Introduction

New reports always provide good copy for long-standing theoretical and policy disputes. A recent review from the King's Fund (Wanless Report, 2006) found very serious shortcomings in social care provision and funding arrangements. Too little of the national income was committed to the social care of older people, and the cost of any system in meeting needs was set to rise. The current means-testing funding system in England, which was found to discriminate unfairly against many people on the borderline between free National Health Service (NHS) care and payment for community care, and which provokes widespread confusion, anger and distress among frail older people and their families, should be scrapped and replaced with a ‘partnership model’. A minimum of two thirds of the cost of a care package, the Wanless Report (2006) concluded, should be guaranteed free at the point of delivery with every £1 of subsequent cost being matched by the state or paid from benefits.

This is clearly a compromise with government intentions to restrict public costs, and to encourage private services and the private replacement of public services at paradoxically greater cost than the measured expansion of public services. There remain immense problems in influencing whether ‘care packages’ are determined by need or individual cost, and how amount and standard of service are to be made available universally. Consequential reduction of disability benefits is also highly debateable. But at least the review accepts that “the system needs to be more universal with broader eligibility criteria” (Wanless Report, 2006, p 208).

An obvious alternative would have been to urge the government to implement the recommendations of the Royal Commission on Long-term Care (Sutherland Report, 1999), the only Royal Commission to have been appointed since the Labour government came to power in 1997. Its key recommendation, that personal care should be free, was rejected. The recommendation has been implemented in Scotland, and is of course an object lesson for continuing comparison. In its 2006 report, the King's Fund has weakly set aside the force of the Sutherland Commission's argument (Wanless Report, 2006) (see also Chapter Four).

Such examples of contrasting policy reports, dealing with the future services, incomes and occupations of older people, arise with increasing frequency. One report is found to be relatively compliant to government, and the next relatively independent of government.