Commission on Social Justice: Minimum wage warning for Labour as party urged to adopt student loans: Health and Community Care

Compulsory insurance for everyone to fund their own long term care.

Charges for community care services for those who can afford to pay.

Treatment for illness free on NHS but assistance with daily living means-tested.

Tax relief to elderly people on health insurance should be abolished.

Long-term care for the elderly and infirm should be funded by universal care insurance, and health promotion rather than illness treatment should be the new priority of a future National Health Service.

These are two of the key ideas on improving and financing health and community care which, because demographic changes are creating an increasingly ageing population, will be the most costly services to be planned by future governments.

One of the most controversial proposals is that long term care in residential homes and help with daily living at home cannot be provided free. In future everybody should make provision for their own long- term care insurance.

This could be through increased taxes, or a form of social or private insurance policies - perhaps incorporated into pension schemes - with the state paying for those who cannot keep up with premiums or whose insurance has run out. A wider debate would be needed to decide which system to adopt.

Given predictions that the resources needed for long term care could double by 2031, the report says: 'Now is the time for younger people to consider, individually and collectively, the possibility of insurance to cover the costs of long-term care needs.

The commission argues there needs to be a clearer definition of health care -which is free, and social care - which is means tested. Essentially it says, the difference is between the treatment needed for illness or injury and the assistance needed in performing the routine tasks of daily living.

In one of its most contentious statements, likely to enrage pensioners groups, the commission is essentially endorsing the Government's planned approach to the funding of long term care so that more pensioners and their families will have to pay for their own care, including in nursing and residential homes.

On the NHS the commission proposes changes which would re-focus health on the basis that 'prevention is better than treatment'. It examines how best to promote good health and reduce health inequalities; how inevitably limited resources within the NHS can best be used and allocated; and how to meet rapidly growing needs for community care.

Britain is 'scarred by health inequalities', the report says. 'The poorest and least powerful are ill more often and die younger . . . From the cradle to the grave, social class affects people's health.'

Research shows that in some of the poorest parts of Britain death rates are as high as they were 40 years ago. A baby whose father is an unskilled manual worker is one and a half times more likely to die before the age of one as a baby of a professional employee.

As British children grow up the poorest are twice as likely to die from a respiratory illness, more than four times as likely to be killed in a traffic accident and more than six times as likely to die in a house fire.

Among men aged between 45 and 64, unskilled manual workers are nearly three times as likely as professionals to suffer from a long-standing illness.

Angina is nearly twice as common among middle aged manual workers as among non manual. In Sheffield and Glasgow people living in the more affluent areas can expect to live eight years longer than those in the most deprived areas.

The report calls for a future government to set targets for removing inequalities in health and says all health authorities should be under a statutory duty to reduce inequalities in health care.

On improving health the report recommends campaigns to change lifestyles such as a government ban on tobacco advertising and more rigorous food labelling.

The report says that in the interests of good health the Government should ban water authorities from disconnecting supplies and end the compulsory introduction of water meters.

The thrust of the health policy is that all the economic and social strategies proposed in the report are the best way to close the health gap - to ensure a more equitable distribution of income; better distributed and better quality jobs; improved education and childcare; a healthier environment with clean and affordable water and better housing, transport and leisure facilities.

Since the commissioners believe health should be improved by better health promotion not just on services in hospitals, they reject proposals for an earmarked health tax.

They argue that the question of priorities and rationing within inevitably limited resources must be properly addressed, perhaps debated by a national forum. One possible outcome of a such debate could be the creation of a universal 'healthcare guarantee' setting out the treatment which would be available as of right and within a specified time.

On private health care the report says tax relief given to elderly people on medical insurance premiums, which costs pounds 85m a year, should be abolished. It also proposes that private hospitals should reimburse some of the costs to the NHS of training staff, perhaps through extending VAT to private medical treatment.

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