Towards a New Social Compact for Care in Old Age

Edited by Janice Robinson Publisher: The King's Fund. ISBN 1857174445. 86 pages.£8.99

Since the government published its response to the Royal Commission on Long-Term Care last year, the debate about the future of long term care has reached fever pitch.The decision to reject the commission's central recommendation to provide free personal care has met opposition from many quarters, and is a cause of much anger and frustration among older people.

In a fascinating and timely contribution, this collection of essays provides the historical, philosophical and political context to long-term care, arguing that it must be seen as part of the wider debate about an appropriate public policy response to an ageing population.

Robin Means provides an absorbing background to the current debate, tracing its philosophical origins back to the values inherent in the Poor Law.

Raymond Plant's contribution evaluates the nature of our piecemeal welfare system, exploring the relative value of tax-based or insurance-based models for funding long-term care.

Armed with this context, we are taken to a view of longterm care in an ageing society.

Hilary Land challenges some common preconceptions about the impact of demographic change in the years to come, while Justin Keen and Chris Deeming deconstruct the Royal Commission's report and the government's response.

They argue that the 'long-term care' is actually a series of closely linked debates with common philosophical foundations in concepts of equity.

The government's rhetoric is one of social justice and fairness, but neither of these values are adequately reflected in their approach towards funding long-term care.

Removing the anomaly of self-funding residents in nursing homes paying for their nursing care is a welcome move, but falls short of a fair and sustainable resolution to the inequities in the long-term care system.

What we need is a radical rethink on long-term care that goes beyond tinkering at the fringes of the system.

For anyone struggling to make sense of the government's policy, this book is a valuable contribution to the debate.