How are councils restricting care?

The Commission for Social Care Inspection (CSI) says access to care is being tightened to include only those deemed to be in the most serious need.

In its report, The State of Social Care in England 2005-6, the commission warns of the "ever-rising eligibility criteria for access to services".

In response to an increase in the number of older and disabled people, many councils have raised the threshold people have to pass before they are entitled to council-funded services, the report says.

Two-thirds of councils set the threshold for care in 2005/6 to those whose needs were deemed "substantial" in 2005/6. Other councils are expected to raise their eligibility threshold in 2006/7.

This means fewer people are receiving services, and those who do qualify have a higher level of need.

"Substantial" includes people needing round-the-clock or other very high levels care, such as people unable to feed themselves or get out of bed.

Who is missing out on council-funded care?

People deemed as needing "moderate" or "low" levels of care, where the council's qualifiying level is set at "substantial".

They will then miss out, have to rely on family or friends, or pay for private care. This includes people who need help with getting out and about outside the house and help with housework.

The definition for those needing "low" levels of care includes when "there is an inability to carry out one or two personal care or domestic routines".

Why is demand for care increasing?

Expenditure by councils in England on social care rose to more than �19 billion in 2004/5, with the upward trend continuing in 2005/6.

A range of factors have resulted in a demand for council care which includes home care, day services and respite care.

The proportion of people over 65 has grown, and projections suggest it will rise by 53% over the next 20 years.

Meanwhile, the number of admissions to nursing and care homes has continued to decline, reflecting government policy to support more people to live independently in their own homes.

The number of young, disabled people has also increased - between 1975 and 2002 it rose by 62%.

Are National Health Service finances having an impact?

Yes, there is increasing tension with councils reporting last year's NHS deficit of more than �500m is affecting partnerships between local authorities and the NHS, the report says.

Charities including Mencap and the Age Concern have also raised concerns.

Many people rely on joint packages of care, organised by councils and the NHS.

There is evidence of the NHS withdrawing from care in the treatment of people with long-term care needs, such as those with heart problems or people who have suffered strokes.

Social care has then had to pick up the responsibility, the commission's report says.

Who are the carers who step in to help?

They are not paid and they look after a spouse, relative or friend who needs support because of the disability or ill health.

There are 4.7m people over 18 who are carers in England.

The report says that most people will be carers during their lifetime, although many do not want to be defined as such. Over a lifetime, seven in 10 women and nearly six in 10 men will become carers.

In the 2001 census, 471,000 carers reported they were in ill health, the report says.

A total of 70% of those looked after by unpaid carers are over 65.

What does the future hold?

The problem is expected to continue as the number of councils who currently provide low or moderate levels of social care is predicted to fall steadily.

The Local Government Association says that in 2005/6 just over 43% of councils provided such care. In 2007/08, it says this figure will be nearly 20%, dropping to 10% in 2008/09 and none the following year.

The Commission for Social Care's report says there are "positive examples" of services designed to support carers, but it points out progress so far is "limited".