Things may finally be changing but, until the GMB union and Ed Miliband got stuck in this week, I have been repeatedly astonished by the failure to link the care homes crisis to the fate of Andrew Lansley’s bill.

It strikes me as a perfect storm. David Cameron’s latest “trust me” love-bombing of the NHS, his five-pledge speech on Tuesday, ignores it – by accident or design? – too, although the union has now managed to drag Jeremy Heywood, one of his most senior officials, into the row.

What’s up? Care of the elderly has been a growing problem for decades as 100,000 more of us oldsters refuse to die each year than experts expected even 20 years ago – and families duck responsibilities to parents which Asian families take for granted.

It’s fixable for a few billion a year – via a mixture of tax, savings and insurance – but governments have postponed radical solutions. This government sank Labour’s belated plans in 2009-10 with its shameful “death tax” election poster, an error which it may already regret. Let’s all try again, Miliband said mid-week.

But that’s not it. Like the banking crisis this is a failure of private sector promises and behaviour, and of state regulation. Badly run care homes have not been properly monitored by regulators – in this case the Care Quality Commission and councils – whose roles are routinely expanded but whose budgets and staff get cut. Recent scandals speak for themselves.

It sounds like a familiar enough story, the more so when you throw in cutbacks in local authority fees paid to private homes, cuts which should have been anticipated by well paid finance directors but clearly weren’t. The UK public sector is mid way through a cuts tsunami.

Labour’s health spokesman John Healey had a stab at the issue when he called care service reform a “must do” for ministers who stymied Labour’s plans.

“One year on, we’re still waiting for any sign of action from the Tories and elderly care services are getting worse not better. The government promised to increase care funding but nine out of 10 councils are cutting access to care services – and wasting billions on the Lansley reorganisation too.

Fair enough, but it doesn’t address the scandal posed by the most acute care home crisis – the threat to the 750 homes, 31,000 patients and 43,000 staff run by Southern Cross, the biggest player to emerge from the gradual privatisation of elderly care, cross-party policy for many years.

The private sector can and does deliver excellent care in some homes, as writer Diana Athill (93) movingly explained about her “loving’’ home this month. But, cuts and local failings apart, Southern Cross is primarily victim of naked financial engineering which taxpayers must now underwrite.

Put simply, Blackstone, the US private equity firm, bought Southern Cross for £162m in 2004, tripled its numbers by buying two more groups, splitting off the property portfolios and expanding the “sale and leaseback” strategy whereby they flogged the care homes to then-booming property firms and rented them back.

Brilliant, eh? But patient numbers faltered (why?), and councils squeezed costs, rents rose and the banking crisis crunched liquidity: now Southern Cross can’t pay its rents. Yet the core scandal remains that Blackstone floated the firm at the top of the market, tripled its money and fled.

Five UK directors sold too and pocketed £35m – just before the price collapsed. Scandalous! Or, as Lord David Owen asked in a little-noticed weekend speech, “why should anyone have ever thought that private equity and Southern Cross could be the model for English NHS reform?”

Good question.