Andrew Dilnot offers a clever solution to a deeply embedded problem, but…

One, it does not apply to Northern Ireland, and two the costs attached may prevent the current Lib Dem Conservative coalition from bring it in… So what’s the problem? In an unwieldly phrase: the under regulated economic burden of long term illness falling directly upon the personal estate of those affected.

Emma Stone at the Rowntree Foundation which commissioned the report:

The big surprise in today’s report is the extended means test for residential (not home-based) care. In 2007, JRF called for the very low threshold of £23k (liquid assets including housing assets) to be doubled, in order to prevent people with modest assets having to lose the lion’s share of their life’s savings to pay for care.

Today, Dilnot has called for the means-test threshold for residential care to be quadrupled to £100k – thereby immediately making the system feel much fairer for large swathes of home-owners in England.

The combined effect of the ‘cap’ and the ‘extended means-test’ for residential care should also benefit people with lower or modest assets more, as under the current system they are liable to lose a larger proportion of their accumulated assets, should they need residential care, than most of their more affluent peers.

This could be seen as a middle England (aka Tory voter protection move), except that the structure of home ownership have changed massively in the last thirty years or so, not least since so many council house tenants where given bargain basement offers to buy out their own homes.

But it is a potential equitable solution to a major hole in health care cover, since this is one of the few areas you cannot cover through private insurance provision. In practice, so long as the hospital agrees you require round the clock hospital support, the state will pick up the bill.

Once you are out, and into residential care the clock runs down on whatever assets you may have accumulated over the years.

The question is does anyone have an appetite to increase the overall cost of public services at a time when those services are being cut? And secondarily, does any political party in Northern Ireland dare to go where the UK government apparently fears to tread?

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