You could be forgiven for treating the government’s promise radically to rethink long-term care for the elderly with some scepticism.

Many promises from Labour to reform the controversial funding system of social care have come to nothing, including a Royal Commission which recommended free personal care for all.

That was deemed too expensive and killed off with lightning speed, although it has been adopted in Scotland.

Insiders say that the government has now finally accepted that the current system, developed along with the NHS 60 years ago, is unsustainable.

The ageing population and the increase in disabled people living longer and fuller lives means that the demand for help with day-to-day living is rocketing.

Yet tighter and tighter restrictions from local authorities on who qualifies for help means that ever increasing numbers of families are forced to make huge financial sacrifices, such as selling their home, to pay for it. Others end up giving up their jobs to care for elderly relatives themselves, because the cost of care is too high, or the quality too low.

One of the key things that will have to be addressed is the “cliff edge” - the financial cut-off that dictates that anyone with a home or other assets worth £21,000 or more gets no help at all. Any reform could mean even more unpopular means-testing, although more people might qualify for help as a result.

The eligibility rules may be re-examined. Under current rules, if one half of a couple remains in the home when the other moves into residential care, or another relative aged over 60 or under16 lives there, it must be disregarded by Social Services when they assess ability to pay. Many widows and widowers who live alone, however, end up having to sell up to fund their residential care.

Other problems that need to be addressed include how carers are supported, in particular those who want to carry on working while they look after their loved ones, and the supply of respite care so they can have a break.

Another question is whether everyone should be entitled to some help, as in Scotland. Ministers say that they favour some form of “progressive universalism” - although that might amount to little more than a universal entitlement to advice on where to find the care.

But the level of financial contribution made by the state and the individual will be the most contentious issue. Most campaigners believe the government will end up increasing its direct funding considerably from the current £1.5 billion year.

These questions will be addressed in the consultation, starting in the new year, and no-one expects any quick decisions. But Alistair Darling, the Chancellor, has already made clear that means-testing is here to stay, however unpopular it might be.

“Most people recognise that there has to be a balance struck between what the government can do and what individuals are asked to contribute,” he said.

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