Liz Jones, Deputy Chief Executive & Policy Director at the National Care Forum, argues that shifting from volume‑driven commissioning to outcomes‑based, collaborative approaches is essential if we are to break the cycle of underfunding, inaction and mounting human cost in social care.
In the context of the government’s focus on creating growth, the economics of social care merit a closer look. The latest data from Skills for Care shows that the social care sector in England contributes £77.8bn to the economy and yet it is rarely seen as a priority growth sector for investment, reform or transformational impacts on people’s lives.
As well as missing the opportunity to support the growth potential of the care and support sector for the wider economy, there is a very real price being paid across communities by the various failed attempts over the years by governments of all stripes to grasp the nettle of better funding, reform and a strong vision for social care.
According to the The King’s Fund there have been at least 18 different attempts at social care reform since 2000; these include: two independent commissions, now a third with Baroness Louise Casey leading Labour’s new attempt, numerous white and green papers, three consultations and many reports all aimed at finding ways to resolve the big challenges associated with ensuring effective, responsive, accessible, affordable care and support for our communities, when and where people need it. Successive governments have started out with initial policy and funding proposals intended to address these challenges only to end up abandoning their plans and commitments, endlessly kicking the proverbial can down the road until it disappears from view.
So, who has been paying the price for this successive inaction over the best part of 30 years?
People who are in need of care and support services are suffering as a result of inaction. Delays in obtaining care and support adversely affects the health and wellbeing of people with care and support needs. Recent that of the people waiting for an assessment of any kind, 36% have been waiting for six months or more.
Existing pressures on funding and resourcing are also restricting investment in prevention and early intervention support resulting in struggles for the wider voluntary and community sector. Insights from NCVO’s
There is also strong evidence about the impact, financially and emotionally, on unpaid carers. The Health and Social Care Select Committee in its April 2025 report Adult Social Care Reform: the cost of inaction, found that 1.5 million unpaid carers are providing over 50 hours of care per week to loved ones (an increase of 152,000 over the past decade). As well as the emotional, psychological and physical challenges this level of unpaid caring brings, there are significant economic impacts for these 1.5m people. Unpaid carers also see their personal income fall to varying degrees depending on the intensity of care they provide:
- Carers who provide 50+ hours of care a week can lose an average of £162 per month, with losses peaking at £192 per month after four years.
- Unpaid carers who provided the lowest intensity of care (less than five hours per week) experienced an average monthly penalty of £44
- A higher percentage of unpaid carers reported having bad or very bad health (7.2%) compared to non-carers (5.4%)
- A lower percentage of unpaid carers reported having good and very good health (71.9%) compared to non-carers (82.0%).
There is also a worrying longer-term economic doom loop specifically affecting women, who make up the majority of unpaid carers. Women are disproportionately expected to juggle work with family caring responsibilities, or give up work altogether, impacting not only on their earnings but also their ability to build sufficient pension pots that will see them through later life. Carers UK reported in 2024 that:
- Female carers in employment are more likely to reduce their working hours or take on more junior roles because of caring.
- 46% female carers in employment reduced their working hours to care compared with 34% male carers in employment
- 26% have taken on a lower paid or more junior role compared with 22% male carers in employment.
- Overall, female carers are more likely to be in employment (either full time or part-time) compared to male carers
- However, female carers are less likely to work full time, and subsequently are more likely to work part time, compared to male carers
- Full-time employment: Female Carers = 24%, male carers = 32%
- Part-time employment: Female Carers = 26%, male carers = 13%
The wider economic impact of losing a large swathe of people from the labour market shouldn’t be overlooked. In its report, State of Caring 2024: The impact of caring on employment, Carers UK highlighted independent analysis which suggested the value to the economy of carers being in employment is £5.3 billion a year. The report also details:
- 55% of carers who had reduced their working hours to care said they hadn’t been able to save as much for their retirement.
- 70% of carers who had given up work to care said they were worried about living costs and whether they can manage in future.
- 43% of carers who had given up work to care said they had bad or very bad mental health (compared to 35% of carers who were still in employment)
As the evidence stacks up to show how inaction on social care reform is creating victims who are least deserving, we all ask ourselves why we are in this cycle of inaction. Indeed, Sir Andrew Dilnot, chair of the Commission on Funding of Care and Support in 2010-11, gave evidence to the Health & Social Care Select Committee in January 2025, where he put this ‘invisibility’ problem down to a shared neglect: “The population as a whole has not complained enough to their MPs. The media have not written about this enough, and politicians have not, in the end, had the courage to go forward and do something.”
Will 2026 be the year where we see positive change? The Casey Commission is due to report initially this year. We and our not-for-profit members continue to engage closely with the Commission team and we believe there’s a strong message for government about the power of working in proper partnership that seeks to find solutions through collaboration.
The government has also recently published a DHSC policy paper detailing priority outcomes and expectations for local authorities. These priorities focus on improving the quality of care and support, enabling enable people to have more choice and control over their care and support and strengthening the join-up between health and social care services. Will these policy developments be enough to ensure effective, responsive, accessible, affordable care and support for our communities, when and where people need it? Let’s see.
One of the final observations we at the National Care Forum would make relates to our international work as part of in our role within the which enables us to usefully explore learning from other countries. For example, Australia’s Aged Care Bill 2024 dismantled the previous Aged Care Act by moving funding structures away from providers towards individuals using the services. This has created a more personalised and individual approach to care services putting the person at the heart of the care they receive. Meanwhile Canada launched the Fixing Long-Term Care Act, 2021 which included the provision of up to $1.25 billion into long-term care homes to be used for the hiring and retainment of long-term care staff with the aim to increase the amount of direct care time for residents.
Much food for thought as the challenges caused to many by historic underfunding of the sector, and ineffective attempts at system reform, continue to wage on.
