people's home, axing three of tres providing respite care for ting the number of child protection orders by 20%, slashing grants to voluntary organisations dealing with drug and alcohol and day services for people with aT rIck. proposing such cutbacks. Birmthe closure of up to half its Leicestershire is to slash social ing £750,000 from its community Surrey County Council is tightcharges as one of the mans to hamshire and Warwickshire, too charges for home care to the raise more than a quarter of its €8.5m home care budget from charges.
Somerset is cutting back on placements of elderly clients in residential and nursing homes, raising charges and axing jobs.
Portsmouth council is trying to force down the pay and conditions of its home care staff to mean the cheapskate terms on offer from private contractors.
But as the carnage grows, two factors emerge as a major scandal:
• most of the cuts are being obediently nodded through by Labour councillors with no attempt to defend services and there is no coordinated campaign collecting information on these cuts or fighting back in defence of social services the way that campaigns have defended the NHS. With hundreds of jobs, and now pay and conditions increasingly at risk, UNISON and other public sector unions must be forced to organise a fightback. means-tested charges, and tence that the extra cash from general taxation, the Lant questions Indeed, after 14 months BUSSTO set up under the Thatcher government, in which con- a mockery of the so-called "seamless service" tinuing care of the frail elderly is largely privatised, proThere is no hint to be found in even discuss the levels of profit the changing patare continuing care of the increasingly frail elderly is largely carving up the market. Instead privatised, provided by the commis- profit-seeking sion's proposals nursing homes. have been eagerly embraced by the Independent Healthcare Association, which represents many private care homes.
No section of the report dis'cusses the glaring inequalities in local provision of nursing and residential home which have left most London boroughs and many other city areas finding it almost impossible to secure local places.
The commission also managed to avoid any discussion of the huge variations in local "eligibility criteria" drawn up in 1995 by health authorities to limit the entitlement of frail elderly patients to NHS treatment, making the access to NHS care a lottery based on your post code.
Many of these are draconian, excluding all but the most extremely incapacitated, and NHS long-stay beds tently using out of closed almost 26,000 "geriatric" beds by April 1998 - 46% of the during the implementation of the Despite the commission's relucthat this relentless cutback reprefor the NHS to pull out suggest any new ment.
Astonishingly, the pressing issue of so-called atheism in the "bed-blocking", in which elderly patients are forced to remain inappropriately in acute hospital beds for lack of places or funds to finance their discharge to a nursing home, is only discussed in the most offhand and passing fashion by the commission.
Winter pressures
Yet the problem 1s one of increasing importance, as the government's allocation of "winter pressures" money to help partially relieve it, has shown. With all of these factors left out of the equation, it is perhaps no surprise that the commission has also ignored the impending halt Transitional Grants", which have been paid since the 1993 reforms to local authorities to compensate for their growing financial responsito sell their houses or liquidate their savings to pay these charges.
But since many older people are in care homes not by choice but as a result of decisions taken by health and social services, this charge, too, would often be unfair, and should be scrapped.
Continuing care for the frail elderly should, like other parts of the NHS, be provided free of charge as a seamless service, and funded from general taxation.
It is a nonsense to argue, as some do, that to drop the means-tested charges and provide home care free of charge would amount to a subsidy to the rich.
Under any likely system, those with substantial wealth make sure they keep well away from the cheapskate nursing homes residential care on offer through social services - and opt to pay well above the local authority "benchmark" rate for Frank Dobson luxury in their twilight years. knows that to Health Secretary Frank Dobextension of the welfare son is already hedging his state to Blair or Brown bets on whether is like promoting any of the commision's proposVatican. als will be put into practice. He knows that to suggest any new extension of the welfare state to Blair or Brown, especially one funded from progressive taxation, is like selling atheism in the Vatican.
The government should be urged to act promptly and implement the limited recommendations for free nursing care: but a further, more thoroughgoing inquiry is now needed to fill in some of the gaps left by the Royal Commission.
Among the issues to be addressed:
• the cost and quality of care in nursing homes, • the training of nursing staff in the skills of continuing care • the possibility of establishing NHS nursing homes, especially in areas where private sector provision is not available.
SWEATING, DANFEROUSLY ABOUT ME EXHAUSTED, CLOSE TO COLLAPSE. BUT ENOUGH FL PSON ОТ Ф ØK Z betrayea by Blair