Care costs can run into tens of thousands of pounds

The Royal Commission attacked government policy on care, highlighting in particular the lack any distinction between personal care and nursing care.

This is important because anyone in England, Wales and Northern Ireland deemed to be in need of nursing care can rely on the National Health Service to pick up the bill.

But if a person is assessed as needing personal care, such as help with dressing, washing, cooking and eating, they could be liable for all or some of the cost.

Level of need

Anyone who has under �12,000 in savings and assets can get personal care free, but anything over that amount and you start paying a proportion of the cost of care.

Those with more than �19,500 - including the value of a home - have to pay for all their care.

The commissioners argue that funding should not be based on the level of need rather than the diagnosis of an illness.

According to the commission free personal care would cost authorities a "modest" �1.1bn.

One example highlighted is that cancer patients usually have all their care costs met by the state, while those with degenerative conditions, such as Alzheimer's disease, have to pay or rely on their families.

The Health Department's guidance and support has not provided the secure foundation needed to enable a fair and transparent system of eligibility for funding to be operated across the country Ann Abraham, Health Service Ombudsman

The commissioners argue that this distinction, made in Department of Health guidelines, is arbitrary and leads to "anomalies and injustices".

That view was supported by the findings of the Health Service Ombudsman report on funding for long term care published earlier this year.

The ombudsman, Ann Abraham, said on its publication: "There is evidence that the Department of Health's guidance has been misinterpreted and misapplied by some health authorities and trusts, leading to hardship and injustice for some individuals.

"But there are also more fundamental problems with the system.

"The Health Department's guidance and support has not provided the secure foundation needed to enable a fair and transparent system of eligibility for funding to be operated across the country."

Recommendations

That report has led to many elderly people and their relatives - helped by charities such as Age Concern and Help the Aged - challenging decisions which have denied them funding for care costs.

In some cases this could result in people being paid back tens of thousands of pounds if they are found to have been unfairly treated.

This might not have happened had the government acted on the recommendations of the Royal Commission four years ago.

In that report, the Commission said Labour should introduce free personal care as well as nursing care, something the Scottish Executive did.