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Scotland's approach to personal care is having an increasing effect on the debate south of the border, says Mervyn Kohler.

Scotland implemented "free" personal care at the beginning of the month, throwing down the gauntlet to Westminster. How will this play out politically?

The deal in Scotland is somewhat circumscribed by its financial dependence on Westminster. The cost of personal care has had to be capped at £145 per week, and an anomaly has emerged in the eligibility for attendance allowance - payable to people living in their own homes but not to people in formal care homes. And Westminster is happy to pocket the £20m or so that would have been paid to those now ineligible.

So far there is little evidence of England claiming parity of treatment, but the volume of parliamentary concern about care home fees and closures, and nursing care payments is rising. It seems only a matter of time before Scotland's approach becomes an additional factor in the general disquiet. Ministers defending the Westminster line have made much of the fact that 70 per cent of care home residents get some or all of their care costs met from public funds, but the residual 30 per cent represent more than 200 residents per constituency. Many of these will have interested relatives and friends who may well vent their feelings in elections.

The issue is not just one of self-interest. There is a profoundly moral point, which the Royal Commission tried to capture by subtitling its report With Respect to Old Age. The need for long-term care is unpredictable, like illness or injury. There are few who would argue against the universal provision for the latter, so why do we have such a wretched debate about the former? It is not as if people queue up greedily to enjoy illness and long-term care: these are mainly frail and vulnerable people with real problems.

Another accusation is that free personal care would benefit the rich. That is precisely why the Royal Commission recommended it should be paid for from general taxation - the better-off would pay the most for it. But they would pay in a fairer, more predictable way than the random costs that arise now.

Resolving how to deal with long-term care costs is also part of the uncertainty over pensions. It is one thing to aspire to build a pension pot that supports one's general standard of living: it is quite another to assemble the funds to meet the contingency of long-term care needs. People are losing the appetite to save, and one reason is the awareness that those savings would be consumed by care home fees.

The NHS is receiving a generous settlement in the comprehensive spending review. There are many calls on these new resources, but it is not impossible to imagine that some of these might just become available for long-term care if the political clamour to emulate Scotland rises.

Mervyn Kohler is head of public affairs at Help the Aged.