Leading Article: . . . but the sick are unimpressed

THE CASE of Jean Gittins, reported on page 4, is deeply disturbing. Unable to do almost anything for herself thanks to brain disease and a stroke, she has been obliged to sacrifice half her savings on being discharged from a Leeds hospital into a private nursing home. It suggests that Mr Clarke (see above) is being over-optimistic about the sense of security imparted by the welfare state.

Most people believe that if they are sick and have paid their taxes and national insurance contributions, they will be entitled to free care. However, that comforting assumption is undermined by the actions of the Leeds Health Authority, which was reprimanded three months ago by William Reid, the NHS ombudsman, over a comparable case. Mr Reid's ruling obliged the health authority to pick up the bill and review its policy. It is still doing so.

The Leeds cases merely highlight a trend that looks like a flagrant breach of Department of Health guidance. This laid down in 1989 that 'no NHS patient should be placed in a private nursing or residential care home against his/ her wishes if it means that he/she or a relative will personally be responsible for the home's charges'. Clear enough: yet under the NHS and Community Care Act 1990, a patient requiring continuing but not specifically hospital care must undergo an assessment. If he/she is deemed to need a place in a nursing home, the local authority must carry out a means test that may lead to demands for a contribution.

The seeming injustice arises because social care has traditionally been means-tested while health care remains free (taxation apart). Does the care of a doubly incontinent and paralysed patient, whose condition a hospital can do nothing to improve, qualify as medical or social? The borderline has never been defined, but needs to be.

The problem will become ever more acute as the closure of long- stay hospital beds continues and even more people live into extreme old age. At present, those who save (and their potential inheritors) are liable to be penalised. Yet long-stay nursing-home care is extremely costly, and not easy to insure against.

One solution that has been floated is for some form of wealth tax on, say, the over-fifties, to be earmarked specifically for long-stay care. It could conceivably be levied on the estate of the deceased. Another possibility would be a voluntary bargain-rate state insurance scheme - or a politically unpopular increase in general taxation. If extra provision needs to be made for extended nursing-home care, people should be told, and soon.