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迪尔诺特表示,新的NHS式社会照护体系可能需要数十年才能建成New NHS-style social care system could take decades, Dilnot says

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贝基·莫顿报道:经济学家安德鲁·迪尔诺特爵士向BBC表示,英格兰新的、类似英国国家医疗服务体系(NHS)的社会护理体系可能需要数十年才能真正实施。

By Becky Morton A new NHS-style social care system for England could take decades to be implemented, economist Sir Andrew Dilnot has told the BBC.

15年前,迪尔诺特爵士曾领导一个委员会提出社会护理体系改革的方案;他表示,现任首相安迪·伯纳姆似乎希望社会护理服务完全免费,包括住院费用在内的所有相关费用都应由政府承担。

Sir Andrew, who led a commission proposing reform of the system 15 years ago, said Prime Minister Andy Burnham appeared to want social care to be completely free, including residential costs. He told BBC Radio 4's Today programme the cost of such a scheme would be "very substantial".

他在BBC Radio 4的《Today》节目中指出,这样的改革计划所需成本“将非常庞大”。由于伯纳姆承诺将在下一次大选中向选民详细阐述自己的改革方案,因此改革“目前变得更加遥不可及”。

And with Burnham promising to put his plans before voters at the next general election, Sir Andrew said change "is now further away". Adult social care provides state support to help people live more independently, including assistance at home.

成人社会护理服务旨在为人们提供国家支持,帮助他们更独立地生活(包括在家中的生活照料)。不过与英国国家医疗服务体系不同,英格兰的社会护理服务在使用时并非免费,导致一些人不得不面临巨额费用负担。

However, unlike the NHS, social care is not free at the point of use in England, leaving some people facing huge bills. In an interview with the BBC's Sunday with Laura Kuenssberg, Burnham suggested his proposals for social care would mean "everyone contributes, everyone is covered" and refused to rule out tax rises to fund such a system.

在BBC的《Sunday with Laura Kuenssberg》节目中,伯纳姆表示,他的社会护理改革方案意味着“每个人都要为此做出贡献,从而确保每个人都能得到相应的服务”,并拒绝排除通过提高税收来为该体系提供资金的可能性。他承诺将在周二的演讲中进一步详细阐述自己的改革构想。

He promised to set out more details of his vision in his conference speech on Tuesday. However, he suggested any proposals would not be implemented before the next general election, as he wanted to stick to the commitments in Labour's 2024 election manifesto, which included a promise not to increase national insurance, income tax or VAT.

不过他强调,任何改革措施都将在下一次大选之前无法实施,因为他希望遵守工党2024年竞选宣言中的承诺——即不增加国民保险费、所得税或增值税。

Labour MP and former minister Darren Jones told Laura Kuenssberg that scrapping the pensions triple lock was an "option that the government should consider alongside others" in order to fund social care reforms.

工党议员兼前部长达伦·琼斯则认为,为了资助社会护理改革,政府“应该考虑其他可行的方案”,包括废除现有的养老金“三重保障机制”。目前的养老金“三重保障机制”规定:养老金增长幅度应至少达到平均工资增长率、通货膨胀率或2.5%中的最高值;维持这一机制也是工党的竞选承诺之一。

The triple lock pension policy guarantees that the state pension will increase by either average wage growth, inflation or 2.5% - whichever is highest - and keeping it in place is also a Labour manifesto pledge. The next general election is not due until August 2029, although Burnham could choose to call one earlier.

下一次大选预计将在2029年8月举行,不过伯纳姆也有权提前举行大选。

Sir Andrew told the BBC change on social care "is now further away" than had been implied when Burnham first promised a new national care service for England in a speech in July, shortly after he became prime minister.

安德鲁爵士告诉BBC,英格兰的社会护理改革“现在比伯纳姆在7月份上任后首次承诺建立新的全国性护理服务体系时所预计的时间要晚得多”。他指出,如果这些改革提案能够被纳入工党的2029年竞选宣言中,那么距离伯纳姆发起关于社会护理问题的皇家调查已经过去了30年;而自他自己的调查小组提交报告以来,也已经过去了15年以上。

Sir Andrew told the BBC change on social care "is now further away" than had been implied when Burnham first promised a new national care service for England in a speech in July, shortly after he became prime minister. He pointed out that if proposals are included in Labour's 2029 election manifesto, that would be 30 years after Sir Tony Blair launched a royal commission on social care and more than 15 years since his own commission reported back.

