The government's review of long-term care could shift the balance of payment between the individual and the state.

The green paper, announced alongside the comprehensive spending review last week, will look at reform of the system of adult care and support 'in order to ensure an affordable system is in place for the 21st century'.

The growing elderly population means that the costs of long-term social care are set to grow enormously over the next decade. In a 2006 report for the King's Fund Sir Derek Wanless predicted that by 2025 there would be a 53 per cent increase in those with some need and a 54 per cent increase in those with a high level of need. It called for significantly higher levels of social care funding to meet that need.

King's Fund chief executive Niall Dickson praised the government's 'historic' move. He said that while it did not necessarily spell the end of means testing, it showed a willingness to create a clearer and fairer system.

'This signals that the government thinks the current system is unsustainable. The government has indicated that it favours a universal entitlement together with a co-payment and progressive elements, which seems to me some form of entitlement for all and something whereby people make a contribution.'

Sir Derek's report concluded that keeping the current system of funding would lead to considerable unmet need. It outlined the idea of a 'partnership model', where people would be entitled to an agreed level of free care, after which individuals' contributions would be matched by the state up to a defined limit. There would still be means testing for people on benefits.

Mr Dickson said the government had not indicated it would carry forward the partnership model but it was looking at something similar.

Social Care Institute for Excellence chief executive Julie Jones said the green paper should include a reworking of the funding model as 'the current pressure in the system is serious'.

Ms Jones said the system was confusing for carers and older people and hoped the green paper would bring some consistency to help people negotiate the system.

Commission for Social Care Inspection chair Dame Denise Platt said: 'Social care has always required a contribution. The size and nature of that contribution will be discussed in the green paper and it will clarify the partnership between the individual, the family and the state.'

The consultation will start in the new year.

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