Who cares

Having a degree and excellent skills count for little if you are disabled and live in residential care. Why? If your CV read like Doug Paulley's, you would probably expect to spend a lifetime as a high-earning IT professional. First-class degree, excellent IT skills, head-hunted more than once as a web designer, age 29.

But the reality for Mr Paulley is that he is likely to while away his days in a residential home and is highly unlikely to be drawing a salary. He has a problem with his autonomic nervous system which means that he has a tendency to pass out at any time; he has had a couple of strokes and uses a wheelchair. He needs to have help on call and his local social services in West Yorkshire say the only way of providing that is for him to be in an institution.

Living in a Leonard Cheshire home with other disabled people in Wetherby, he has a young man's desires and aspirations, and bitterly resents - but fully understands - the institution's need to run to a rigid timetable. "It used to be that I wouldn't have a set bath day because it felt quite institutional," he told the BBC News website.

But trying to go against the grain meant that he often had to miss out, so he gave in. Doug's care fees cost £930 per week which the law says he would have to cover, minus £20, if he were earning enough. So realistically, working would only earn him £20 a week. "It annoys me quite considerably and I've written to the government many times about it," he said.

He thinks the problem is that there is an underlying assumption that people in residential care are either not capable or willing to work. "It's quite bad that such a large section of society is being written off."

Mr Paulley says that until he raised the issue many people were unaware that people in residential care were living in enforced idleness. With his pet cat for company, he fills his time by teaching IT as a volunteer to school children and also designs websites free of charge for non-profit organisations. The cost to the taxpayer of keeping people like Mr Paulley in an institution is almost £1,000 per week. Campaigners say that social care in the UK delivers the wrong services at high cost and needs to be completely redesigned.

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"From the perspective of disabled people, lots of them are very dissatisfied with the services they receive, and lots of the professionals involved are dissatisfied providing these services," said Simon Duffy, director of In Control, an organisation that is lobbying to put older and disabled people in charge of their own care. "It's spending more money - and increasingly high levels of money - on fewer people which is, by definition, an inefficient system."

Mr Duffy believes that, at long last, the economic crisis in the system means that politicians are being forced to look at better ways of giving people assistance.

The Department of Health now speaks the language of "person-centred planning", "direct payments" and "individual budgets". hese are all measures which will put those in need of care in control of the services they receive. Many will become employers for the first time and administer their care package like small businesses.

Working against this approach is the assumption that the professionals - social workers, doctors and others - know best. But the minister with responsibility for social care, Ivan Lewis, says he is trying to persuade those who work on the frontline that his new ideas can work.

Critics say the economy suffers twofold - because carers are forced to give up paid work and because those in residential care are unable to work or contribute to the state. The way the social care system is redesigned to take account of the predicted demographic changes over the next 25 years will have a significant impact on all of us - young or old, disabled or non-disabled.

It will take courage and vision to get it right.