' is working for older people in London and how it will cope in the future.