Good afternoon from New Economy Brief.
Last month Baroness Louise Casey said that the UK is facing “a moment of reckoning” on adult social care. She is chairing an independent commission into the sector, and will make her first formal report later this year. The government is hoping it will make recommendations for both medium and long-term changes – in particular on how to implement the national care service Labour promised in its 2024 general election manifesto. After years of inaction and stymied progress from successive governments, this week’s New Economy Brief asks – will this be enough to finally deliver the systemic change we need?
A system created to enable us all to live well. Adult social care sprang from the post-war creation of the welfare state and the NHS, designed to enable us all to live well, including in ill health, old age or if living with a disability. Historically, adult social care (which supports those over the age of 18) has provided many different services, both institutional and in the community, including day centres, residential homes, domiciliary services, support workers and a vast range of social activities.
In 2023/24 around 2 million requests for support were made to that system, and almost a million people received long-term care at some point in the year. Though around two thirds of those requesting social care support are over 65 years old, evidence from the NHS shows the number of younger people asking for support is growing more rapidly.
But the model isn’t delivering on its promise. Progressive visions of adult social care, such as Social Care Future’s, are grounded in the idea that ‘we all want to live in the place we call home, with the people and things we love, in communities where we look out for each other, doing the things that matter to us’. But as funding has shrunk over the long term, this is far from the reality for many. Nearly 100,000 people have been denied government-funded care because it is limited to those with less than £23,250 in savings or assets, a threshold frozen since 2010. Costs can be eye-watering for those who have to pay themselves – averaging £1,000 a week for residential care in England and Wales.
The situation is compounded by overstretched workers, with research from Homecare Voices identifying a range of substandard employment practices – including long hours, low wages and pressure to work – with a knock-on effect on the quality of care people are receiving and that care workers can provide themselves with.
Millions more aren’t supported at all. A failure to keep up with increasing demand has left an estimated 3.5 million people without the care they need and almost 5 million unpaid carers in England, some recipients of care themselves. There are significant inequalities in access to care too: unmet need is twice as high in the most deprived areas as in the least deprived.
Previous attempts at reform haven’t been seen through. Recent attempts to reform adult social care include the Dilnot Commission in 2011, focused on delivering a fair, affordable and sustainable funding system, and the Care Act 2014, which gave local authorities new duties and changed how care is delivered. But austerity and overreliance on local taxation and on one-off cash injections rather than sustained funding over time hampered the impact of the Care Act. According to the Social Care Institute for Excellence, this left it incomplete.
Cautious optimism about the new commission. According to the terms of reference for Baroness Casey’s commission, it aims to make adult social care “more productive, preventative and to give people who draw on care, and their families and carers, more power in the system”. And Casey’s initial reflections have offered tentative hope, with positive reactions across the sector. Particularly interesting was her assertion that if William Beveridge were alive today he’d add “how we support and care for an older, sicker population and greater levels of disability” to his famous list of “five giants” – idleness, ignorance, disease, squalor and want – social ills that needed to be tackled for British society to improve.
Focus on a national care service The first phase of the Casey Commission, due to report later this year, focuses on implementing Labour's commitment to create a national care service. Its manifesto envisioned this as “a universally-available service, with personal care provided free at the point of use, and that all who need it can access it”. A range of experts have endorsed the idea. Women’s Budget Group and the New Economics Foundation have called for such a shift and the Fabian Society and Unison have also supported a national care service that is for everyone and with choice and control for individuals embedded in it. But with no consensus on exactly what such a service should look like, there are challenges ahead.The way Scotland’s plans were watered down should serve as a warning of how hard it is to create such a major new system.
Funding is essential, but won’t be enough by itself. Whatever route is taken, one thing is clear: a new funding deal will be needed. The Health Foundation estimates that just keeping up with growing demand will cost £8.3bn by 2032/33, and that doing so while also improving access and covering the full cost of care would bring that figure to £18.4bn. This is on top of existing pressures on local authorities, who have a statutory duty to provide adult social care but whose budgets are ‘buckling under the pressure’ of delivering it, making them increasingly dependent on emergency funding.
Commercialising care has consequences. Adult social care has become increasingly commercialised since the 1980s and as research from both Common Wealth and CLES has shown, extraction and private equity are ingrained in the current system. With money flooding out of the system as profit to enrich a handful of people, this model is a bad deal for both individuals and the state. There are many ways to reverse this trend, from increasing regulation of private providers to bringing services back into public ownership.
Wider transformation is possible – and necessary. A national care service would be a vital step forward, but we also need to fundamentally reimagine how care is valued, delivered and supported across society. Without that wider shift, this “moment of reckoning” risks becoming another missed chance for meaningful change.
An unabating energy crisis. The ongoing war in Iran and the knock-on threat to oil prices has led to calls to increase energy security in the UK, but research from Uplift suggests that we first need to learn lessons from the past. It finds that UK oil and gas discoveries licensed over the last 14 years have produced just a month’s worth of gas. The analysis suggests new drilling won’t do much to reduce bills, so we should focus on renewables. Elsewhere, over 40 leading UK civil society organisations have signed a letter to the Chancellor calling for a new levy on the excess profits firms in many sectors – including energy – are expected to make from the ongoing crisis.
Businesses under strain as the new financial year comes around.New analysis from IPPR finds that the UK has the second lowest business investment in G7, with manufacturing suffering the worst gap between investment needs and realities. And, as the same author outlines elsewhere, the risks of this underinvestment will only get worse as businesses’ energy costs rise over the coming months. The research comes as a UKHospitality report, based on surveying 20,000 hospitality businesses, suggests that almost two thirds plan to cut jobs to manage changing business rates and wages, while one in seven is facing permanent closure.
A more conscious role for the Bank of England. In the context of under-investment, Positive Money argues that the Bank of England should take on a ‘more conscious discussion of credit policy’. The proposals include improving its lending schemes ‘to support capital-intensive investment that generates new income, such as renewable energy, which is otherwise more vulnerable to changes in monetary policy.’
