By Sue Littlemore
Social affairs correspondent, BBC News
Many vulnerable people who need social care do not receive it
Ways of making England's social care system fairer have been recommended by a government-backed review.
The Commission for Social Care Inspection suggested changes to the existing criteria used by local social services departments to decide who gets help.
That system - which assesses people's needs as low, moderate, substantial or critical - has been widely condemned, as growing demand has forced approximately three quarters of councils to ration their support and confine help to people with substantial or critical need only.
It means many vulnerable people who need social care simply do not receive it. In one case, a family was forced to move home to a different town to get the right level of care.
For 17-year-old Aisha Ahmad, a spoon can be too heavy to lift and a pen needs to be particularly light for her to be able to use it.
Aisha was born with spinal muscular atrophy type 2, a condition which means her muscles are very weak.
She uses a wheelchair and needs help to eat her meals, wash, dress, and with all her personal care.
Aisha also needs someone to turn her in bed during the night. In short, she needs support 24 hours a day. However her physical weakness hasn't held her back.
She is currently studying for her A-levels. She already has 11 A* grade and one A grade at GCSE level, and one A grade in maths at AS-level under her belt.
It got to the point my body couldn't cope and I ended up in hospital
Aisha and her mother Ghzala rely on carers to do the "night shift". They arrive at 2100 and stay until 0745. The arrangement is working, but a few years ago life was very different.
At that time, the support on offer from Ghzala's social services department was quite inadequate. She was taking care of Aisha 24 hours a day. Ghzala became exhausted.
"It got to the point my body couldn't cope and I ended up in hospital," she said.
Later Ghzala discovered she'd get better support if she lived in a different town. She felt if she didn't get help, Aisha would end up in a home - so she moved. But she feels strongly that no one should have to change their address to get the right care.
"Not everyone has the option to move. Moving is an added stress on families who are already under so much pressure," she said.
"It's so unfair, a need is a need and that should be identified and a solution found wherever you live."
The sense of unfairness is exacerbated by the way the criteria are applied. The commission reported that judgments vary between professionals and between councils.
Consequently, people's access to social care depends on where they live and can feel like a postcode lottery.
In the report, requested by the government, the commission suggested new criteria which focus more on preventing people's needs getting worse.
The commission said this system should mean some people currently not getting social care would become eligible, but it accepted not everyone who needed support would get it.
However, another recommendation would apply to anyone needing care. It suggests everyone should have proper help when they come to make choices about their care, including assessment, advice and information.
All these suggestions, the commission admits, fail to address the fundamental problem with social care which is simply that it is seriously underfunded.
The government has accepted that and is currently engaged in a major public consultation on how to reform social care funding in England.
In the meantime, though, the commission believes its recommendations would bring about more immediate improvements for many people needing social care.
Care Services Minister Phil Hope says there are plans to update the criteria, and that the commission's recommendations will be taken into account.