The government has no time to lose if it wants to reform social care

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Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.

The writer is chief executive of The King’s Fund

The UK government came into power with determination to transform an NHS it says is “broken but not beaten”. It commissioned a rapid-fire analysis of the state of the NHS from Lord Ara Darzi and quickly identified the three shifts it said were necessary to make the service fit for the future. There is now a large-scale public engagement exercise under way to understand what the public wants to happen. 

All the more strange, then, that on social care — which is umbilically tied to the NHS in many ways — it has stumbled from one mis-step to another.

On long-term reform, it began by cancelling the measures — including a cap on lifetime care costs — due to be implemented in October 2025. These reforms were not universally supported within social care so the postponement was not in itself a sign that the government had abandoned ambition. The problem is that no alternative reforms have even been suggested to take their place, except for promises of a “national care service” that has still yet to be defined, and a “long-term plan” on which work has apparently yet to start. Reform, it seems, is stuck. 

October’s Budget added injury to impasse. The changes announced to employer national insurance contributions loaded extra costs on providers that they hadn’t anticipated and couldn’t afford.

The changes even threatened to damp enthusiasm for the government’s one “hit” on social care: measures in the employment rights bill which would increase care worker pay. While the measures are welcome, providers were already concerned that they would end up paying for the reforms. With the changes to NICs, they are even more alarmed. 

So in a few short months the mood in the social care sector has gone from cautious enthusiasm to bewilderment and, now, anger. Bewilderment at what long-term vision the government really has for social care. And anger at the fact that such a critical part of the national health and care infrastructure is being so consistently overlooked and is expected to simply suck up the extra costs it now faces. 

Yet it is not too late to rescue what has been a disappointing and confusing start by the government. Three things are needed. 

First, it must address the financial challenges faced by the sector arising from the Budget. Social care providers are campaigning for exemption from the NIC increases, but that would be politically difficult for the government. Some sort of compromise will need to be reached that assuages providers’ concerns without requiring the government to appear to backtrack.  

Second, the government has to decide how it will take forward the long-term reform needed in social care. England has a system that shuts out people with modest means and needs, and forces them to pay for their own care. More people should be entitled to state support, although that will cost more money at a time when there isn’t enough even to fund the current system.

Previous administrations have frozen in the face of this challenge, and the current one has shown little sign of getting to grips with it either. In these circumstances, some form of task force or royal commission may be the only realistic way forward. It would allow the beginning of a public debate about the reforms needed and, crucially, the realities of paying for them. 

Third, the government should get on with putting in place the building blocks of reform. It might consider here the two NHS shifts that most apply to social care: from “analogue to digital” and from “sickness to prevention”. On the digital side, the previous government had taken action to increase the number of providers using digital social care records — that should be built on. In prevention there is scope to move social care towards an approach that focuses on getting people back on their feet and remaining independent. 

There are other areas in which the government could also make progress. The social care sector itself has developed plans for workforce reform. There is also an opportunity to improve quality by making care more focused on the needs of the individual and to join up services more effectively, particularly in critical areas like hospital discharge. None of these need to wait for a royal commission. 

The government still has time to rekindle the optimism that greeted its arrival in power by making progress on one of the great policy issues of our time. If not, the social care sector and the people who draw on its services will be looking at yet another hard winter.