Free elderly care expansion plans spark row

Plans to expand free home care for the elderly sparked furious exchanges at Prime Minister's questions today as a new report said "radical changes" were needed to maintain the care system in the face of increasing demands.

The Care Quality Commission's (CQC) annual report on health and social care services in England said a predicted 1.7 million more adults will need care by 2030, putting pressure on already-stretched public finances.

The Government's Personal Care at Home Bill, which would provide 400,000 vulnerable elderly people with free care in their homes, was criticised by council leaders earlier today and Tory leader David Cameron accused Gordon Brown of using it to promote "cheap dividing lines" between the parties ahead of the general election.

Mr Cameron demanded to know where the funding was coming from and insisted the Prime Minister wanted the "benefits" of the policy before the election, leaving the costs to afterwards.

But as Speaker John Bercow struggled to keep the noise down, Mr Brown hit back, attacking the Opposition leader for breaking cross-party "consensus" on the policy.

Accusing Mr Cameron of a U-turn, he said the Tories' "wall of noise" would not hide the fact that they did not have a policy on the issue, adding: "This is a big challenge... this is no time for a novice."

Mr Cameron asked the Prime Minister if he could rule in or rule out a compulsory levy on the elderly to pay for care, but Mr Brown sidestepped the question and said developing a "full social care system" would take time and needed consensus.

The CQC report, which was published today, said tailoring services to meet people's individual needs would help save money while allowing people to remain independent.

CQC chairwoman Dame Jo Williams said: "We all know that the context is changing. Trends such as increasing demand and rising expectations will be exacerbated by pressure on finances. That means we cannot go on as we are. To cope, we need some radical changes in the way that we organise and deliver services.

"This means shifting the culture away from a one-size-fits-all approach to care that puts the needs of individuals and carers at the centre of everything. A key part of this will involve helping people maintain their independence and health."

The Government has said around £2.7 billion could be saved every year by helping patients avoid making unnecessary hospital visits.

But the CQC said this would require "a fundamental cultural shift" allowing patients to control their own care.

Stephen Burke, chief executive of the charity Counsel And Care, said "an honest and serious" debate was needed about funding.

He said: "Politicians, nationally and locally, owe it to older people, their families and carers to prioritise care reform and funding. As the University of Birmingham has highlighted this week, there are massive economic and social benefits to be gained from a new, properly funded care system.

"Older people and their families want to know what care they will get and how much they will have to pay.

"One way to fund better care would be a care duty on estates but it must be done fairly through a percentage on all estates above a certain value. For example, 2.5% on estates above £25,000 would raise enough to meet the current shortfall in care funding. And it would help older people and their families who currently face losing their home to pay for care."

Director of the Patients Association Katherine Murphy said she welcomed the report's "clear direction" that the NHS and social care services had to start working more closely.

She said: "It is vital this approach becomes widespread if we are to make the most of increasingly restricted budgets and ensure users get a responsive service."

Simon Lawton-Smith, Head of Policy for the Mental Health Foundation, said: "There has been a lot of talk about person-centred services and joined-up health and social care over the last 20 years, so in a way it's disappointing that the CQC still has to make these arguments.

"The hope now is that the likely need to reduce funding might concentrate minds on reform. An often-overlooked benefit of treating people as individuals and focusing on maintaining their independence and health is that it has the potential to save money."