Counsel and Care is a national charity getting the best care and support for older people, their families and carers. We do this by providing advice, information and financial support and by influencing future policies, services and funding. www.counselandcare.org.uk

Older people face major problems getting the care and support they need in Britain today. They, along with their families and carers, struggle day in day out to live independently, or to pay the high cost of care home fees.

Put simply, the number of older people is growing while the number getting care services is falling and the 'Care Gap' is widening. With our ageing population, urgent action is needed to stop the Care Gap widening.

The Government's 2007 spending review presents a major opportunity to re-think care services for older people and re-focus priorities.

The care lottery

Older people face a care lottery. Access to care depends on where older people live and their income; it depends on their local authority and its policies on charging and eligibility criteria.

A national survey of local authorities conducted by Counsel and Care has revealed that it is almost impossible for older people to access support in the community, unless their needs are severe. Two-thirds of local authorities have set their criteria at the top two levels of substantial or critical need and a number of councils are expecting this to increase. Many older people whose needs fall below this level are not getting the help they need from social care services.

The survey paints a worrying picture of future service provision, as increasing pressure on both NHS and social services budgets has led to a reduction in the number of older people who receive services. The survey also shows that there are high charges for services in some areas - with weekly charges of up to £315.90, and average hourly charges for services of £10.39.

The contradiction in care is that while older people are paying higher charges, fewer are getting services. Pressure on budgets means that fewer older people are eligible to receive support, leaving many struggling to meet what may be low level needs, but which can have a great impact on their quality of life. It is also short-sighted policymaking and ends up costing the government more in the long run.

Investing in older people's care will yield financial as well as social gains. Preventing falls, for example, reduces hospital admissions and other related costs. Targeting investment on new technology - such as telecare systems to monitor older people in their own homes - will also produce savings in health and social care.

To provide community services with an emphasis on prevention, there needs to be a change in priority. This can be achieved through a more strategic use of existing funds, together with an acknowledgement from the Government through its spending review that services cannot be improved without extra resources.

The dignity and well being of older people depends on them being able to access adequate support to help them live independently for as long as possible. Currently, older people are being denied this right - instead they are being condemned to isolation and dependency.

Older people, their families and carers won't tolerate the widening Care Gap. Their expectations are rising, they want a bigger say over their services and are much more likely to vote. As a society we can't afford not to close the Care Gap.

Urgent action and investment is needed to deliver better care and support for Britain's ageing population. Growing discontent among older people, their families and carers about 'patchy, inequitable and costly' care cannot be ignored.

There are a range of practical measures that the Government can implement in its 2007 spending review. We also need a long-term strategy for better care and support for older people and how it is fairly funded. This needs to be shaped by a public consensus about how the cost of care for older people is fairly shared between the state and individuals.

The spending review provides a once in a lifetime opportunity to tackle underfunding and create quality care and support that is comprehensive, fair and affordable and offers better value for money.

• State supported equity release schemes to help older people make better use of their assets and stay in their own homes.
• Proper funding of care home places and fair implementation of a new continuing care funding framework.
• Independent care advisers in every community and a national care advice service.
• Ending means-testing for disabled facilities grants for older people.
• Tax exemptions on care vouchers to help carers who work and extending carer's allowance for pensioners.
• A Sure Start for older people project in every neighbourhood and investment in early intervention and telecare.

• A fairer funding system: so that those who have capital can keep more of it than they do currently, and by giving people in care homes greater financial freedom with a higher personal expenses allowance. The vision also sets out the benefits of introducing minimum levels of need which will be met by care services, ensuring greater clarity and less regional inconsistency than exists currently. The recommendations from the Joseph Rowntree Foundation provide a way forward towards the partnership model of funding set out in the recent Wanless review.
• Information, advice and advocacy for every older person, their family and carers, so that people can be supported to make informed and considered decisions which take into account all of their possible options. This needs to be provided through independent care advisers who would work alongside older people throughout the decision making process. With people increasingly required to pay for their care, it becomes even more important that they not only access the services that they need, but also that they are achieving value for money. Supporting and signposting to independent advice and advocacy organisations is key.
• Making it easier for carers to care so that as much informal care as possible can be maintained and supported. The report argues that this can be achieved through the introduction of care vouchers which would give employees tax breaks to pay for services which would benefit their older relatives. Other key ideas include allowing people over 60 to receive carer's allowance, increasing the level of carer's allowance so that it matches the minimum wage, and provision of adequate emergency support and respite services for carers.
• A stronger focus on improving service quality through the Commission for Social Care Inspection, ensuring value for money for those who self-fund their care, as well as those supported by the state. Currently, around 20 per cent of residential providers and 30 per cent of domiciliary care agencies do not meet the general standards demanded by the inspectorate and most services still fail some of the minimum standards.
• Rolling out Sure Start for older people into every neighbourhood, providing a single point of access for information, support and services through the LinkAge Plus programme.
• Support for those who use private assets to fund their care, along with a clearer settlement which sets out what costs individuals will be expected to meet with their capital and savings. There needs to be a national debate, similar to the recent pensions debate, in which the challenges of funding care in the future are honestly discussed with the public and a settlement reached on the best way forward.
• Increasing financial control and empowerment to service users through Direct Payments and Individual Budgets, increasing the number of people eligible to receive them by supporting people to manage their care through independent advice and advocacy.
• Better and more housing options so that future housing stock is well maintained, easily accessible, and integrated well into the local community, providing real 'lifetime homes'. Developing care homes so that they present a real choice for older people, rather than being seen as a 'last resort' is essential, as well as making it a realistic option for people to receive support in their own home for as long as possible.

Policy makers cannot escape the fact that any sustainable model of funding older people's care in the future will require extra resources. The question is how those extra resources should be allocated and what proportion of funding should be expected from individuals themselves. The current system is confusing and alienating for many older people who find the costs they have to bear unexpected and unjust.

For a new system to command public respect there must be clarity about the need to share the costs of older people's care and the benefits older people can expect to receive in return. Older people with assets must be given support to use them in a way which will enhance their care options, but not decimate them entirely. In general older people must be given more choice with dedicated advice and information services to support their decisions.

There is no getting away from the fact that action needs to be taken now in order to secure a safe and sustainable future for older people and their care and support services, as the status quo is not an option. Services are already severely stretched, so a new way has to be found to ensure that the growing needs of older people are met. Key to this will be the 2007 Spending Review which must allocate more resources to these essential services and develop a national consensus on the long-term vision.

Action now will reap rewards in the long term - for generations of older people, for our society and for the economy by helping save precious NHS resources.

Many of the solutions outlined above are common sense and could be implemented now, but others are innovative, and need the backing of brave decision makers prepared to act now to make the vision happen in 10 to 20 years time. What we need is a better funding settlement combined with the commitment of policy makers and services providers to agree the way forward. We need to be ambitious in creating older people's care and support that really does close the Care Gap.