On 30 July the ACR website published Why we need to campaign for the return of Social Care to the public sector, an article about Birmingham by me which was originally posted on the Birmingham Against The Cuts website on 8 September 2025. (See Link 1 below). Now we have a different context, with a Government led by Andy Burnham which has put the reform of adult social care high on his and the public agenda. It is an opportunity that the whole of the Left needs to make full use of. The article below is my attempt to bring together from various sources the arguments and the evidence as a toolbox for the campaign for the radical transformation of Adult Social Care in England that we all need. (Adult social care in Scotland, Wales and Northern Ireland is not the same as in England, as each country has different legislative frameworks and funding rules.)
Burnham’s proposals
Prime Minister Andy Burnham has launched a strategy to establish a National Care Service in England, aiming to build a unified system that integrates seamlessly with the NHS. On 29 July Burnham delivered a speech on social care at a care home in Golders Green. He set out the urgency of the situation and his commitment to “bring the political will needed to tackle the challenge at hand, taking on the tough issues that Westminster has ducked for too long”. He has set out the core principles behind the National Care Service that the Government will build: (See Link 2)
- The system must allow people to move seamlessly between hospitals, home care and community services.
- This service must be fully and sustainably funded
- The service must start with prevention, supporting people to live independently for longer
- Citizens’ needs must be at the heart of plans, removing budget battle lines between organisations and making sure local social, primary and community care works together effectively
Burnham announced plans to expand the existing social care fair pay agreement into a broader workforce reform. This will aim to improve pay, training, job security and career progression for care workers – including creating progression routes from social care into NHS positions and treating the two sectors increasingly as ‘one workforce’. Burnham has invited leaders of the Conservatives and Liberal Democrats to cross-party discussions on identifying common ground for social care reform.
Here is a summary of the key components, timelines, and challenges of Burnham’s recent proposals:
1. Accelerated Timetable and the Casey Commission
- The Review: The government commissioned Baroness Louise Casey to lead an independent review of adult social care to draft the blueprint for the National Care Service.
- New Target: The final report deadline has been accelerated by a year, moving the delivery of concrete recommendations from 2028 forward to summer 2027.
- Public Input: The commission has launched the “Big Conversation on Care,” a large-scale public consultation targeting input from up to one million people by April 2027.
2. Core Operational Principles
- Seamless Integration: Ensuring patients transition smoothly between hospitals, home care, and community services to permanently reduce delayed discharges.
- National Standards: Ending the current “postcode lottery” by introducing national benchmarks for care consistency across all local authorities.
- A “Home First” Approach: Prioritising independent living and home-based support over early residential care placement.
3. Workforce Reform
- NHS Alignment: Proposals aim to tie social care careers closer to NHS frameworks.
- Fair Pay: Plans include establishing broader workforce reforms to improve pay, mandatory training, and clearer career progression pathways for care staff.
4. Cross-Party Collaboration
- Consensus Building: Acknowledging that past social care reforms failed due to political weaponization, the Prime Minister invited opposition leaders to seek common ground.
- Shared Risk: The government is pushing for a shared-risk funding model where everyone contributes, ensuring no one has to sell their home to pay for care.
Immediate Hurdles and Critiques
- Funding Ambiguity: While the Prime Minister noted that reform will require “difficult decisions” regarding taxation, specific funding mechanisms have not been confirmed. The government remains committed to its manifesto pledges not to raise income tax, National Insurance, or VAT.
- Implementation Lag: Sector experts warn that even with a 2027 review deadline, translating recommendations into law means a comprehensive National Care Service may not fully materialise until the early-to-mid 2030s.
Speaking alongside the Prime Minister was Baroness Louise Casey, the Chair of the Independent Commission on Adult Social Care. This is the official public engagement campaign running from July 2026 to April 2027, targeted to reach one million people across England to debate tough social contract and funding questions in “The Big Conversation on Care”. You can find more details and track the ongoing consultations via the official portal for ‘The Casey Commission Big Conversation’. (Link 3)
“The state of health care and adult social care in England 2024/25”
That is the title of the latest report by the Care Quality Commission (CQC), the independent regulator of health and social care in England, published on 24 October 2025. (Link 4) It says that approximately 78% to 83% of adult social care in the UK is delivered or managed by independent and private for-profit providers, while publicly provided care has dropped to roughly 4% to 9%.