在英格兰和北爱尔兰,资产价值超过23,250英镑(包括房产)的人目前无权从地方政府获得护理费用补贴。在威尔士,社会护理服务同样需要经过经济状况评估才能获得资助。在苏格兰,政府为所有被评估为需要帮助(如进食、洗澡等)的成年人提供个人护理服务,但这些服务并不包括住宿、食物和日常生活费用,这些费用仍需根据个人经济状况来决定是否可以获得补贴。

In England and Northern Ireland, people with assets worth more than £23,250 - including their home - are not currently entitled to help with care costs from their council. In Wales, social care is also means-tested. In Scotland, state-funded personal care is offered to all adults who are assessed as needing help with tasks including eating and bathing. However, this does not include accommodation, food and everyday living costs, which are subject to means testing. Sir Andrew said a Scottish-style system would still leave people in residential care facing "very substantial bills", which Burnham has said he wants to avoid.

安德鲁爵士表示,即使采用苏格兰的模式,住在养老院中的老人仍需面临“巨额的护理费用”,而这正是伯纳姆希望避免的情况。健康基金会估计,如果英格兰建立由政府全额资助的普遍性社会护理体系,每年的成本可能高达185亿英镑。

The Health Foundation has estimated a universal social care system in England, with the government funding all support, could cost around £18.5bn a year.

伯纳姆在周日表示他认为这些成本会更低,但他尚未详细说明自己将如何为这些计划提供资金。安德鲁爵士认为,采用类似英国国家医疗服务体系(NHS)的社会护理模式,其成本可能会超过180亿英镑;而苏格兰的模式虽然成本可能仅为这一数字的一半,但仍需要巨额资金。他还指出:“从伯纳姆的言论中可以看出,他设想的这一改革可能需要很多年,甚至几十年的时间才能真正实现。”他希望看到一个所有社会护理服务都由政府资助的体系,但这样的体系所带来的成本将会非常庞大。

On Sunday, Burnham said he believed the costs would be lower than this but he has not set out how he would fund his plans. Sir Andrew said he believed an NHS-style social care system could costs "well in excess of £18bn", although a Scottish model could cost half this figure. He added: "I also think that there was an indication in what [Burnham] said that he's imagining something that could take many years, even many decades before it came to fruition." Sir Andrew said he would "love to see such a scheme", where all social care is government-funded, but "the cost would become very, very large".

此外,安德鲁爵士认为,如果对个人在护理服务中所需支付的费用设定上限,那么这种体系仍然可以为老年人提供有效的帮助。

He added that a system where the amount people must pay towards their care is capped, "could still work well for elderly people". Sir Andrew's own commission proposed a lifetime cap of £35,000.

安德鲁爵士自己提出的建议建议为护理费用设定一个终身上限,即35,000英镑。

The report's recommendations were accepted by the Conservative-Liberal Democrat coalition government, led by David Cameron.

这份报告的建议被由戴维·卡梅伦领导的保守党-自由民主党联合政府采纳了。

However, the implementation of the cap was delayed to 2020, with Cameron blaming pressure on the public finances, and the idea was eventually dropped by subsequent Conservative governments.

然而,这一上限的实施被推迟到了2020年;卡梅伦将原因归咎于公共财政的压力,随后几届保守党政府最终放弃了这一提议。

However, the implementation of the cap was delayed to 2020, with Cameron blaming pressure on the public finances, and the idea was eventually dropped by subsequent Conservative governments.

其他改革医疗体系的提案也均以失败告终。例如,特蕾莎·梅领导的保守党政府曾计划要求那些在家接受护理、且护理费用超过100,000英镑的人全额支付费用,但这一提议被反对者称为“痴呆症税”(即对老年人的不公平征税)。

Other proposals to reform the system have also failed, with Theresa May's Conservative government scrapping plans to make people receiving care at home pay the full costs if they were worth at least £100,000, after this was branded a "dementia tax" by opponents.

在戈登·布朗政府期间,伯纳姆曾提出通过征收人们去世后的遗产税来资助国家护理服务的计划;这一提议同样遭到工党反对者的强烈反对,因此在工党在2010年大选中落败后未能继续推进。

Meanwhile, when he was health secretary in Gordon Brown's government, Burnham's plan for a national care service suggested this could be paid for through a compulsory contribution from people's estates after they die. The idea was branded a "death tax" by Labour's opponents and the proposals went no further after the party lost the 2010 general election.

这些事件反映了英国议会内部的政治博弈以及相关政策制定的复杂过程。

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