The social care crisis is out of control – and Priti Patel’s curb on migrant workers will push costs higher

By 2010, 75 per cent of people with moderate needs were already being denied free care. The situation is untenable, says Vince Cable, yet the solutions are very costly and politically controversial

Patel has sparked nationwide debate on how new immigration measures will affect the social care sector (AP)

We are told that this government will bravely go where others have feared to tread and solve the problem of funding adult social care. This is a subject that can quickly disappear into arcane debates around financing mechanisms but has a profound effect on very many vulnerable people and their families. At its heart is a simple but difficult question: who pays for the cost of looking after the growing numbers of elderly people, especially dementia sufferers, who cannot care for themselves? Should it be the elderly themselves, out of their savings or insurance if they have any? Or their families? Or the rest of us through taxation?

Our collective unwillingness to confront this question has resulted in confusion and frustration on several levels. In particular, it has exposed the arbitrary line rationing what is and isn’t available through the universal free service of the NHS.

Cancer, strokes and broken limbs guarantee world-class health treatment, free of charge. Alzheimer’s or Parkinson’s do not qualify. You can get free treatment for bowel cancer and a colostomy bag fitted on the NHS, but cleaning up after an incontinent dementia patient is someone else’s problem. The state will pay if you crack a hip getting into the bath, but not to help you take a bath safely if you are infirm.