According to the Care Quality Commission's annual report, care is approaching a tipping point. But will it be the tipping point for sustainable change or for a complete collapse of the care system?
Have the growing demands and financial pressures, closures of care homes and undeliverable contracts all combined to create a burning platform for change?
Certainly many, including this writer, have been warning that care is in crisis. Growing numbers of older and disabled people together with severe cuts in funding for care have led to the inevitable crunch. The care market is creaking as providers struggle to maintain and improve quality while margins shrink.
The knock-on effect is systemic as hospitals and A&E in particular struggle with demand, and it is personal as millions of older people and their families can't get the help they need. They should all be writing to their MPs about how the care crisis is affecting their lives.
There is now almost universal consensus about the care crisis, the main causes and the need for an urgent solution. What is lacking is consensus about the solution - both about what should be done and how it should be funded.
Recently the King's Fund published its proposals. The House of Commons Communities and Local Government Select Committee is conducting an inquiry into care funding. And early next month the Commission on Care is due to publish its recommendations.
Any solutions must address the underfunding of care (starting with the autumn statement in November) but this must be done alongside substantial reform of the care system. My five starting points for a fair, simple and sustainable system would be:
-A clear vision of the care system in 21st century Britain, ambitious for our ageing population and their families and providing independence, control and early intervention
-An integrated system which brings together care, health and housing as inseparably entwined parts of the solution to helping older people live well, safe and warm at home
-A single body locally would be responsible for commissioning and funding joined up health and care within a strong national framework to end the postcode lottery
-Much more support for family carers so that better care becomes a key part of the economic and social infrastructure that makes the country and family life work for all
-The funding of care must be similar to health ie free at the point of need and funded by taxation, with government ensuring sufficient revenue to meet growing demands
To succeed a new vision has to win popular support. Universality is key to ensuring buy-in from the whole population and to tackling the unpopular and fragmented local variations that currently exist. Universality is also critical to raising the status of care and caring, and the value placed on care.
Finally, a key principle is that the new system should be based on the sharing of risks and the sharing of the costs of care
Of course change will take time. But there are steps that could be taken on the way to delivering this new vision. We must make a start urgently - none of us can afford another wasted five years, like those that have followed the Dilnot Commission. Older voters will make their views heard at the next election if better care is not on the agenda.
Stephen Burke is director of United for All Ages and Good Care Guide