Key Breakdown of the Sector
- Residential Care: Up to 96% of adult residential care services are outsourced or run by private and independent providers.
- Workforce Employment: Roughly 78% of the adult social care workforce is employed by independent (private) sector employers, compared to just 7% directly employed by local authorities and 7% by the NHS.
- Public vs. Private Split: Historically, publicly provided care has fallen sharply from around 42% in 2001 to under 10% today, shifting the heavy reliance onto private for-profit and voluntary/third-sector organizations.
The proportion of older adults receiving council-funded long-term social care in England has fallen to roughly 3.6% of the population, down from 8.2% two decades ago.
Key Trends in Public Care
- Widening Gap: Requests for adult social care support grew by 9%, while approvals for long-term or short-term care increased by only 4%.
- Tighter Eligibility: Local authorities face strict funding pressures, leading to stricter means tests and eligibility criteria that leave more people without state support.
- Rising Reliance on Self-Funding: Individuals with savings or assets above strict thresholds must pay for their own care or rely on family and unpaid carers.
Detailed data should be available for every Local Authority. (You can read my short analysis of the example of Birmingham at Link 5)
Will local government have the funding and the powers?
Jonathan Carr-West, Chief Executive at the Local Government Information Unit (LGIU), said:
“Much of what the Prime Minister announced […] was very positive and demonstrated an urgency that has often seemed to be lacking in the past. But, there was a large local government-shaped space in his speech.”
“Social care comprises the majority of council discretionary expenditure, so any effort to fix the very broken system has to be viewed as part and parcel of local government reform. The question now is whether an accelerated timeline can take us far enough along the road of genuine co-design and financial credibility so that progress doesn’t stall when election fever kicks in.” (Link 6)
Many organisations have raised concerns that the Commission’s timeline is too slow. Care England has argued that the 2028 deadline for phase two recommendations “risks delaying vital action in a sector already at breaking point.” The Royal College of Nursing has warned that ‘vulnerable people’ ‘could not wait until 2028 for change. The Community Care website said on 25 August that “Social workers lack confidence that prime minister Andy Burnham will succeed in reforming adult social care for the better. Over half of respondents to the Community Care poll said Burnham would be unable to secure the funding needed”. The Health Foundation estimates that an NHS-style, fully state-funded adult social care system in England could cost an extra £18.5 billion a year by 2035. Burnham and his Chancellor will face a stark choice: reallocate money from somewhere else or look for new sources of revenue.
“We want to get the market out of social care and make support free at the point of use”
A more radical critique and alternative is offered by the End Social Care Disgrace Campaign, a non-party political alliance calling for radical change to social care. It advocates a comprehensive, radical overhaul of the existing social care model to make it public and universally accessible. (Link 7)
“We want to get the market out of social care and make support free at the point of use. Disabled and older people, families and communities must shape what is needed to ensure everyone is enabled to have choice, dignity, and control over their lives.
We the undersigned, pledge our commitment to campaigning to end the crisis with Social Care by supporting the call for a National Care, Support, and Independent Living Service. We will raise the seven NACSILS demands internally within our trade unions, political organisations and campaign groups as well as externally, with members of the public, local and national policy makers, and the mass media because we believe a new Service has to be:
- Publicly funded, free at the point of use
- Publicly provided, not for profit
- Nationally mandated but designed and delivered locally
- Co-produced with service users and democratically accountable
- Underpinned by staff whose pay and conditions reflects true value and skills
- Designed to meet the needs of informal carers
- Informed by a task force on independent living led by user-controlled groups from diverse backgrounds”
Their response, including some specific policy proposals, to Andy Burnham’s latest announcements on Social Care, is worth quoting in some detail:
It is not yet clear whether he has the courage and headwind to row against the neoliberal tide and official fiscal orthodoxy which will be necessary to get the boat afloat and whether Labour is prepared to go it alone if cross party efforts threaten to scupper it. He has talked about the need to improve the quality of care but has not given any clear indication that he is committed to genuinely radical change, co-produced with disabled and older people, carers, care workers and local communities to deliver the kind of life enhancing support people want and need. This needs to be a far cry from the current, largely institutionalised care that robs people of agency, choice, control and dignity. He has indicated previously that he wants to see much fairer and wider access to support but not whether he will make support free at the point of use. He has talked about stopping profiteering but not about reversing the privatisation of social care and developing ‘not for profit’, publicly accountable provision.
