A new world order in which you choose from an extensive menu of care options tailored to your needs? A large cheque to be disbursed in dollops to your preferred professional back up? Dream on.

The onward march of austerity has already stretched care budgets beyond their natural elasticity, which can only get worse when the cuts bite in earnest next spring.

The common experience is real difficulty accessing much-needed services, and, even where they can be found, the deliverers have too many clients and too little time to do more than the basics.