Can social care ever really be fixed? Experts react to the latest in a long line of promises

The Big Conversation on Care is the latest attempt to fix England’s broken social care system. Getting a handle on this issue has been attempted no fewer than 22 times since the 1990s – but Prime Minister Andy Burnham has vowed that this time they’ll find the right answers. But what might these be – and will the tough choices on how to pay for it lose Labour votes?

More pay, more prestige for care workers

Anna Barford, Research Professor, Language Technology Lab

Care is a broad concept covering things like cooking, cleaning, childcare, teaching and healthcare. These labour-intensive activities are essential to enable individuals, communities and societies to survive in the face of challenges such as poverty, economic shocks and climate change. As such, spending on care should be seen as an investment rather than a cost.

Care needs are met by a diverse set of people, including the family or household, volunteers, not-for-profit organisations, businesses, and the state. Some of this work is paid (often underpaid), while some is unpaid. And it falls disproportionally on women.

England’s social care budget does not cover this full range of activities. For adult social care, the budget includes spending on community-based support as well as care homes. Investing in adult social care translates into better jobs, better-supported families, and care needs that are met more fully. Burnham’s speech pointed to this, with his plans to increase pay and prestige in the social care workforce.

Spending should be understood within the wider ecosystem of care. However, decision-makers often overlook how unpaid care work, paid care work and other paid work relate to one another. As paid and unpaid care is largely done by women, well-paid care work could improve gender pay gaps. And providing paid-for support for care activities can free up women’s time to do paid work. For example, providing childminders and carers for elderly relatives can help to balance the competing demands on women’s time.

Fixing social care is a huge – and expensive – job

Conor O’Kane, Senior Lecturer in Economics

The prime minister has outlined what he would like social care reform to look like. Broadly speaking, he wants to see better pay and career paths for those who work in the sector. He would also like to protect people from having to sell their property or other assets to pay for care, which can run into hundreds of thousands of pounds. But while almost all political parties in England agree that social care needs to be reformed, there is little consensus on how this should be paid for. Burnham provided no further detail.

I suspect that the UK nations will eventually adopt a scheme similar to the one the Republic of Ireland introduced in 2009. The “Fair Deal” addresses some of the key concerns that the PM has raised. The scheme takes into account a person’s income, savings and assets when deciding how much the state contributes towards residential care costs. Crucially, the assets element, which for many will be their home, only counts for the first three years that they are in residential care. This prevents assets being completely consumed by care costs. But this type of scheme does not come cheap.

Ireland’s Fair Deal costs the state the equivalent of around £1 billion a year. Given the difference in populations, a similar scheme for the UK could cost around £13 billion a year. That still does not cover the cost of the pay increases that Burnham wants to see for that sector. To raise this kind of money, he would need to increase the 20% income tax rate by about 2%, for example.

There is also some talk of an estate tax to raise the funds. Given that the PM is committed to both the current fiscal rules on borrowing and not raising taxes, I would expect Labour to go into the next general election with an outline of how a reformed social care system would operate and be paid for. But only time will tell whether voters will give them the mandate to finance this major reform to adult social care.

Public are confused – but clear that the state should pay

Anthony Kevins, Senior Lecturer in Politics and International Studies

Any discussion of attitudes on social care in England must begin with two
observations: people are not happy with the status quo, but they also don’t really understand how the current system works or how it is funded. This is a tricky starting point, since it makes it difficult to assess how much public support there would be for any proposed reforms.

What does seem clear however, is that most people want the state to share the cost of social care with users. Support for full state coverage for everyone is relatively low, and even fewer people believe that users should have to cover costs on their own.

So how might the public want that new spending to be financed? My research suggests a hierarchy of preferred funding options, ranging from council tax – the least popular option – to a wealth tax on people with assets worth more than £1 million – the most popular option. Increases in inheritance tax and national insurance contributions were relatively unpopular. And an income tax rise on higher earners was second only to wealth taxes in popularity.

As always though, the devil will be in the detail of the funding plan. It’s unlikely that any mechanism will avoid at least a little backlash.

Technology is not a silver bullet

Kathrin Cresswell, Professor of Digital Innovations in Health and Care

One of the biggest challenges is moving beyond treating health and social care as separate systems. Burnham has promised a more integrated approach. I don’t believe that the two necessarily need to be fully integrated, but they do need to work together more effectively. That means investing in the relationships, governance and basic infrastructure that allow organisations to coordinate care around people’s needs. It is this kind of investment that enables lasting change.

Technology will undoubtedly be part of the solution, but it is not a magic bullet. The history of large-scale digital programmes in the NHS shows a consistent pattern. Expectations have often exceeded reality because the complexity of implementing the changes was underestimated.

New technologies, including AI, are unlikely to be different if they are seen as solutions in themselves. Real transformation depends less on adopting the latest tech than on supporting organisations to work together, developing shared ways of working, and building the culture needed for information and services to flow across organisational boundaries.

Social care presents an even greater challenge than the NHS. It is more fragmented, operates with fewer resources, and levels of digital maturity vary greatly. For many providers, the priorities are quite simple: reliable connectivity, basic digital infrastructure and technologies that support communication, independence and day-to-day care. It’s not always about the latest innovations.

Perhaps most importantly, we need to be realistic about how quickly success can be realised. Social care is fundamentally about supporting people to live well, maintaining independence and preventing crises. These benefits emerge gradually, requiring sustained investment and realistic expectations.

Better connections with communities

Robin Miller, Professor of Collaborative Learning in Health and Social Care

Burnham is right to emphasise both that social care is more than a complement to health and that the NHS will not work effectively without a strong social care system. For the past 30 years, successive governments have sought to ensure better collaboration between health and social care. The latest iterations see multi-disciplinary teams working on the ground while overall coordination is handled by “integrated care systems” (partnerships between health and care organisations in both the public and private sectors).

While some progress has been made, long-standing tensions remain. These are due to professional dominance of healthcare in local and national debates and insufficient investment in social care. At the same time, national performance focuses predominantly on NHS waiting times.

The proposed national care service may bring some consistency, but ultimately collaboration will be achieved through closer working between professionals and services – focused on what matters to communities. Health and social care will have to be better connected with local people and the networks that sustain them – this will involve health and care professionals working as equal partners with the voluntary and community sector. One example of this is through community hubs, where professionals are available within accessible venues such as libraries, supermarkets and sports clubs.

This is certainly a good start from the prime minister. But improving social care will also mean tough choices for the NHS – including changing its priorities on how its money is spent to divert more towards community and prevention.