When asked ‘would you be prepared to pay 1p extra on your income tax to fund better and fairer care for older people?’, 75 per cent of those surveyed said that they would. The 55+ age group showed the greatest support at 82 per cent, and the 45–54 age group – often known as the ‘sandwich generation’ who care for both children and ageing relatives – were the next highest at 77 per cent.

Two-thirds of people think that the cost of care for older people should be government funded, with a quarter saying it should be means tested. Those in the 18-24 and 25-34 old age groups are more in favour of means testing.

The survey, commissioned by Counsel and Care and Lawpack Publishing Ltd, reveals that 42 per cent think that care and support services for older people are worse compared with five years ago, with only 13 per cent thinking they are improving. Among the 55+ age group, 54 per cent say that services are worsening. This confirms Counsel and Care’s recent survey of local authorities which highlighted the widening care gap as councils restrict the number of older people eligible for care services.

The survey also found that a quarter of 45-54 year olds do not know where to find advice and information on care for older people – even though this age group is most likely to be helping ageing parents with care.

These findings support our view that urgent action needs to be taken on the funding of long-term care, and that the public is willing to participate. Clearly the public want better care for our ageing population. It is critical that we win support across all ages and generations if we are to end the underfunding of care and support for older people.

If we can develop a co-payment option that is a true partnership between the state, the family and the individual, we can move towards a fairer system of paying for care in the future. That is the challenge for the government in its spending review this autumn and beyond.

The 12 members of the Commission were from a variety of public, private and voluntary backgrounds. We collected a mass of oral and written evidence, held public meetings throughout the UK, and studied arrangements in other countries. In March 1999 we recommended, by a large majority, that the cost of ‘intimate’ personal care required as a result of illness or disability, such as washing, feeding and toileting, should in principle be met by the state from general taxation. Our reasoning was founded in simple equity and morality. We judged that the cost was affordable, at least by a government determined to tackle this issue.

Our recommendation did not – as some of our detractors have claimed – amount to ‘free personal care’. Rather it meant that the government should pay a fixed but generous amount of all care home bills to reflect nursing and personal care costs, with people meeting ‘board and lodging’ costs from their own resources on a means-tested basis. In the jargon, the Commission advocated ‘co-payment’ in which costs are shared between state and individuals, a system that works effectively in Scotland.

Ten years on, I have no doubt that this is the right medium-term approach. People don’t get ill or disabled through their own fault; if the state can fund care for people with cancer then it should also fund it for old folk who have falls or develop Alzheimer’s. If the Commission made a mistake, it was not to insist that personal care in these circumstances should really be part of the NHS.

It’s very interesting that the Wanless study for the King’s Fund, which, like the Royal Commission, had no preconceptions, came to a similar conclusion – that it is the state’s duty to guarantee a basic level of care to everyone irrespective of means. That’s what a decent welfare state should be about.

Over the past year I have been handling the financial affairs of a very old relative, now in a poor and confused state in a nursing home following a fall. This experience has brought home to me the justice of the Royal Commission and Wanless proposals. Although above the means-testing line, she is by no means wealthy. But month by month her hard-earned income and savings get drawn down to pay for care that she has not volunteered for.

So I really welcome this Caring Choices coalition and wish it well. The campaign to put England, Wales and Northern Ireland on a similar ‘co-payment’ basis to Scotland must continue to the point where ministers can no longer patronise or ignore it. And we must ensure the issues get to Cabinet level and don’t stay stuck with transient junior ministers.

In recent years, other countries – including Germany and Japan – have overhauled their funding for care, creating entitlements for everyone and more consistent rules about how much private individuals should contribute. Within the UK, Scotland has taken a step in this direction by abolishing charges for personal care at home and introducing a flat-rate contribution to care home fees that is intended to cover the cost of personal care tasks.

There are some arguments for going down such a ‘universalist’ route in the UK as a whole. Helping someone carry out the basic functions of everyday living is not cheap and it is not a cost that a private individual can readily budget for. Private insurance on reasonable terms is not available. The problem is that insurers know too little about the longevity and health of older people several decades ahead to be able to offer products on reasonable terms.

That is why the Joseph Rowntree Foundation has argued in the past for a form of social insurance to which we all contribute when we are working and from which we all draw out when we need to. The case remains strong but this does not mean that the state should provide everything. We may want to opt for a foundation of support, where individuals are expected to make a contribution and where they are able to buy a higher level of care with their own resources if they wish to.

Of course the big question is: if we want wider support from the state, are we willing to pay for it through higher taxes or insurance contributions, or perhaps reprioritising of money spent on healthcare? We are keen over the next year to listen to the views of the public on this issue. The additional amount that is needed to pay for decent care is tiny compared, say, to growth in spending in the health service.

At the Foundation, we are also able to draw on the experience of residents of our own continuing care retirement community at Hartrigg Oaks in York. Here, residents are given peace of mind, having bought into a community where they can draw on the kind of care that best suits their current needs, with a minimum of disruption and without having to leave the area where they live. What we have learned from this project is how much people value stability at a stage of life when uncertainty is particularly unwelcome. We think that this principle needs to be applied more widely, and will be bringing our practical experience to debates about the future.

Julia Unwin CBE is Director of the Joseph Rowntree Foundation.

The current system is chronically under funded. Budget increases not even keeping pace with demographic change have squeezed care services, and people with moderate needs have suffered most. With little or no support, people’s chances of staying healthier for longer are reduced.

The system survives only because of the huge contribution made through informal care by families and friends. Their role is recognised in words and is likely to continue, but carers need more than the minimal help and support they get.

The funding system penalises people with moderate savings, a shock to many just when they are most vulnerable. If left in place, it will discourage hundreds of thousands from receiving support they need.

The postcode lottery is alive and well in social care, with large inequitable differences in local authority charging. There are perverse incentives encouraging excessive use of care homes rather than care at home. Poor people with assets less than £21,000 are left with £19.60 a week personal allowance after care costs. It is the exact opposite of the rhetoric about independence and dignity.

Today, up and down the country, relatively few older people are eligible for NHS continuing care. The benefits of ‘free’ care have been replaced by means testing. This shift began more than 20 years ago, but it is a policy largely introduced by stealth, noticed only when people need help.

As we await the Chancellor’s announcements on future funding of social care later this year, it is crucial to emphasise the urgent need for additional spending simply to prevent further deterioration. Furthermore, changes in the population over the next 20 years would demand significant increases in spending even if the present system is retained.

In the longer term a more enlightened system must be adopted. Central to finding the right solution will be agreeing, as a society, what outcomes we want to achieve for older people and what kind of care system we will provide them. A fairer, more rational system must be built on the foundation of a basic entitlement for everyone, calculated to reflect the level of care required rather than the financial means of the individual.

The other key question is ‘who pays what?’ The current complex funding and benefit regime must be replaced and the huge financial risk to people of extended and expensive social care must be pooled across the population.

The immediate reaction to my review when it was published suggested that we had reached a tipping point where government and opposition parties all acknowledged the major shortcomings in the system.

All of the leaders in the field seem to me to be ready for a frank and open discussion about the realities created by an ageing population, and the competing demands on the tax base. What they are all agreed on is the need for a system that ends the current shameful treatment of older people and transforms the rhetoric into a reality of dignified lives.

Sir Derek Wanless is a Senior Associate of the King’s Fund. In addition to his review of social care for older people for the King’s Fund, Sir Derek has also produced two significant reports for the government on the NHS. He was formerly chief executive of NatWest Group.