The price of care falls by the wayside 

After what seems like a very long time - the consultation closed on 21 January last year - the new standards for the conduct of care homes for older people have finally been published. There are 38 standards and they will form the basis for the work of the National Care Standards Commission from April 2002. 

The two critical words are "national" - the standards will apply equally to residential and nursing homes in London, Lancaster and Looe. And "minimum" - in some cases homes will already be exceeding them, though there is no cause for complacency and the standards should be a platform from which higher standards can be developed.

Beginning with the business of making a choice, homes will be required to produce a statement of aims, objectives and philosophy, along with a statement of the services and facilities provided and the terms and conditions for residence. They will be expected to produce a brochure or user's guide describing these matters in plain English.

These steps are intended to provide prospective users and their families with sufficient information for them to make an informed choice about where they will live and should be helpful. However, many families will come up against the single most important impediment to choice - the lack of funding.

No amount of brochures will compensate for council purchasing policies that have the effect of excluding older people from homes charging above the "local rate". Unless the prospective resident has friends or charitable sources willing to provide a top-up, bridging the gap between what the provider charges and what the purchaser is prepared to pay, the choice will be strictly limited.

When Counsel and Care responded to the consultation, we underlined the need to establish a national standard in relation to the cost of care, as well as to the conduct of care homes. The absence of such a standard remains a real impediment to homes reaching high standards that they and their staff set out to achieve.

Much of the debate over the past year has focused on the physical space requirements and rapidly became polarised between providers resistant to the proposed new standards because of the difficulties they would find in complying, and those who inspect or advocate for residents who wanted to see rapid improvements. That issue has been pushed off the agenda, for the time being at least, by allowing a very long lead-in time - to April 2007 - for the introduction of larger room sizes. Private space is important to all of us, and will not become less important as we grow older, but maybe now we can get on with addressing some of the other equally important issues that have been obscured by this topic. 

From April 2002, policies and procedures must be in place to protect residents from abuse. The establishment of a register of staff considered unsuitable to work with vulnerable people will provide additional protection. But this alone will not deal with a "dripping tap" of affronts to the dignity and wellbeing of residents. Our contacts with residents, their relatives, managers and care staff tell us that there is a great deal of scope for staff adversely to affect the lives of residents.

A raised voice, a thoughtless word or just not being available to lend a sympathetic ear to someone, perhaps because of pressure of other work, may each in their own small way contribute to unfulfilled lives. One of the most telling findings from interviews conducted for the Office of Fair Trading 1998 report, Older people as consumers in care homes, was that residents reported staff were too busy to talk to them. 

A still largely untrained workforce presents a threat to the welfare and wellbeing of residents. So it is encouraging that the standards address the training needs, qualifications and skills mix of the staff group. At least half the care staff should be trained to NVQ level 2 by 2005 - a high but necessary target. But there will be problems with recruitment and retention that will affect the ability to achieve this target so long as the care sector is unfavourably placed to compete with commercial organisations in the labour market. 

Once again, then, the issue of a fair price for care rears its head. Until such a time as agreement can be reached on a target price, providers will continue to express concerns about their capacity to deliver care, staffing and services to all the standards against which they will be inspected.

Campaigners working to protect and promote the rights of older people have had enough of the government saying that councils have had increased resources and enough of councils telling us they are under-resourced. Squeezed in the middle are older people whose care depends on these issues being satisfactorily resolved. 

Publishing national minimum standards is an important milestone. Let's ensure that they don't become a millstone consigning more homes to closure with a narrowing of choice for consumers. 

• Les Bright is deputy chief executive of Counsel and Care, a registered charity providing information, advice and advocacy for older people and their families. It also conducts research, publishes the findings and seeks to influence policy and practice.