Meanwhile the current deeply unfair, largely means tested, heavily rationed social care provision continues to cause serious harm and avoidable deaths. (Below are some examples.)
· Around one in four people with unmet social care needs were subject to emergency hospital admissions on account of potentially avoidable conditions. …
· Over 13 million people per year, have their discharge from hospital delayed, many on account of the lack of appropriate and timely social care support. The large majority are older people. …
· Disabled people and their families are more likely to live in poverty. In 2024 The Rowntree Trust estimated that 3 in 10 of the 13 million people living in poverty were disabled. If you add in carers and 2 other household members, almost half of those living in poverty are affected by disability….
· The quality of life of many disabled and older people in receipt of support at home is often abysmal as the drive for profit distorts their daily lives. People are objectified into bundles of largely physical needs…
· Care and support workers doing stressful, demanding skilled work are seriously undervalued, under paid and often receive little or no training. The median hourly rate for care workers in March 2025 was £12.00 and one fifth are on zero hours contracts. It’s not surprising that turnover rate is close to 30% on average but 43.5% for those with less than one year’s experience.
What Burnham should do
What we need from Burnham and Baroness Casey’s Commission is a serious, radical and rapid plan to work not just with politicians but more importantly with disabled and older people, carers and care and support workers to set up a ground breaking National Care and Support Service which is free at the point of use, “not for profit” nationally mandated but locally designed to deliver what people truly want and need, alongside a commitment to build inclusive communities. However, people suffering harm cannot wait for jam tomorrow, should tomorrow come! Burnham has an opportunity to make a difference now and at the same time start laying down some tracks for the way forward. He could and should
A. Fund and oblige Local Authorities to
i. Make domiciliary support free at the point of use without delay as in Hammersmith and Fulham and Tower Hamlets
ii. Drop the pursuit of existing care charge debts
iii. Work with disabled and older people, carers, care workers and local communities to develop ‘not for profit’ provision not just by the Local Authority but by Cooperatives, micro enterprises, peer support projects etc.
iv. Work with carers in their area on setting up a flexible menu of practical and personal support
B. Pursue an immediate rise in the pay of care and support workers to a minimum of £15 per hour, without waiting for the slow implementation of the Employment Rights Act.
C. Ensure that all sponsorship of care workers from overseas is transferred from individual providers to Government stewardship and rescind extensions to the “leave to remain” qualification period.
D. Look seriously with DWP colleagues at providing a guaranteed income /stipend rather than ‘benefits’ for carers.
E. Start now challenging narratives that diminish us all, exclude and divide us one from another and block a radical transformation of social care i.e.
i) Reframe Social Care as a universal service that any one of us might need at any time – sometimes with no notice, making clear that it is in everyone’s interest to pool risks
ii) Challenge the ‘othering’ of disabled and older people and the narratives that deepen rather than close the gaps between us
iii) Call out the harmfulness of neoliberalism, which creates profit shaped societies increasingly drained of human interactions and make clear it is a political choice not received wisdom
F. Promote close working together between the NHS and Social Care at all levels with both seen as separate but equal partners in enhancing the physical and mental health and wellbeing of the population. Immediately it is necessary to protect the representation of Local Authorities on Integrated Care Boards which is under threat in the Health Bill 26/27.
G. Insist that other Departments – housing, transport, employment, education, culture, planning etc. at national and local levels are on board with building inclusive communities where there is opportunity for everyone both to contribute and benefit.
Making the state the sole payer of social care could end profiteering
And this article by David Rowland on August 14, 2026, “To solve the social care crisis, we need to bust the death tax myth”, is also useful. Here is an extract: (Link 8)
“According to the latest data collected by the ONS, there are currently 137,000 people paying for some part of their care in a residential or nursing care home and
83,000 people paying for care in the community – mainly homecare services.
