IT is more or less an open secret that older people who pay their own care home fees subsidise those whose places are paid for by a council.

Scottish Care, the industry body for care homes, says few of its member businesses would be viable on the basis of local authority clients alone.

This situation is made worse by a national care home funding agreement which has seen councils make minor increases in the rates paid.

But not in real terms. An increase of around one per cent in the rates for residential care contrasts with what Scottish Care claims is an 8.5 per cent increase in overheads for providers.

The body has been clear in the past about the fact that costs are having to rise for self-funders as a result, leading to significant cost differences. These were highlighted by a recent Scottish Care report: “Many deem these differences to be unfair to those paying for their own care and believe these are becoming... increasingly unequal due to the inability of public rates to cover costs to services of delivering high quality care,” it said.

The result, according to a new report from the Competition and Markets Authority, is that on average self-funders in Scotland will now be paying 39 per cent more for the same place as someone funded by a council.

Why hasn’t this glaring unfairness been addressed? Well the experience of the Conservative Party at the last general election is symptomatic of the reasons.

Theresa May’s biggest election blunder was to propose painful measures to address the shortfall in funding for elderly care.

The evidence from the impact on Tory poll ratings is that the public simply aren’t ready to accept the consequences of the collision of several unhelpful home truths.

In a buy now -pay later culture, few of us are setting aside enough in savings to pay for care in our old age. With an ageing population, that deficit is becoming pressing.

Austerity has left councils in particular facing budget deficits making it hard to pay for care at all, let alone improve its quality. Costs are rising, and even with the guarantee of a living wage for care workers, homes are still struggling to recruit staff.

But we will have to tackle these uncomfortable truths. The CMA is right to say the current differential for self-funders is unsustainable.

Pleas for more funding seem optimistic given the pressure on public finances. Alternatives to residential care such as better support to stay at home could help some, but not all people.

But any answer must address the growing unfairness of care home charges.

A debate is needed about the standards we expect and the cost we are willing to accept.

Increased taxation to ensure the wellbeing of elderly Scots is a measure which could find support. But the public will need to be convinced any money raised will be spent on better care, and that the better off are not being treated unfairly.