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In my last editorial I pontificated about geriatrician’s collaborating with GP consortia to influence commissioning. Now that the government  have acceded to the professions’ advice to include secondary care in the commissioning bodies, and with the launch of the DH (England) commissioning pack for dementia services, surely there could be no better time for geriatricians to influence the future shape of services for the major consumer’s of health and social care! Don’t wait to be asked – put yourselves forward, make your enthusiasm known. Whether or not you agree with this government’s proposed healthcare reforms the NHS will change and we should engage in the process to ensure older people’s services do not miss out. It is better to build from the inside than trying to chip away from the outside. I may be advocating ‘the end justifying the means’, but we must remember that the impact of change takes time to realise and so we must take every opportunity to build  a health and social care system fit for our future whilst ensuring today’s older people are not disadvantaged by the process of evolution.

And so speaking of our future: how many of you believe that you are amassing any wealth in order for your children to inherit this? Or is your estate (no matter how small or large) for your benefit whilst alive with any residue for your children once you are dead? That’s right, I am advocating that we lobby through the British Geriatrics Society for amendments to the Dilnot Report! Dilnot proposes that no one should have to pay more than £35,000 towards long-term nursing care in their old age; and that those with assets of less than £100,000 would not have to contribute towards their care. So middle income Britain still loses out and those who could afford to pay for their care are supported by the State after contributing only a small proportion of their overall wealth. Dilnot describes the existing system, in which many people risk losing the majority of their assets, including their home, to pay for care as “confusing, unfair and unsustainable” and in urgent need of reform. I agree! I also agree with his statement that: “This problem will only get worse if left as it is, with the most vulnerable in our society being the ones to suffer.” But I disagree with his contention that: “By protecting a larger amount of people’s assets, they need no longer fear losing everything.” Can we not, once and for all, agree as a nation that no matter what the reason for needing care (at home or in a care home) the daily living costs (by which I mean food, heating and lighting, clothing, reading materials, personal music, etc) should be paid for by the individual as they would have been had they not been disabled. Furthermore, if the individual can no longer live in their own home then it should be sold to fund these aspects of their care, not mothballed for their children to inherit! Those who have no estate would continue to be cared for by the State as they always have been. Let’s argue for improvements in care rather than waste energy on debating who will pay for it! My children have been charged with the responsibility of ensuring I get excellent and appropriate care, should I need
it, and not to squabble with the State over what they might or might not inherit.

Do feed back your views on the Dilnot Report and if you agree with me let the BGS secretariat and President know. Finally, do share your expertise with your BGS colleagues by writing for the CME Journal. As always, I welcome feed-back from you as to whether the journal is helping you to fulfil your CME needs and with any suggestions for improvements.

Duncan R Forsyth