Page last updated at 13:59 GMT, Tuesday, 30 March 2010 14:59 UK

Q&A: Social care

Social care is at the top of the political agenda at the moment.

With the ageing population and pressure on public sector funds, everyone admits the system is in need of serious reform.

Elderly person's hands
Social care is currently means-tested in England

How does the social care system work currently?

Adult care in England is means-tested at the moment. Everyone with savings of over £23,000 pays for support they may need washing, dressing and eating.

If an individual needs a care home place the £23,000 threshold includes the value of their property.

This has created a situation where some people have been forced to sell their family home when they need residential care.

What is more, councils, because of limited funding, have started to restrict access to care themselves.

Three-quarters of local authorities only allow access to help when a person's needs are judged substantial or critical.

This basically means if a person does not need help throughout the day then they do not get any state help.

The problems have led to a fall in the numbers getting help in their own homes. It now stands at 340,000 - a fall of a fifth over the past eight years.

The situation - coupled with the challenge of the ageing population - has led to a widespread acceptance that reform is needed.


What are the options for the future?

Ministers published a series of proposals last summer with Health Secretary Andy Burnham saying it was time to "grasp the nettle" and have the debate.

One of these was introducing a compulsory charge, perhaps as much as £20,000, which could be taken from a person's estate after death. This has been dubbed a "death tax" by the Tories.

But the policy paper also floated the idea of voluntary insurance or creating a system whereby the government provides a certain level of basic care which individuals could then top-up themselves.

In March, ministers came out in favour of the compulsory fee method, but refused to put a figure on the sum they wanted from individuals.

Instead, they have said a commission will be set up to look at how much and in what way people should contribute.

The Tories have come out firmly in favour of voluntary insurance. They have proposed an £8,000 optional fee to cover the cost of care homes, while they are drawing up plans for support in the home.

The Lib Dems like the idea of a partnership with the state providing a certain level of care, which could then be topped up. They did not initially back a compulsory levy, but have said they are open to the idea.

Hasn't the government already said it will provide free care?

Yes. Prime Minister Gordon Brown announced at the Labour Party conference last year that he wanted to see free personal care for the most in need.

This took many people by surprise because it came as ministers were consulting on the above proposals.

Critics have suggested the move was politically motivated as it allows Labour to fight the election promising it will provide free care.

However, this only covers care in a person's home and is only for those with the most severe need.

Ministers believe the policy, which is currently being debated in parliament, will help nearly 300,000 people - although the majority of these already get state support under means-testing.

On top of this, ministers have also said those in care homes for two years will get free places from 2014 as part of a phased introduction of their new system.

However, if a compulsory levy was introduced - and that is all dependent on Labour winning this election and the following one - it would be hard for ministers to argue it was in fact free.

What do the experts want?

There is pretty widespread support for a compulsory charge. Social services chiefs, voluntary and private sector organisations which run services for councils and charities all believe it is the best option.

They fear a voluntary scheme would lead to too many people opting out, undermining the system.

The Local Government Association, the official body representing councils, has remained neutral. This reflects the cross-party political membership which makes up the group.

However, both the LGA and many of the others have serious concerns about some of the assumptions being made by politicians and fear they are under-estimating demand for services and how much they cost.

What happens elsewhere?

Wales and Northern Ireland both have means-tested systems which are similar to England, but both are looking to review the arrangements in the future.

Scotland, however, has already diverged since devolution.

It provides free personal care, but in recent years has started tightening the eligibility criteria for the same reasons councils in England have.

England is not alone in looking for a new solution to social care. Many other countries have changed their systems in recent years.

Traditionally, care for the elderly has been done by family members in many countries.

But with the ageing population and families becoming more spread out, changes have been made.

A variety of systems exist on mainland Europe, including insurance schemes, private markets and subsidised retirement villages.

In the US, most services are run for profit, although faith groups are also beginning to get involved.

Canada, meanwhile, has a means-tested system.

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