Leading article: Dignity and decent care, from cradle to the grave

Gordon Brown's announcement on social care for the elderly yesterday helped shift the media spotlight briefly away from his own political troubles. But, unfortunately, from the perspective of the elderly, the Prime Minister's announcement contained little substantive. Mr Brown merely unveiled a six month public consultation.

Ministers have been promising for some time to get to grips with this issue. As long ago as 1999, a Royal Commission looked into it. But other, less problematical, subjects have always taken precedence. We must hope that, this time, the Government will actually deliver, because the problem of how to care for the elderly grows steadily more pressing. Standards of full-time and ancillary care are, in the main, dire. Without migrant labour the system would have collapsed some time ago. The social care services are already under-funded and over-stretched. But such strains will only get worse as time goes on.

This is partly due to social changes. Fifty years ago, it would have been normal for the elderly to live with their extended family. This is increasingly rare; the strain of helping the older generation with washing, dressing and cooking now often falls on local government and the social services. But the strains are also demographic. In 20 years time, a quarter of the UK's population will be over 65 and the number of people over 85 will have doubled. This new generation of elderly will also live longer and thus need care for longer. Reform of the system is not a luxury; it is a political and social imperative.

Across the political spectrum there is an agreement that the present system of rationing care through means testing in England, Wales and Northern Ireland (Scotland has provided free long-term care since 2002) is unfair. Anyone with assets of more than £21,500 must pay their full costs. The system thus penalises those with modest savings. And many (those with meagre pensions and all their equity tied up in their homes) have been forced to sell their property to pay for their care. There is also a manifestly unjust official distinction made at present between social care, which is means tested, and medical care, which is provided free on the NHS.

But the solutions to such iniquities are far from obvious. The provision of Scottish-style universal care would be prohibitively expensive and also channel funds to those who are well-off enough to pay for care themselves. Scotland itself is struggling with the social care bills. The technical challenges are rather similar to those involved in the pensions crisis, in terms of the need to calibrate the incentives to save and anticipate the demographic strains to come.

This newspaper recognises the spending implications, but nevertheless errs on the side of broader social care coverage, along the lines of the recommendations made by the King's Fund two years ago. This report suggested a minimum level of care guaranteed by the state, which would then be topped up by the individual. This will not be cheap, but the British public have a right to expect basic medical and social support from the cradle to the grave. And a government that claims to have money for a ludicrous ID cards scheme and NHS super computers should at least have enough funds to ensure a dignified old age for all of its citizens.

There is another argument in favour of decisive action. If these are to be Mr Brown's final years in government, what more attractive legacy is open to him, as things stand, than setting in train a bold and egalitarian reform of the social care system?

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