For the past two decades at least, successive governments have struggled with how to achieve an affordable and sustainable funding system for care and support in England. Following on from three previous reviews,1 2 3 on 4 July the Dilnot Commission published its report on this subject.4 The report concluded that the funding system for social care is broken and will get worse unless it is fixed. The system is confusing, unfair, and unsustainable. Urgent action is needed. Unlike the 1999 report from the Royal Commission on Long Term Care,5 the Dilnot review does not recommend “free personal care.” Instead, a new partnership is proposed between the individual and the state “where individuals need to take reasonable and appropriate responsibility, but the state provides protection for those with greatest needs.”

Since the establishment of the welfare state in 1948 health and social care have been separate in England. Over time the boundary between these has shifted, and what was once regarded as healthcare now often comes under social care. The implications are substantial—although NHS care is free at the point of need, social care is means tested. Many people have little or no awareness of this until …