The latest “Wanless report” on securing good social care for older people in England1 is a welcome contribution to the debate about caring for older people, and in particular about paying for their care. It completes a trilogy of reports by Sir Derek Wanless, a former banker who was initially commissioned by the Treasury to provide an evidence based assessment of the long term resource requirements of the NHS2 and later reviewed the wider determinants of health.3 The latest report attempts to find a middle way between complete state funding of social care for older people and strict means testing.

At present most older people in England who need personal care face tests of their financial means and will have to pay for their own care if they can afford it. The Wanless report supports critics of the government who argue that means testing has led to inequities in payment for care. Politically, the most controversial aspect of the problem lies in people having to sell their homes to pay for care: anyone with assets over £20 500 has to …