Published: 30/01/2003, Volume II3, No. 5840 Page 22 23

Graeme Betts wants motherhood and apple pie within a Hillingdon primary care trust empire and a budget as large as the Pentagon's (Home truths, feature, 9 January). Everyone will love him and he will be thought a good man.

His article does not distinguish between healthcare and social care. It does not recognise that one is a free-atthe-point-of-delivery system, while the other is a meanstested system because the state will never be strong enough to support all social care needs for the 10 per cent of its population that come into the category of the very elderly. There are many reasons why free-at-the-point-of-delivery healthcare should be separate from means-tested social care, but it is essential to make the two systems work in collaboration.

Mr Betts wants people to be able to stay in their own homes as long as possible, and I share that objective. The challenges to achieving this are not only to do with cost. In much of south-east England, it is proving increasingly difficult to find employees despite many local schemes to enhance pay. High concentrations of elderly people needing support in their own home do not match high concentrations of people wishing to enter this labour market.

There is a fund of goodwill for volunteer services to take part of the workload (in the style of meals on wheels) but the increasing regulations to protect the elderly have eliminated much of this potential.

The majority of the elderly requiring social services own their own homes. This equity could be a major contribution to the resource problem, and schemes do exist to guarantee free life tenancies, but there are ethical and social problems.

There are those who would rather die in need than lose the chance to give their children the capital value of their property.

There are also those who say it is wrong for the poor and indigent who do not own their own properties to have a service free if responsible savers have to pay.

This is a less attractive argument in a society that is increasingly a property-owning democracy, and because means-testing throughout the ages has always meant those who have assets pay, and those who do not do not pay.

Finally, the first step towards helping the very elderly to get the care they need is to establish clearly where the boundary lies between free and means-tested services and to establish a transparent and easily understood set of means-testing rules, however unpopular, that allow people to make appropriate choices about the support they want in their last years. In the South East, the solution is still a long way away.

The government's decision to strip resources from the social services budget of south-eastern authorities that cannot find staff and give it to the northern authorities, which do not have difficulty employing staff at their current level of funding, will exacerbate the problem year on year for the next three or four years.

Roger Dyson County Councillor Essex county council