So around 220,000 households are paying for social care, in most cases out of the inheritance that they would otherwise leave their spouses, children, grandchildren or other family members. In effect, the law states that if your care needs meet the legal threshold but you happen to have assets above £23,500 you are compelled to spend your wealth purchasing care, before you are allowed access to tax funded residential care
Whether this meets the precise definition of a tax is of course subject to debate as in most cases payments go to private companies rather than the exchequer.
In 2026 the median length of stay in a nursing care home is around 40 weeks and the average weekly fee for a self-funder is currently £1,400, meaning that most people receiving this form of care who pay out of their own resources currently pay in the region of £56,000.
If the state stepped in to fund social care on a free at the point of need basis, it could also do away with one of the further iniquities of the current set up, namely the exploitation of fee-paying individuals by for-profit investors.
Those pushed into paying for their own care by the state are placed at risk of becoming cash machines for private companies
it is the private pay market where money is to be made. Those paying privately can be charged double the amount that the local authority pays for a bed in the same care home.
These sometimes extortionate fees feed a business model which requires that large chunks of an individual’s care bill are siphoned off to pay rent, profits, and interest on high-cost debt.
Although the large majority of the care sector is run by small and medium sized businesses around one third are owned by large chains backed by private equity investors. Our research from before the pandemic showed that around £1.5 billion leaks out of the care home sector each year in the form of returns to investors – a waste of resources which should be going to frontline care and which again depletes the assets and wealth of those forced to pay, leaving less for family members to inherit.
Making the state the sole payer for social care would enable the government to radically reshape this highly dysfunctional market, remove providers who use financial engineering to divert scarce resources to offshore investors, raise standards across the board as well as rewarding care workers with decent pay, working conditions and training.”
Tackling social inequalities in adult social care
“Reframing long-term care policy: from services to social determinants” is the title of a very useful article by Tania Burchardt in the latest issue of the Journal of Social Policy, July 2026. This is an Open Access article, free to read. (Link 9)
… in this article, I will argue that framing long-term care policy around ageing, services and financing obscures another important explanation, which is that the problem of long-term care is substantially a problem of inequalities, rooted in social and economic determinants, which generate need, impair access to support and contribute to a poor experience of care. (p717)
For both working-age and older people, then, many of the main impairment types that give rise to needs for support with day-to-day living are more common among ethnic minorities and exhibit socio-economic gradients. Moreover, the environments in which people live tend to compound rather than offset the disadvantage, meaning that the same impairment is more disabling. (p725)
Tackling the social determinants of long-term care must be central to long-term care policy. (p735)
See also “England’s two-tier care system deepens social care inequalities” by Anders Bach-Mortensen, Benjamin Goodair, Michelle Degli Esposti and Catherine Needham, July 2025. (Link 10). A useful longer report (64 pages), also free to read, is “How care inequities shape social care experiences” by the Social Care Institute for Excellence (SCIE), published in July this year. (Link 11). Its starting point is that
“Experiences of care are not equal. Access to appropriate support, the quality of care received, and people’s choice, control and dignity can vary significantly depending on personal circumstances, location, health needs and how services are designed and delivered. … The research focused on exploring lived experiences of inequities, and how intersecting factors such as disabilities, ethnicity, gender, age, socioeconomic position and geography shape experience and expectations, and what could support a more equitable and person-centred care system care system.”
I hope this article will be a useful contribution to the mass public campaign we need to ensure that Andy Burnham and his Government urgently make the radical improvements in the policies and the funding for Adult Social Care that we urgently need.
Links
Link 2: https://www.gov.uk/government/news/pm-sets-out-new-path-to-fix-social-care-together-29-july-2026
Link 3: https://caseycommission.co.uk/2026/07/demo-news-article-in-conversation/
Link 4: https://www.cqc.org.uk/publications/major-report/state-care/2024-2025/access/asc
Link 6: https://www.caremanagementmatters.co.uk/prime-minister-sets-out-strategy-for-reforming-social-care/
Link 10: https://research.birmingham.ac.uk/en/publications/englands-two-tier-care-system-deepens-social-care-inequalities/ Link 11: https://www.scie.org.uk/app/uploads/2026/07/SCIE_Inequity-in-social-care-report_Jul-2026_digital-003_interim-pdf.pdf