Who should pay for supporting us as we grow old and need care? That was the subject of a Government review headed by Andrew Dilnot that was published this week. The response has been almost unanimously positive, and in some areas, quite rightly.

The current system, as the review points out, is 'confusing, unfair and unsustainable'. Since 1901, there has been a 25-fold increase in the number of people who live beyond the age of 85, and the costs of caring for older people are rising astronomically. So who could possibly disagree with recommendations for capping individual contributions, reducing the disincentives of saving for old age, and making only those who need care pay for it?

Well, the Chancellor of the Exchequer might - he is being asked to source up to an extra £2.2bn from a Whitehall budget that is already under immense strain. The review boldly states that no one will pay more towards care, whilst many will pay less.
But that isn't quite true - taxpayers will have to pay more.

The government has already stumped up quite a lot of extra cash for elderly care - last year's spending review saw an extra £2bn go in. Will the Treasury be ready to slow the pace of deficit reduction by pumping in another slug of funding? We can't expect to look to local councils for the cash - they are already seeing cuts of not far off 30% in their grants.

This issue of who should pay is the rock upon which previous attempts to reform the care system have foundered. So what's different this time? And is there even a danger that by asking the state to shoulder more of the burden, Dilnot is actually eroding personal responsibility? This report sends the signal that all's well, saving for old age is taken care of. The reality is far removed from this.

There is a broader, less headline-grabbing bone of contention here which Dilnot does not effectively address, and which national politicians may be reluctant to discuss: what exactly should be the rights and responsibilities of senior citizens? Should the current generation of elderly people and the baby boomers who follow them be obliged to contribute more to their own social care given their net gain from the welfare state?

Perhaps what is required is not just continued reliance on a centrally proposed scheme for social care, but more community initiatives. The universality of the propositions in the report are an attractive way to promote a national model for care, but they could end up stifling local, council-led innovation, damaging the potential of communities to create tailored models to suit local needs. Dignity in old age is not just about domiciliary care, but about being able to play a role in your community.

So, a top-line success for Dilnot. But his report should be just the start of a far more fundamental debate about the place of older people in our society.

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