Long-term care

the issue explained

Care services for vulnerable adults and older people have had a shake-up since Labour came to power. But not all reforms have proved successful, reports David Batty

SocietyGuardian.co.uk

Since coming to power in 1997, the government has introduced a series of reforms to care services for vulnerable adults and older people with mixed success.

Growing partnership between the NHS and social services has led to a new range of rehabilitation and respite care. National standards have been set to raise standards of care for the elderly. While the white paper, Valuing People, should ensure more rights and freedoms for people with learning disabilities.

However, hundreds of care homes have closed, thousands of care home residents have been denied the funding they are entitled to, while the government has missed its target to move hundreds of people with learning disabilities out of Victorian asylums.

The government's most contentious long-term care policy has been its decision to reject the recommendations of a royal commission it set up to look at how this care should be funded. Only the Scottish executive fully implemented the commission's recommendation that all nursing care and personal care, such as bathing, washing and dressing, should be paid for by the state at a cost of roughly £1bn per year. England, Wales and Northern Ireland chose only to cover the costs of some nursing care. This has severely limited the funding provided to most care home residents and forced many to sell their homes.

The situation has been further complicated by a lack of clarity about which care home residents are eligible for "continuing care", where all nursing and personal care costs are met by the NHS. The health service ombudsman, Ann Abraham, said last year that tens of thousands of residents have been denied the free care they are entitled to. Another major concern is the loss of 74,000 care home places over the past seven years. According to financial analysts Laing & Buisson, hundreds of care homes have closed because operators' costs are not met by the funding they receive from local authorities. But councils claim they cannot afford to pay more because they receive insufficient funding from central government.

On a more positive note, a growing number of partnerships between social services departments and NHS trusts has led to the development of intermediate care services, providing intensive rehabilitation and recuperation. This has led to a slight reduction in the number of people needlessly stuck in hospital, commonly known as bed blockers, because no follow up care is available in the community. However, these care partnerships will be tested this year with the advent of bed blocking charges.

Under the Community Care (delayed discharges, etc) Act, councils now have to pay fines of £100 per person per day for any hospital beds that are blocked because social services fail to arrange community-based care for a patient. The financial implications are huge because discharge delays cost the NHS £170m a year.