It is one of the biggest domestic policy issues of our times - where should the balance be struck between the individual and the state's responsibility for paying for care in old age? A much-anticipated government policy paper for England has still not surfaced. Experts are calling it a "national scandal" with services in parts of the country near collapse and millions of vulnerable people deprived of the care and support they need.

 

The document (known as a Green Paper) on the future of adult social care in England was first promised for the summer of 2017. Delays and postponements followed and despite official guidance that it would appear in 2018, the paper remained unfinished and under wraps in Whitehall.

In January the Health and Social Care Secretary Matt Hancock told MPs he intended it to "happen before April". But April is not far off and there is no sign of imminent publication.

Sources indicate that hopefully the paper will emerge during April. But with the Easter parliamentary holiday there are limited dates for a launch. The May local elections have thrown up another obstacle in the shape of "purdah" during campaigns. Traditionally, official policy announcements are not made in the weeks before polling day.

The Brexit debates and votes have made it harder for ministers to focus on domestic issues like social care, let alone decide a date for a policy launch.

The paper is a cross-government exercise and needs buy-in from Downing Street and the Treasury. There are thorny questions to be resolved and differences still to be ironed out. So don't hold your breath. It may yet be a while before the document sees the light of day.

And this is causing increasing concern amongst both leaders in the social care sector and their counterparts in the NHS. A group of health 15 health organisations has now written to the Prime Minister calling for action. They note that it is unusual for one part of the public sector to call for more funding for another part. Led by the NHS Confederation, the group argues that "social care is on the brink of collapse" and that 1.4 million older people in need in England now receive no help. After a two year wait, they claim, it is time for the government to put things right.

The Green Paper will not contain long-term funding plans for local authority provision of social care. They will come with the Treasury spending review which is due in the autumn. But the paper will address the question of an individual's responsibility for paying for care. Only those with assets below £23,250 receive local authority help with care costs. This includes the value of a house if the care is in a residential facility.

Historically, this has left some families having to sell a house to cover the costs of looking after a parent in a care home. It is possible to defer these bills until after the parent's death but the property may need to be sold then to repay the local authority. One solution is to cap lifetime social care costs and this was government policy until 2017 when the idea was shelved.

Matt Hancock, in a letter to the Prime Minister leaked to the Daily Telegraph, warned that plans for such a cap at around £100,000 could cost taxpayers billions of pounds and would only benefit a small number of better-off families. In an interview with LBC radio, Mr Hancock was asked if people would in future still have to sell their houses to fund social care.

He described this as "an injustice" and dropped a strong hint that the current means-tested system was due for a major shake-up, with the burden spread across all taxpayers. The Health Secretary has already talked about ideas for new forms of levy or taxation to cover future social care costs.

This could involve a state-backed insurance scheme which those in work are automatically enrolled into, along the lines of the workplace pension scheme introduced after government legislation in 2008. Opting out would be possible.

Another possibility is higher National Insurance contributions, or a special levy, to be paid by the over 40s with the proceeds ring-fenced for social care.

The latter idea was proposed by three Commons Select Committees so has the advantage of cross-party support. When it comes, the green paper will have a series of ideas and there will then be a consultation process. It will no doubt be a weighty and important document, but with questions rather than firm proposals.

Those seeking answers and solutions to this vital domestic policy issue may have to wait a while yet. Scotland provides free personal care for the elderly. Wales has a weekly cap on home care and Northern Ireland has free care for over 75s at home.